KATSINA

PROCEDURE MANUAL

MAY, 2018

Revised Edition
Preface

The Nursing Procedure Manual booklet provides general guidance and

information on nursing clinical procedures. The Manual book is the basis in
which Nursing Practice is builton.

This revised edition is in fulfilling of the requirement of Nursing and

Midwifery Council of Nigeria (NMCN) for revising and updating the
Manual periodically to meet current needs and conformwith the dynamic
nature of the Nursing profession. It is meant for Nursing Educators, Clinical
Instructors, Staff Nurses/Midwives and Student Nurses towards the
promotion and maintenance of excellence in Nursing education and
practices.

The Manual booklet contains fifteen chapters in which related procedures

are grouped as a chapter and each procedure has definition, indication,
purpose, requirement and procedure/method. The procedures are presented
in clear, simple and precise way for easy understanding and practice.

Aminu Bello Abdullahi,

Director, KasimuKofarBaiSchool of Nursing Katsina

ii
Foreword

The revised edition of Procedure Manual is a clear, precise and simple

booklet to serve as a general guideline for Nursing Practice and Training.

The booklet has been designed, written and structured in accordance with
Nursing and Midwifery Council of Nigeria (NMCN) guideline and in
keeping with the current trends in Nursing education and practice.

I wish to commend the Director, KasimuKofarBai School of Nursing

Katsina, Aminu Bello Abdullahiand the entire staff of the School for
producing the Procedure Manual book.

I strongly believed that this book will behighly beneficial to Nursing

education and practice in Nigeria. I therefore recommend the booklet to all
Nursing students and practitioners.

Alhaji Abba SadaDikko,

Provost, Katsina State College of Nursing and Midwifery

iii
Acknowledgement

In the name of Allah, the most Beneficent, the most Merciful. All praises
and thanks are due to Almighty Allah for making it for possible to produce
this revised edition of the Procedure Manual.

I wish to express my appreciation and gratitude to the Provost, Alhaji Abba

SadaDikko; Registrar, HajiyaMaimunaLeko and other officials of the
College for their support and encouragement. I also wish to deeply
appreciate the Deputy Director, HajiyaSafiya Ya’u Yamel; HOD (Nursing),
Malam Mohammed Nuraddeen Umar; SAO, Malam Musa Danbaba and the
entire members of staff for their continuous support.

I’m highly indebted to Women for Health organisation and its Katsina State
Team Leader, Hajiya Hafsat Musa for their continuous and consistent
support to our School and healthcare delivery in Katsina State.

My sincere and immense gratitude goes to theChairman of the Procedure

Manual Review Committee, Alhaji Sani Maida and his teeming members:
Aminu Lawal (CRO), Mr Elisha Zokale, Mansur Isah, the CNO I/C General
Hospital Katsina, Hajiya Maryam Abdul; Sister Abu Ibrahim and
Mal.Hassanu Mahmud for their patience and time devotion in reviewing
this procedure manual book. I also appreciate Ibrahim Zakariyau, Head of
ICT Unit, for typing and editing the book.

May peace and blessing of Allah be on all that directly or indirectly

contributed toward this book.

Aminu Bello Abdullahi,

Director, KasimuKofarBaiSchool of Nursing Katsina

iv
Nurse’s Pledge

I solemnly pledge myself before God and in the presence of this assembly,
to pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous, and will not
take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my

profession and will hold in confidence all personal matters committed to my
keeping, and all family affairs coming to my knowledge in the practice of
my calling.

With loyalty, will I endeavour to aid physician in his work and devote
myself to the welfare of those committed to my care.

v
Nurse’s Anthem

YES AM PROUD TO BE A NURSE!!!

We called to serve humanity

Endowed with the Act and SENSE of CARING
We are built on INTEGRITY and DISCIPLINE
That Transcient through every generation
IMMACULATE and AMICABLE
We are the source of HOPE to ailing ones
And the FOUNDATION for building a Health world
Together we shall Stand

CHORUS:

Nurses are GREAT

Nurses are CARING
An epitome of HUMILITY to SERVICE
We are specially ordained for this VOCATION
YES AM PROUD TO BE A NURSE!!!

From near and far we have gathered with one goal

To Uphold the good name of our PROFESSION

N – for Neatness and Splendor

U – for Understanding
R – for Responsiveness
S – Selfless Service
I - Innovative and Initiative
N- for Nobility
G – Gentleness and Love

CHORUS:

Nurses are GREAT

Nurses are CARING
An epitome of HUMILITY to SERVICE
We are specially ordained for this VOCATION
YES AM PROUD TO BE A NURSE!!!

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Table of Contents
Preface.............................................................................ii
Foreword.........................................................................iv
Acknowledgement..........................................................vi
Nurse’s Pledge..............................................................viii
Nurse’s Anthem..............................................................ix
CHAPTER ONE: INTRODUCTION.............................1
Ethics of Nursing.........................................................1
Ethical Concept Applied to Nursing........................1
Qualities of a Professional Nurse................................2
The Nursing Team.......................................................4
The Wards....................................................................6
CHAPTER TWO: RECEPTION.....................................7
Admission of a Patient to the Hospital........................7
Discharge or Transfer of a Patient.............................10
Ward Report.............................................................12
CHAPTER THREE: WARD HYGIENE......................18
Disinfection of Furniture...........................................18
Dump Dusting (Now mainly done by Hospital Assistants)
...................................................................................19
CHAPTER FOUR: ORAL AND GASTRIC PROCEDURES 22
Administration of Medicine.......................................22
Care of the Mouth (Oral Hygiene)............................24
Serving of Meals........................................................28
Feeding of Helpless Patients......................................30
Passing of Naso-Gastric Tube (N.G. Tube)...............32
Tube Feeding (Tray)..................................................35
Gastric Lavage...........................................................38
CHAPTER FIVE: BEDDINGS.....................................43
Bed Making...............................................................43
Types of Beds........................................................45
Bed Accessories.........................................................59

vii
 Positions Used In Nursing.........................................61
Lifting and Moving of Patient...................................64
CHAPTER SIX: HAIR AND SKIN HYGIENE...........66
Inspection of Head.................................................66
Washing Hair in Bed.................................................68
Treatment of a Verminous Head...............................70
Bed Bath....................................................................72
Bathing Babies and Older Children...........................76
Babies with Cord...................................................79
Older Children.......................................................79
Assisted Bath/Bathroom Bath...................................80
Care of Pressure Areas..............................................81
CHAPTER SEVEN: VITAL SIGNS............................84
Vital Signs Observation.............................................84
Temperature...........................................................84
Rigor......................................................................86
Pulse.......................................................................86
Respiration.............................................................87
Taking of Temperature, Pulse and Respiration.....89
Blood Pressure (BP)..............................................95
Auditory Or Ausculatory.......................................97
Tepid Sponging..........................................................99
Dilution of Lotion................................................102
CHAPTER EIGHT: SKIN CARE AND APPLICATIONS 106
Application of Cold Compress................................106
Application of Heat.................................................107
Medical Fermentation (Hot Application)................110
Application of Splints..............................................112
CHAPTER NINE: SKELETAL..................................114
Application of Plaster Of Paris (POP).................114
Traction....................................................................119
Skin Traction.......................................................121
Skeletal Traction..................................................124

viii
 Head Halter Traction...........................................128
CHAPTER TEN: URINARY PROCEDURES AND COLLECTION OF
SPECIMENS...............................................................131
Giving and Removing the Bedpan and Urinal.........131
Changing of Incontinent Patient..............................133
Collection of Specimens..........................................135
Sputum.................................................................135
Faeces..................................................................135
Urine....................................................................137
Urine Testing...........................................................139
Test for Abnormal Constituents..........................142
CHAPTER ELEVEN: RECTAL.................................147
Rectal Examination..................................................147
Rectal Insertion of Suppositories.............................148
Administration of an Enema....................................149
Nurses Responsibility, Before, During And After Administration Of An
Enema..................................................................153
Passing of Flatus Tube.............................................154
Rectal and Colonic Washout...................................156
CHAPTER TWELVE: STERILE PROCEDURES....159
Administration of an Intramuscular Injection.........159
Intravenous Infusion................................................163
Blood Transfusion...................................................165
Wound Dressing......................................................168
Method I:.............................................................170
Method II (Using Dressing Pack)........................172
Removal of Sutures.................................................174
Venous Cut Down...................................................176
Chest Aspiration/Paracentesis Thoracis..................177
Paracentesis Abdominis...........................................180
Lumbar Puncture.....................................................182
Care of Colostomy.................................................186
Catheterization.........................................................188
CHAPTER THIRTEEN: SPECIAL CARE/PROCEDURE 193

ix
 Administration of Oxygen.......................................193
Moist/Steam Inhalation............................................196
Physical and Neurological Examinations................198
Apical Heart Beat....................................................200
Fluid Intake and Output Recording.........................201
Last Offices..............................................................203
CHAPTER FOURTEEN: OPHTHALMIC.................207
Examination of the Eye...........................................207
Swabbing of the Eye................................................209
Irrigation of the Eye.................................................211
Instillation of Eye Drops..........................................213
Application of Eye Ointment...................................216
Application of Heat to the Eye (Warm Compress)..217
Hot Spoon Bathing..................................................219
Epilation...................................................................220
CHAPTER FIFTEEN: ENT PROCEDURES.............223
Examination of the Ear, Nose and Throat Patient...223
Positioning of Patient and General Set Up Before History Taking 223
Syringing the Ear/Ear Irrigation..............................225
Instillation of Ear Drops..........................................228
Aural Toileting /Dressing........................................230
Instillation of Nasal Drops.......................................232
Spraying the Nose....................................................234
Packing the Nose.....................................................235
Removal of Nasal Packs..........................................238
Suction Displacement Therapy................................240
Steam Inhalations....................................................241
Examination of the Throat.......................................244
Spraying the Throat.................................................246
Taking Post Nasal Swab..........................................248
APPENDIX.................................................................250
Commonly Used Terms and Abbreviations............250
Abbreviations of Medical Terms as Used in Prescriptions253

x
xi
 CHAPTER ONE: INTRODUCTION
Ethics of Nursing

Ethics is derived from a Greek word "Ethios" which

means customs or practice. Ethics is the science that
deals with customs, habits, and general
characteristics or people. Therefore,nursing ethics is
the science that deals or governs Nursing conducts
and its relationship with other people.

Ethical Concept Applied to Nursing

The fundamental responsibilities of the Nurse are

fourfold:

1. To promote health;
2. To prevent illness;
3. To restore health;
4. To alleviate sufferings.

The need for Nursing is universal. Inherent in

Nursing is respect for life. dignity and right of man.
It is unrestricted by consideration of nationality,
race, creed,colour, age, sex, politics or social status.

1
Nurses render health services to individuals, the
family and community to co-ordinate their services
with those of related groups.

Qualities of a Professional Nurse

It has been accepted that a professional Nurse must

possess the following qualities: -

1. Reliability
2. Intelligence
3. Sympathy
4. Sensibleness
5. Tolerance
6. Obedience
7. Moral uprightness
8. Economy
9. Adoptability
10. Smartness
11. Faithfulness
12. Punctuality
13. Truthfulness
14. Observant
15. Sense of Assessment
16. Guidance and counselling

Conduct

2
Nurses should know the acceptable behaviour in
Nursing so that they can adhere to them and be
cautious in all aspects of their duty.

- Give respect to the senior.

- Respond to patient, relatives and co-workers
politely.
- Be alert in attending any visitor, give respect
and consideration as if they were your
personal guests, give information desired.
- Do not leave your department for any reason
without permission from your senior. Report
before and after duty.

Uniform

Respect the uniform, for it carries qualities that help

to identify the person.However, in wearing the
uniform the following rules should be observed:

- Neatness and cleanliness from head to toe.

- Finger nails shall be cut short, no nail
varnish.
- Full uniform must be worn on duty.
- A Nurse on duty should not chew-gum.
- Hair should be neatly done, no long hair
hanging over the shoulder or face.

3
 - Hair style should be the type that head tie will
be well fixed.
- Shoes should be properly polished.
- No smoking on duty.

The Nursing Team

1. Chief Nursing Officer (CNO)

The overall head of the Nursing team in the
hospital
2. Assistant Chief Nursing Officer (ACNO)
Acts in the absence of CNO
3. Matron/Sister
He/she is the leader of the ward team,
responsible for Nursing care of each patient,
and for enabling all the members of the
Nursing team to carry out their work
efficiently. He/she is essentially a good
administrator, teacher, and an adviser as well
as being skilled Nurse. The doctor depends
highly on the charge Nurse
4. The Staff Nurse
The staff works hand in hand with the charge
Nurse. She is an assistant and if sister is
absent she is her deputy taking the
responsibilities of the above.
5. Student Nurse
4
 Students are essential members of the ward
team and are to give service to patient under
staff supervision; the student is in the ward to
learn. This is achieved by the effort and
support given by members of the trained
staff. Students should aim at the highest
possible degree of Nursing skills. They
should be given increasing responsibilities
according to given lectures. They are to carry
procedures under supervision of staff.
6. The Clinical Instructor
Clinical Instructor works in unison with the
hospital and school, working with the
students at the bedside of the patient,
organizing group discussion and practical
demonstration whenever time permits. They
are concerned with all matters involving
students in the clinical area.
7. The Tutors
Teaching in the school is their priority. They
also visit the wards to help in practical
teaching. This helps to get the feedback from
the classroom teaching.

5
The Wards

The ward is a department in the hospital where

patients are admitted and cared for as in-patients.
There are Medical, Surgical, Paediatric,
Orthopeadic, Obstetrics and Gynae wards. They are
just like classroom for student Nurses thus they
should be made conducive for learning. There are
also psychiatric and ophthalmic units for the same
purpose.

6
 CHAPTER TWO: RECEPTION
Admission of a Patient to the Hospital

Definition: A process of making the patient

comfortable in the ward for assessment and
treatment.

Purposes

1. To admit a patient to the hospital for

diagnosis, treatment, or observation.
2. To prepare the patient for further
investigations.
3. To ensure adequate rest to the patient to
improve the health status.

Requirements

1. Vital signs tray

2. Weighing scale and tape
3. Requirement for urine testing
4. Clean Hospital gown
5. Forms for patients' documentation

N.B. The above mentioned requirements might have

already been found set in the ward.

7
Procedure

1. Greet the patient and his relatives cheerfully

2. Offer them seat and proceed to care for them,
3. If it is an emergency admission, place the
patient on bed and proceed with the
admission procedure.
4. Obtain the following information and make
sure the folder is completed.
Information to be Obtained
1. Full name of the patient
2. Full address and phone number
3. Address of the patient's closest person (Next
of Kin) and phone number
4. Age
5. Sex
6. Occupational Status
7. Religion
8. Nationality
9. Consent for operation of the patient ifhe is to
have surgery. If the patient is below 18 years
of age, the consent must be signed by his
parents. If the surgery involves certain
gynaecological procedures the husband and
wife must both sign.
10. Telephone number if any;

8
 11.Name and address of the religious leader.
12.Doctor's name
N.B: The students should endeavour to know the
rational for obtaining this information.
1. Obtain past Nursing, medical, obstetric,
surgical and mental history.
2. Use opportunities for health teaching and
allow patient to ask question.
3. Give or encourage patient to bath and provide
hospital gowns. If he is able, this can be done
by the patient in the bathroom.
4. Take and record the temperature, pulse,
respiration and blood pressure. Report any
abnormality to the Nurse in-charge.
5. Introduce patient to nearby patients and staff
6. Orient the patient to the ward and ward
routine, including the toilets and baths.
7. Observe the patient in relation to physical and
emotional status during and after the
procedure.
8. Observe also:
a) Signs of anxiety, agitation,
restlessness, Irritability. timidity,
withdrawal depression, happiness,
general body cleanliness, vomiting,
demands etc.

9
 b) Observation of physiological Status:-
such as dyspnoea, height, weight,
vision, nutrition, motor function,
speech impairment ,constipation,
diarrhea, menstruation, condition of
hair and, scalp, eyes, nose, mouth,
teeth and all parts of the body.
9. Obtain urine for routine ward urinalysis.
10.Check the patient's clothes and other
valuables and hand them to his next of kin,
who signs on collection or to the Nurse in-
charge for safe keeping.
11.Begin treatment as ordered
12.Reassure patient and do everything possible
to make his stay comfortable.

Discharge or Transfer of a Patient

Definition: A process of preparing the patient to go

home on completion of treatment or continuity of
care in another health care facility.
Purposes
1. To give individual care and consideration to a

10
 patient who is leaving the hospital.
2. To emphasize necessary health
instruction to the patient before he returns
home or place of transfer
Procedure
1. Confirm patient's discharge by checking the
bed head ticket and call the patient by name.
2. Inform patient's family and assist patient in
getting ready to leave the hospital.
3. Be sure that the patient collects all his
belongings/balance of deposit if any.
4. Be sure that, the patient and his family
understands treatments and medications that
should be done at home.
5. Inform patient when to return for follow up
visits
6. Assist the patient to his transport, ifhe is too
weak, provide wheel chair for him.
7. Remove the bed linens from the bed and send
for washing.
8. Prepare the bed for the next patient.
9. Record discharge proceedings on bedhead
ticket and take the bed head ticket to the
Medical record office
N.B:If the patient is transferred to another Health
Institution, the same procedure is followed. In

11
addition, a letter from the attending doctor, should
accompany the patient who is usually transferred by
ambulance.
Discharge against medical advice
a) Doctor and the Nurse have to explain the
dangers of patient discharging himself.
b) If the patient insists then, he can sign under
the witness of a Nurse who also signs.

Ward Report

Definition: This is the act of writing a detail

happening of the patients and ward environment and
giving a verbal report of the ward bythe Nurse
during handing and taking over of the shift duty.
Purposes
1. To give an up to date picture of the ward
2. To give some guidelines to the Nurse taking
over the ward in regards to orders to be
carried out.
3. To provide an adequate/accurate record of
patient care and treatment.
4. To provide a means of communication to

12
 assist in giving comprehensive Nursing care.
5. To ensure continuity in patient care.
6. To serve as a legal document in case of any
legal action.
7. To ensure proper documentation of care
given to patients during the shift.
Types
1. Verbal report;
2. Written report;
3. Combined (verbal and written).
Points To Remember When Writing Ward
Report
Ward report should be written on the following
patients:
1. Newly Admitted Patients: - Report should
be written on every n patient giving such
details as the history, diagnosis,
investigations, religion, treatment as well as
the vital signs - and any order to be carried
out. Finally, general observations of the
condition of patient both on admission and
while compiling the report should be stated.
2. Seriously Ill Patients:- Report should be
written on such patients stating their TPR and
BP at the time of report as well as their
general conditionthroughout the shift. New

13
 treatments and fresh order should be
mentioned and any fresh order. Instructions
given by the doctor should be noted.
3. Discharge andAbscondment: - Report
should also be written on discharged patient
or abscondment giving details on the final
diagnosis, result, date and time of discharge
in case of discharge or approximate time of
absconding in the case of abscondment.
4. Deceased Patient: - Report should be written
on patient who died giving such details as the
condition of the patient when the shift started,
the time condition changes or become worst,
the time the Duty Nurse was notified, name
of the doctor and the time he was informed.
Methods through which each contact with
either the Duty Nurse or the doctor was made
should be stated as well as the method by
which such orders were received e.g. through
telephone. Any emergency treatment
rendered should be stated. Approximate time
of death and name of the Doctor who
certified the death should also be stated. Final
time the corpse was removed to the mortuary
should be noted too.
5. Transfer: - Report should be written on any

14
 patient transferred in or out of the ward. The
name or the hospital or ward either from
which or to which the patient has been
transferred should be stated. Diagnosis,
treatment, investigations and any orders to be
carried out should be stated in the case
oftransferred in. Name of the Doctor should
be stated both for transfer in and out. In the
case of transfer out especially to another
hospital method by which the patient is to be
conveyed to the other hospital and the time
for his departure should be stated.
6. Pre-Operative Patients: - Report should be
written on all patients going for surgery. It
should include the preparation that is to be
done or that has been done, Information
about the pre-operative medication should be
noted; i.e. time it is to be given or when it
was given. Instructions should include the
food and drink for the patient and when to
have nothing.
7. Post-Operative Patients: - Report should
also he written on every post-operative
patient stating the time he was sent to the
theatre and when he came out. His general
condition at the time of report, whether

15
 regaining consciousness or not, whether he
has passed urine and the latest TPR and BP
record. Any post-operative treatment or
medications given and the time it is due to be
given should be mentioned. Condition of the
operated site should also be noted.
8. Non Serious Patients Having Specific
Treatment: - Patients having specific
treatments or problems e.g. patients on
traction or P.O.P should be reported upon and
if something has been done on them, e.g. any
new prescription, X-ray, re-adjustment of
traction or re-application of P.O.P. should all
be mentioned.
NB: All ward reports must contain information on
the followings:
1. New prescriptions
2. Haemorrhage observed
3. Special Diets
4. New/offered Nursing orders and any
observations made.

16
 CHAPTER THREE: WARD HYGIENE
Disinfection of Furniture

Definition: A process of making furniture free of

dust and microbes.
Purpose
- To remove dust and reduce the growth of
microorganisms

Tray Procedure

Requirements
1. Bowl
2. Flanell or mop
3. Jug of disinfectant
4. Floor mackintosh
Procedure
1. Have everything arranged on a tray;
2. Place mackintosh under the furniture;
3. Put disinfectant inside the bowl, dip the mop
inside and squeeze;
4. Clean the furniture well;
5. Allow to dry.

17
Dump Dusting (Now mainly done
by Hospital Assistants)

Definition: A procedure using clean rags

and disinfectant to make the ward
environment clean and free of dust and
microbes.

Purposes
1. To minimize the Spread of infection
2. To make the ward look clean and neat
Requirements (Trolley Procedure)
1. Two bowls
2. Two clean rags:
3. A jug of warm water:
4. Disinfectant e.g Dettol 1:40 or soap in a dish
Bottom Shelf
1. A brush in a receiver
2. Receiver for used water
3. Receiver for waste papers
Procedure
1. Explain the procedure to the patient.
2. Prepare trolley and take to bed side.
3. Remove patient's belongings from the top and
inside the bed side locker and place them by
the side of the bed.
4. Remove any waste/dirt from the locker by
18
 using brush and receiver for waste.
5. Put one rag into prepared solution, squeeze
excess water and start dump dusting the
locker from inside top and corners. Use the
second rag to dry and replace the belongings.
6. Repeat 5 above to dump dust cardiac table,
bed stand, drip stand, window edges etc.
7. Rinse the used rag in the bowl of clean water
and dip into disinfectant solution, squeeze
excess water and proceed with cleaning until
the ward is clean.
8. Change water when necessary and discard
used water into the receiver for used water
and other waste in the receiver for waste
papers.
After the procedure arrange all the patient's
belongings and discard trolley.
N.B. Dump dusting should be done daily after bed
making by Hospital Assistants, supervised by the
Nurses.

19
 CHAPTER FOUR: ORAL AND GASTRIC
PROCEDURES
Administration of Medicine

Definition: A procedure of serving drugs orally with

documentation.
Purpose
- To serve the drug as prescribed to cure ill
health
Trolley
Top shelf
1. Drugs in labeled containers;
2. Prescription cards
3. Jugs of water and flavour
4. Tumblers with saucer and teaspoon
5. Medicine measures for syrups and mixtures
6. Straws in container
7. Oil protectors
Bottom shelf
1. Bowl of warm water
2. Flannel for drying tumbler and spoon
3. Receiver
Procedure
1. Prepare trolley
20
 2. Two Nurses procedure (one as a witness)
3. Start the procedure bed by bed, going round
the Ward.
a) Collect all prescription and the drugs you
require
b) Collect medicine in a spoon or medicine
glass and place on a saucer with a witness
close by.
c) Provide water in tumbler
d) Check if it is correct patient, correct drugs
and prescription(call patient by name)
e) Give the patient the drug making sure the
patient has swallowed all and record
f) Put prescription in its folder
g) Wash spoon and tumbler then dry with a
flanell.
4. Place trolley in a safe place after the
procedure.
5. If D.D.A drug is to be given, the general rules
for its administration should be followed.

Care of the Mouth (Oral Hygiene)

Definition: Is the process of cleaning and refreshing

the mouth of the helpless patients to promote the
flow of saliva and prevent infection.

21
Purposes
1. To clean the mouth so as to prevent sores and
dental carries.
2. To moisten the mouth and promote normal
flow of saliva.
3. To observe the condition of the mouth.
4. To teach patient the principles of oral
hygiene.
5. To refreshen the mouth and promote appetite.
6. To strengthen the Nurse - patient relationship
and provide a sense of belonging.
Indications
1. Unconscious patient
2. Very ill patient
3. Patient on milk diet
4. Patient on nil per oral
5. Post-operative patient
6. Patient with diseases of the mouth
7. Psychiatric patient on special treatment e.g.
continuous narcotics.
Requirements (A tray procedure)
1. Gallipot containing gauze swabs
2. Large kidney dish containing 3 gallipots for
solutions
3. Receiver containing the following:
 Mosquito artery forcep

22
  Plain dissecting forcep.
 Mouth gag (for unconscious patient)
 Tongue spatula/depressor
4. Padded orange sticks in a container
5. Denture bowl with brush
6. Cape mackintosh and towel
7. Feeding cup with water to rinse the mouth
8. Four (4) bottles containing:
i. Sodium bicarbonate
ii. Hydrogen peroxide
iii. Glycothymoline
iv. Glycerine
Procedure
1. Explain the procedure to the patient
2. Prepare tray, take to bed Side and screen bed
3. Place patient in a comfortable position either
lying down with the head titled to one Side or
sitting up position.
4. Place cape mackintosh in position
5. Wash and dry hands; inspect mouth for any
abnormality
6. Remove dentures if any, and place in denture
bowl.
7. Pour Solutions into appropriate containers
8. Wind wool swabs around artery forcep and
clip in position

23
 9. Dip swab into appropriate solution and press
the wool swab against the side of the gallipot
to prevent it from dripping.
10. Clean the mouth in the following order:
Inside the cheeks
Teeth and gum
Roof of the mouth
Under and top of the tongue
Lips
11. Continue swabbing until the mouth is clean
12. Clean between teeth with orange sticks
dipped in sodium bicarbonate and give mouth
wash or swab the mouth in the same order
with glycothymoline to leave refreshing taste
and encourage salivation
13. Lubricate lips With glycerine borax or liquid
paraffin or Vaseline
14. Clean dentures and replace ifrequired
15. Remove cape mackintosh and make patient
comfortable
16. Remove and discard tray
17. Wash and dry hands
Strength of Solutions Used:
1. Sodium bicarbonate 1:60
2. Glycothymoline
3. Glycerine (liquid paraffin or Vaseline)

24
 4. Hydrogen pyroxide 1:8
Complications of the Procedure:
1. Injury to the oral cavity.
2. Bums due to use of strong or improper
dilution of solution
3. Aspiration pneumonia due to wrong
positioning

Serving of Meals

Definition: A process of nourishing a patient with

necessary diet to improve nutrition and aid recovery.
Purposes
1. To serve a meal that is appetizing, hygienic
and of nutritional value to the patients;
2. To serve meal that enables the patient to
defecate with relative ease. Food is to be
served immediately after general cleaning in
the morning. - Breakfast 9 a.m. - 10 a.m. -
Lunch 12:30 p.m. - Dinner - 6:30 p.m. (Time
may vary in different hospitals)
Requirements
The following requirements on a trolley
1. Bowl containing food
2. A bowl containing soup
3. Plates (if patients have their individual plates

25
 this is not required)
4. A bowl containing clean water
5. Two big spoons
6. A kidney dish
7. A salt in a container
8. Cups
9. Bowl containing drinking water
10. Two hand towels
11. Sponge or rag
12. Cutleries
Procedure
1. Inform patients and prepare trolley.
2. Wheel trolley into the ward and tell
patient the food to be offered.
3. Using the big spoon, taste food, put the food
and soup in separate containers. If patients
have their individual containers collect the
plates and do the same.
4. Place food and soup on patient's locker.
5. Proceed to do the same to all other patients.
6. In an orderly manner go round again to
collect individual containers and cups.
7. Wash containers, place back in position and
discard trolley.
8. Allow enough time for eating and assist
patient where necessary.

26
 9. Report the amount consumed by each patient
to the Ward-in-charge.

Feeding of Helpless Patients

Definition: A procedure of serving food to the

helpless patient in order to meet the nutritional
requirement of the patient.
Purposes
1. To give food by mouth when the patient is
unable to feed himself
2. To ensure proper nutrition
Indications
1. Patients that are unable to use their hands
(disabled)
2. Bilaterial hand injuries;
3. Very ill patients;
4. Patient on bilateral cast. (Upper limbs)
Requirements: (A tray procedure)
1. Diet as ordered
2. Bowl and plate
3. Spoon or fork as needed
4. Feeding mug
5. Drinking cup with water
6. Napkin or cape if available
Procedure

27
 1. Sort out whether patient is on special diet and
explain procedure:
2. Prepare the food on the tray in an attractive
way and take to bed side:
3. Place the patient In an appropriate position:
4. Place the cape and towel under the chin and
over the chest:
5. Place the food within the patient's line of
vision:
6. Encourage the patient to eat by offering him
small amounts:
7. Offer small amount of liquids between solid
food:
8. After the meal is finished remove the cape
and towel and offer water to drink:
9. Make patient comfortable and discard tray.
Note:
1. Do not hurry the patient while feeding him.
2. Offer the food in small amounts and slowly
enough for the patient to empty his mouth
each time.
3. Make the patient feel that you are interested in
what you are doing.
4. Remember that the patient's diet is an
important part of his treatment. Therefore, if
the patient is not hungry or does not want to

28
 eat, it IS the Nurses responsibility to
encourage him to do so.
5. Never force a patient to take food against his
will.
6. Whenever possible, use the utensils
that he normally uses.
7. If patient can help by handling part of the
food, let him do so.

Passing of Naso-Gastric Tube (N.G. Tube)

Definition: It is the process of passing a naso-

gastric tube through the nostril into the stomach.
Purposes
1. For feeding purpose;
2. Pre-operatively (G.I.T. operation)
3. For diagnostic purpose;
4. For gastric lavage (washout)
5. For aspiration of gastric content
Indication
1. Unconscious patient
2. Patient on nill per oral
3. Patient with injury of the mouth
4. Following a major surgery
Requirement
Medium size tray containing the following:

29
 1. Ryles tube
2. Gallipot with gauze swabs
3. 10mls syringe
4. Litmus paper
5. A lubricant
6. Vomitus bowl
7. Receiver for soiled swabs
8. Spigot
9. Adhesive strapping
10. Small bowl with water
11. Small towel
Procedure

1. Explain procedure to the patient.

2. Sit the patient up if possible with the neck
slightly flexed.
3. Place towel in position.
4. Lubricate the first few inches of the tube.
5. Steady the patient's head with one hand and
pass the tube along the floor of the nose and
advise the patient to swallow.
6. Continue until 45-50cm have been passed.
7. If you are not successful, do not force the
tube, alter the angle at which you are passing
it or try the other nostril.

30
To check the tube is in the stomach
1. Inject 5ml of air into the tube and listen with
a stethoscope at the epigastric region for
bubbles.

Observe the patient for signs of cyanosis or coughing which

indicates the tube is in the respiratory tract .

2. Aspirate the stomach contents and test with
litmus paper if it's acidic you have got the
tube in the stomach.

Always:
 Check the position of the tube before feeding
and start with water and end it up by flushing
with water (thus rinsing);
 Fix the tube to the nose with a strapping;
 Spigot the tube;
The following items can be kept at bedside
 20ml or 50ml syringe
 Graduated measure
 Bowl of water to rinse syringe
 Gauze - swabs
N.B. For N.G. tube feeding
 20ml or 50ml syringe- Bowl of cold water
 Towel - Lotion thermometer
31
  Litmus paper
 Measured amount of liquid food.

Tube Feeding (Tray)

Definition: Is the process of feeding the patient with

liquids using tube.
Purposes
1. To feed the patient
2. To maintain proper nutrition.
3. To correct feeding deficiencies
Indication
- As for passing of naso-gastric tube
Requirements
Tray with the following: -
1. Oesophageal tube for nasal or oral route;
2. 50ml syringe or glass connection, tubing,
funnel and clip;
3. food thermometer;
4. Blue litmus paper:
5. Lubricant;
6. Protective for the patient (cape mackintosh)
7. Measured amount of food in a jug;
8. Small jug of water;
9. Fluid balance chart:
10. Beaker of mouth wash and receiver;

32
 11. Vomit bowl in case of vomiting
N.B: Whenever possible the feed should be prepared
using ordinary kitchen utensils. If medicines are
given at the same time, the appropriate medicines
and prescription card should be included.
Procedure
1. Prepare the tray;
2. Explain procedure to patient;
3. Screen bed and bring tray;
4. Help patient to sit in a comfortable upright
position;
5. Place cape around patient's neck;
6. Wash hands;
7. If necessary, clean nostril with solution of
sodium bicarbonate on padded orange stick;
8. Lubricate end of tube:
9. Measure length on tube from nose to xiphoid
of sternum;
10. Nasal route: Pass tube quickly and firmly in a
backward and downward direction up nostril
and ask patient to swallow. Take care that the
tube is not curled up in the mouth.
11. Oral route: Pass tube over tongue at side of
mouth and ask to swallow. In both cases
watch for cyanosis or coughing as it is
possible to pass tube into the larynx and

33
 trachea. If you are in doubt, then pinch tube
and withdraw quickly.
12. When sufficient length of the tube has been
passed check the tube for correct position by
aspiration of a small amount of gastric juice
and testing for acidity with litmus paper.
13. Introduce a small amount of water into
syringe and if no distress continues with feed
allowing it to run in slowly.
14. When feed is finished, run through 30cc of
water.
15. If the tube is to be removed - pinch the tube
and remove gently but quickly.
16. If the tube is to be left in - spigot and strap
the end of the tube to the patient cheek just
above the molar bone.
17. If oral route is used and tube removed, give a
mouth wash.
18. Make patient comfortable.
19. Remove screen and discard tray.
20. Enter the amount given on fluid balance
chart.

Gastric Lavage

Definition: This is the act of washing out the

34
stomach in order to remove poisonous and irritating
materials.
Indications
1. Patient with poison
2. Obtaining of gastric specimen
Purposes
1. To washout the gastric contents
2. To control bleeding in gastric ulcers
3. Preoperative preparation in gastric surgery
4. To relieve nausea and vomiting
5. To cleanse the stomach in preparation for
gastric surgery
6. To obtain a specimen for diagnostic purposes
Requirements (Trolley) - Clean procedure
Top shelf
1. A large bowl containing a funnel, Naso
Gastric tube and a dressing forceps
2. A receiver containing a rubber tubing, clip
and glass connection
3. A large jug of prepared solution
4. Gauze swabs in a receiver
5. Lotion thermometer
6. Lubricant in a gallipot
7. A liter measure for filling funnel
8. Mouth gag and tongue depressor (if required)
9. Adhesive strapping and scissors

35
 10. Specimen bottle and 20ml syringe
11. Litmus paper both red and blue
12. A feeding cup with clean water or mouth
wash
13. A gallipot containing clean water
Bottom Shelf
1. Vomit bowl
2. Receiver for used swabs
3. Protection for the patient
4. Floor mackintosh
5. Bucket for return water.
Procedure
1. Explain procedure to the patient.
2. Prepare equipment in treatment room, check
the temperature of the solution and bring
trolley to patient's bedside.
3. Screen bed and position patient in sitting up
or semi-recumbent position.
4. Place bucket for return water in position.
5. Place cape in position and spread floor
mackintosh.
6. Clean nostrils with gauze swabs.
7. Measure the length of the tubing to be
inserted by measuring from ear to nose and to
the xiphoid process of the sternum and mark
with plaster.

36
8. If patient is an adult and is conscious. explain
- to him how breathing and swallowing can
assist in passing the tube with minimal pain.
9. Lubricate tube and gently insert it through
one of the nostrils (the mouth may be used)
reminding the patient to breath deeply and
keep on swallowing until the labelled area
reached or some contents begin to flow.
10. Ensure tube is in stomach by testing the
contents with litmus paper. If tube is in
stomach, tape it to the face.
11. Assemble tubing and glass connection to a
funnel.
12. Using a litre measure pour in solution and
clip.
13. Connect tubing to the tip of the N.G. tube,
unclip and pour in solution into the funnel
slowly, raising funnel up so that solution
flows by gravity.
14. If sufficient solution has been passed, invert
funnel into the bucket so that gastric contents
now return into bucket. Obtain a specimen if
required and continue irrigating until all fluid
has been given and desired results obtained
(water returned as poured).
15. Disconnect tubing, remove tube and make

37
 patient comfortable.
16. Observe and record amount of contents
before discarding.
17. Remove screen and discard trolley.

38
 CHAPTER FIVE: BEDDINGS
Bed Making

Definition: The process of preparing hospital bed

for effective patient care.
Scientific Principles: -
As a Nurse prepares a bed she considers the hard
and soft tissues of the patient resting against the
mattress.
The body exerts uneven points of pressure against
the mattress and the greatest pressure is made at
points of prominence or of greater weight. The
pressure may be so great or prolonged that the blood
supply is cut off and the part becomes gangrenous.
The means of stimulating circulation such as
exercises should be encouraged while on bed as
circulation is slower while in lying position. These
exercises also maintain muscle tone; and as muscle
tone improves the joints assume their proper
position. When a person lies in bed his body
position should approximate to standing position as
nearly as possible.
Bedclothes also need to be changed as often as
possible as a result of moisture and in order to

39
protect the patient and prevent transfer of infection
from one patient to another.
A well-made bed also aids establishing good rapport
in meeting the psychosocial needs of the patient and
also encourages him to do the same while at home.
Purposes
1. To make patient comfortable and safe
2. To prevent pressure sores
3. For treatment purposes
4. To prevent cross infection
5. For aesthetic reasons
Principles of Bed Making
1. Two Nurses procedures
2. Assemble all requirement before starting
3. Beds should be made as often as necessary
4. All worn out materials should be replaced as
soon as possible
5. Bed clothes to be placed on striper or 2 chairs
6. Patient should never be left uncovered or
unsupported
7. Communicate with patient as much as
possible during procedure
The Basic Hospital Bed should have the
following:
1. Bed stead
2. Tarpolin cover (over springs)

40
 3. Mattress with rubber cover or mackintosh
4. Pillow with polythene cover

Types of Beds

1. Unoccupied bed (empty bed or closed)

2. Occupied bed (open)
3. Emergency admission bed
4. Fracture bed
5. Bed for drying plaster cast
6. Operation bed (post operative)
7. Divided bed
8. Cardiac bed
9. Cot bed

Unoccupied Bed

Definition: A bed prepared to receive a patient

following a plan admission into the ward.
Requirements on a Trolley
Top shelf
1. 2 clean bed sheets
2. 1 draw sheet
3. 1 clean pillow cover
4. 1blanket or counterpane
Bottom shelf
i. 1 draw mackintosh
41
 ii. 1 pillow
Procedure
NB. Two Nurses’ procedure
1. Explain procedure to patient
2. Collect all requirements on a trolley and take
trolley to the foot of the bed.
3. Avoid all unnecessary steps and movements.
4. Move away the locker or any other object
obstructing you from free movement.
5. Place two chairs back to back at the bottom
of the bed (or bed stripper)

6. and place items on them in order of

application.
7. Turn mattress from end to end and pull it
tight to the head of the bed (if necessary).
8. Spread bottom sheet over mattress and tuck it
in at the top and beginning from top to
bottom making tight (envelop) corners.
9. Place draw mackintosh approximately 40cm
from the top.
10. Place draw sheet to cover draw mackintosh
and tuck in both sides together.
11. Spread top sheet on bed allowing a turn over
about 50cm at the head end and tuck in at the
bottom and on either sides.

42
 12. Cover the top sheet with a blanket or
counterpane allowing it to hang loosely on
either side of the bed. Fold top sheet over
blanket.
13. Tuck in the bottom with envelop corner to
make a neat appearance.
14. Slip pillow into its cover so that the corners
fit well. Place it on the bed with the open end
away from the door.
15. Put chair under foot of bed, straighten the bed
and return locker to its former position and
remove trolley.

Occupied Bed (For Ambulant Patient)

Definition: A bed prepared for already admitted

patient for rest and comfort.
Requirements
Same as for an unoccupied bed with the addition of
linen bin.
Procedure
1. Explain procedure to the patient
2. Set trolley and wheel to bedside and assist
patient to sit comfortably on a chair.
3. Place two chairs back to back (or striper) at
the foot of the bed.

43
 4. Remove pillow and place on a chair.
5. Strip bed, fold and place blanket and linens
on the chairs accordingly or discard in linen
bin if they need to be changed.
6. Turn mattress from end to end and put it tight
on the bed.
7. Make bed as for unoccupied bed until when
draw sheet is in position.
8. Place pillow in position with open end away
from the door.
9. Place top sheet and truck in at bottom making
an envelope corner.
10. Place blanket on top and tuck at bottom
making an envelope corner.
11. If patient is back on bed cover him with both
top sheet and blanket otherwise fold them
threefold.
12. Place chairs back to their position, straighten
bed, return locker to its former position and
remove trolley.

Occupied Bed with Patient on the Bed

There are two known methods, namely:

Method I: Rolling Patient from Side to Side
1. Explain procedure to the patient.

44
2. Set trolley and wheel to bedside.
3. Screen bed and close nearby windows.
4. Strip bed loosely, leaving patient with a
pillow and covered with a bed sheet.
5. Roll patient to one side and roll draw sheet
and draw mackintosh towards him. If bottom
sheet needs changing roll it also.
6. Tuck in the clean sheet on one side and roll it
to the centre of bed. Unfold draw mackintosh
and draw sheet over the top or the rolled
sheet.
7. Roll patient gently over the bump to the
opposite side.
8. Remove dirty sheets and put into linen bag.
9. Smoothen the bottom sheet and tuck it in. Do
the same with the draw mackintosh and draw
sheet.
10. If the bottom sheet is not changed it should
be un-tucked, brushed clean with a hand and
tucked again. Pull it well up, straighten and
smoothen it before tucking in the draw
mackintosh and draw sheet.
11. Turn patient back to the centre of the bed and
support him while his pillows are shaken and
re-arranged.
12. Place patient in a comfortable position and

45
 make up the top of the bed.
13. If the top sheet needs changing place it over
the dirty one and remove the dirty one.
14. Cover patient with top sheet if necessary.
15. Ensure that bedclothes are loose over the
patient's feet by pulling them loosely.
16. Straighten bed and replace locker back to
position.
17. If patient is using a bed cradle place it in an
appropriate position before the top sheets.
Method II: From Top to Bottom
1. Observe I - 3 in Method I
2. Lift patient to the foot of the bed where he
can be supported by a Nurse
3. Straighten or change bottom sheet at the head
of the bed. then lift the patient to the already
made up top part of the bed supporting him
by one Nurse as the other make the lower
end of the bottom sheet.
4. Make up the top bedclothes as for method
one
NB: The patient must never be uncovered or
exposed

46
Cardiac Bed

Definition: A bed prepared for patients with

difficult breathing to ease respiration.
Indications
1. Patient with congestive heart failure
2. Patients with severe respiratory disease
3. Patients with ascitis.
Requirements
Same as for a simple bed with the addition of the
following - back rest, bed table with a soft pillow,
sputum mug, 3 - 4 extra pillows, a bed cradle, a bed
sheet, sand bags or foot rest and one air ring with
cover.
Procedure
1. Inform patient, screen bed, close nearby
windows.
2. Wheel trolley to the patient’s bedside.
3. If patient is ambulant assist him to sit
comfortably on a chair otherwise move him
to the foot of the bed as a Nurse supports him
in an upright position.
4. Make up bed as for a simple bed until when
draw sheet is in position.
5. Place backrest in functional position and
arrange pillows in order. If patient is on bed

47
 move him towards the head of the bed so that
he sits in an upright position.
6. Place air ring in position.
7. Support both feet with sand bags at the sole
of feet.
8. Make up top clothes over a cradle and place
bed table with a small pillow and sputum
mug in front of patient.
9. Place chairs under bed, remove screen
replace locker back to its former position and
discard trolley.

Emergency Admission Bed

Definition: A bed prepared to receive patient that

need immediate attention to ease patient’s problem
Indications
1. Patients with road traffic accident.
2. Acutely ill patients.
3. Patients that require urgent attention
Requirements
Same as for a simple bed with the addition of the
following: - 2 blankets, hot water bottles, bed blocks
or bed elevator, vital signs tray, oxygen cylinder,
suction machine and a drip stand.
Procedure

48
 1. Make bed as for a single bed until when draw
sheet is in position.
2. Spread first blanket over bed.
3. Put hot water bottles over bed and spread
second blanket in position.
4. Place top linen and blanket in position
leaving the part toward" the main door open.
5. Arrange oxygen cylinder with its accessories
and suction machine by the side of the bed.
6. Place vital signs tray on a locker.

Divided Bed (Cradle Bed)

Definition: A special bed prepared to aid comfort

based on individual’s problem.
Indications
1. Patient with fracture of the lower limbs,
2. Patient with lower limb amputation;
3. Patient with newly applied plaster of Paris on
the lower limbs.
4. Patient with burns.
5. Patient with abdominal operations.
Requirements
Same as for occupied bed with the addition of the
following:
1. 1 Bed sheet

49
 2. 1 Blanket
3. Bed cradle
Procedure
1. Make bed as for simple bed until when the
draw sheet is in position.
2. Make top half of bed by spreading a bed
sheet over the bed leaving enough at the top
to overlay.
3. Fold blanket into two and place on it with the
lower end at the centre of the bed.
4. Fold lower end of bed sheet over blankets
and then fold top part of the bed sheet.
5. Make lower half of the bed by spreading the
second sheet over bed and tucking it at the
bottom.
6. Spread second blanket over it, tucking it at
the bottom and fold the top part allowing
1
about th to overlap the top divided part.
6
7. Fold upper part of the bed sheet over blanket.
8. Place bed cradle in position.
9. Slip pillows in their cases and place in
appropriate place.
NB:
1. If the bed is to be used for a patient with a
lower limb amputation the followings are

50
 added.
 3 dressing towels and mackintosh
 2 Sand bags
 1Tourniquet
 1 Draw sheet
2. If the bed is to be used for a patient with
newly applied plaster of Paris on lower limbs
the followings are added:-
 A dressing mackintosh and a towel
 A protected pillow
 Fracture boards.

Post Operative Bed

Definition: A bed prepared to receive a patient

following surgical intervention to aid recovery and
prevent complications.
Requirements
Same as for a simple bed (Preferably clean sheets)
with the addition of the following: -
1. Protective sheeting and towel.
2. Oxygen cylinder and attachments.
3. Tray for intravenous therapy
4. Suction machine
5. Post anesthetic tray
6. Side rails

51
 7. Resuscitation trolley
8. Bed blocks or elevator
9. Hot water bottles if necessary
10. Drip stand
11. Vital signs tray
Procedure
1. Remove pillows and place on chair.
2. Make foundation bed as usual until when
draw sheet is in position.
3. Place protective sheeting and towel over head
of bed and tuck under mattress.
4. Place the top bed clothes and fold lengthwise
into a pack and place on top of the bed.
5. Leave pillows on a chair and push under
patient's bed.
6. Arrange additional requirements in readiness
by the bedside.

Cot Making

Definition: A special bed prepared for babies and

other small children to protect them from falls and
injuries.
Trolley procedure
Top Shelf
 Two cot sheets

52
  One pillowcase (cot size)
 1draw sheet
 Cot cover
 1 Cot mosquito net
 Cot blanket
Bottom Shelfen
 1 Mackintosh
 I Small pillow
NB: A linen bin should accompany the trolley.
Procedure
Make bed as for a simple occupied bed until when
the top bed clothes are in position. Then spread
mosquito net over the cot to protect child from flies
and mosquitoes.

Bed Accessories

Definition:
These are equipment used alongside with bed for the
added comfort of the patient according to the type of
Nursingcare required.
1. Bed Cradles: These are made of metals and
are used to take the weight of the bedclothes
from the body e.g in cardiac and burnt
patients.
2. Backrest: These are made of wood or steel.

53
 Backrests now form part of the bed and can
be adjusted as required. They help to support
the patient and aid breathing.
3. Air Rings: Hollow rubber rings fitted with a
valve. They are blown up to form a cushion
on which the patient sits to prevent pressure
sore. Rings must be put into a cotton cover
before being placed under the patient. Used
on obese and cardiac patients.
4. Fracture Boards: Used in patients who are
in a plaster splint or need firm support after
spinal injuries or operations. They are placed
under the mattress to prevent it from sagging.
These are composed of wood pavels, which
may or may not be perforated. They are used
under the mattress to prevent sagging and
maintain even surface where fracture beds are
not available. Mostly used on patients with
fractures.
5. Bed Blocks: They are used to raise the head
or foot of the bed in case of shock or
haemorrhage. Metal elevators which may
either be portable or attached to the bed can
also be used for this purpose.
6. Ripple Bed: This is sometimes called airbed.
The bed is covered with a mattress which is

54
 composed of alternating pressure pads, which
are alternately inflated and deflated. It is used
for prevention of pressure sores.
7. Hot Water Bottles: These are rubber bottles,
which are filled with hot water and placed in
a patient's bed or over the patient. It should
be protected by flannel cover. They are used
to provide warmth to the patient.
8. Pulleys: Pulleys are crooked bars over the
head of beds with suspended chain and
handle to aid patients lifting and for regular
active exercise.
9. Parallel Bars: These are extra appliances
made of iron bars. They are attached to the
head and foot of the bed with parallel
support. They are used for cross-pelvic
tractions and putting mosquito nets.

Positions Used in Nursing

1. Recumbent: This is where the patient lies

flat on the back with a pillow under the head.
Indication:
a) To Nurse patient at complete rest as it
provides full relaxation
b) For examination of the front trunk.

55
2. Semi-Recumbent: This is where the patient
is half propped up with two to three pillows.
Indication:In medical and surgical Nursing
e.g. chronic and acute chest conditions and
gastric conditions.
3. Prone: Patient lies flat on face with a pillow
under head (which is turned to outside).
Small pillow is placed under the ankles to
prevent toes from pressing on the bed and a
pillow is placed under the chest.
Use:Patient with burns on the back or severe
bed sore.
4. Semi- Prone (SIMS): Patient is placed on
one side with the lower arm resting behind
the other in front. The lower leg is stretched
behind and the other is bent in front. The
chest and head are positioned so that any
secretion from the mouth is drained out.
Use:For unconscious patients and
gynaecological examination.
5. Upright / Fowler’s Sitting: Patient sits
upright supported with pillows. Patient may
have cardiac table as dyspnea is relieved by
leaning forward and may also require air ring
to relieve pressure.
Use: For patients with chronic heart disease,

56
 dyspnea or post-operative chest or heart
condition and for drainage of abdominal
cavity.
6. Dorsal: Similar to recumbent but here the
thighs are flexed and knees are abducted.
Use:For abdominal and vaginal examination,
bi-manual examination and catheterization.
7. Lateral: Patient lies on left or right side with
buttocks to the edge of the bed, head is bent
forward and thighs and knees flexed.
Use:Rectal examination, vaginal and perineal
examination, giving of enemas and
suppositories. N.B. Usually the left lateral is
the most suitable for enema because of the
anatomical arrangement of the gastro-
intestinal tract.
8. Genupectoral (Knee Chest): Patient kneels
on table near the edge, thighs vertical, the
chest rests on a small flat pillow and head
bent beyond while arms are flexed round and
over the head.
Use:For vaginal examination, high colonic
irrigation and in cases of vesceroptosis to
assist in replacing dropped organs.
9. Lithotomy: Patient lies in recumbent
positions, knees well flexed, abducted and

57
 hanged so as to maintain position.
Use:Commonly used in the theatre for
gynaecological and perineal operations/
examinations.
10. Trendelenburg: Patient lies in recumbent
position with thighs abducted and knees
flexed backwards.
Use: Same as for lithotomy.

Lifting and Moving of Patient

Patients, who cannot move themselves, are to be

moved by the Nurse in a comfortable manner
without either hurting the patient or damaging
his/her own spine.
1. Lifting the patient up the bed
2. Lifting the patient from bed to chair or from
chair to bed
3. Lifting the patient from bed to stretcher or
from stretcher to bed
Types
1. Conventional or orthodox lift
2. Australian or shoulder lift
NB: For more details on lifting and moving of
patients refer to notes on the Foundation of Nursing.

58
CHAPTER SIX: HAIR AND SKIN HYGIENE
Inspection of Head

Definition: A procedure that involve looking at the

structure of the head to detect abnormality and
observe the colour and texture of the hair.
Purposes
1. To inspect the hair for pediculosis or
dandruff.
2. To remove dirt and tangles from the head
3. To teach the patient principles of hygiene
Requirements: Tray (clean procedure)
1. A bowl of cotton wool swabs
2. A bowl containing carbolic Acid solution
1:20
3. Jaconet cape
4. A receiver containing a fine comb, a wide
toothed comb and a brush
5. A protection for the bed (If patient is on bed).
6. Two Gowns/Aprons and shower caps
7. A pair of gloves
Procedure
1. Explain procedure to the patient
2. Prepare tray, take to bedside and screen bed

59
 3. Wear gown, shower cap and put on gloves
4. Place jaconet around the patient's shoulder
and place a protection for the bed in position.
5. Hold the swab with one hand and place it
underneath the head and hold the comb with
the other hand.
6. Gently comb hair towards the swab so as to
prevent lice or tangles from falling.
7. Repeat this process all over the head
inspecting carefully, particularly around the
neck and behind the ears.
8. Drop the used swabs in the bowl containing
carbolic acid solution 1:20
9. Brush and comb hair if not infested
10. Remove tray and screen
11. Make patient comfortable
12. Disinfect comb by leaving it in carbolic acid
solution for 2 hours
13. Report condition of the head to the Nurse in-
charge of tile ward

NB: It is important to inspect the head of every

patient on admission and the procedure is usually
carried out while the patient is in a sitting position
(either in bed or on a chair).

60
Washing Hair in Bed

Definition: A process that involves inspection and

washing of hair to detect and treat abnormality.
Purposes
1. To promote good supply of blood to the scalp
2. To keep the hair free of dirt and tangles
3. To teach patient principles of personal
hygiene
Indications
1. On admission where inspection reveals dirt
2. The head of female patients who are confined
to bed should be washed weekly
Requirements: Trolley (clean procedure).
Top shelf
1. Bowl of warm water (temp. 37ºC)
2. Two jugs of water (for cold and hot water)
3. Small jug for pouring water
4. Container for shampoo or soap solution
5. Bath thermometer
6. Comb and brush
Bottom Shelf
1. A long mackintosh
2. Floor mackintosh
3. Two bath towels
4. One jaconetcape

61
 5. A gown or an apron
NB: Two buckets, one for used water and the other
for used cape. Floor mackintosh should be by the
side of the trolley.
Procedure
1. Explain the procedure to the patient
2. Prepare trolley, take to bedside and screen
bed
3. Wear gown/apron
4. place patient in upright or lying position and
place bed table in Position
5. Protect bed with a long mackintosh, patient
with cape and the floor with floor
mackintosh.
6. Prepare water in bowl (temp. 37 0C) and
place on table
7. Wash hair with water using jug, apply
shampoo rubbing it into scalp and then rinse
with water.
8. Repeat the above until the hair is
thoroughly washed
9. Change water and rinse thoroughly
until all the soap is removed
10. Dry hair thoroughly with a towel or use a
dryer if available
11. Comb hair, make patient comfortable

62
 and discard trolley

Treatment of a Verminous Head

Definition: A procedure that involves cleansing the

verminous head to treat infection.
Purposes
1. To treat a verminous head
2. To make patient comfortable
3. To teach the patient the principles of hygiene
Indication
- Patient with verminous head
Requirements: Trolley (clean procedure)
Top shelf
1. Two pair of gloves
2. A container with D.D.T. emulsion, Benzyl
benzoate cream or \ethane oil.
3. A receiver with carbolic acid solution 1 :20
4. Hair comb and brush
5. Bowl with cotton wool swabs .
Bottom Shelf
1. Along mackintosh to protect to the bed
2. A floor mackintosh
3. Cape mackintosh
4. Two gowns and 2 shower caps
5. Polythene container for used swabs

63
 (Disposable)
Procedure
1. Explain procedure to the patient
2. Prepare trolley, take to bedside and screen
bed
3. Wear gown and shower cap then put on
gloves
4. Make patient comfortable and place cape in
position
5. Spread long and floor mackintosh
appropriately
6. Part the hair with a comb, apply emulsion
over scalp with cotton wool swabs and gently
message scalp with finger tips
7. Repeat above until the lotion is applied all
over the scalp
8. Remove articles, make patient comfortable
and discard trolley
NB:
1. When D.D.T. is used the head should be
washed daily for 2 weeks (it remains active
for 2 weeks).
2. When Benzyl Benzoate cream or lethane oil
is used hair should be combed daily for ten
days (remain active for ten days.)

64
Bed Bath

Definition: This is a bath given to ill patient on bed.

Purposes
1. To clean the body from dirt, sweat and other
secretions and microorganisms.
2. To freshen the body and relieve discomfort.
3. To encourage blood circulation.
4. To promote self-image.
5. To inculcate in the patient, the principles of
hygiene.
6. To establish rapport (Nurse - patient
relationship).
Indications
1. Unconscious patients
2. Paralyzed patients
3. Very ill patients
4. Patients with multiple fractures
Requirements
A trolley procedure
Top shelf
1. 2 jugs for hot and cold water
2. Mixing bowl
3. Bath thermometer
4. Soap in a dish with three (3) flannels
5. Comb and nail scissors in a receiver

65
 6. Powder and Vaseline
Bottom shelf
1. 2 bath towels
2. Clean linens and pyjamas if necessary
3. Container for dirty water at the side of the
bottom shelf
4. Dirty linen bin.
Procedure
1. Explain procedure to the patient
2. Prepare trolley and take to bed side
3. Screen the bed, close windows and put off the
fan
4. Remove extra pillow and top covers, leaving
patient covered with only the top sheet. If it is
cold, a light bath blanket (sheet) may be used.
5. Prepare water at the proper temperature 39 0C
– 40 0C.
6. Put towel under the patient's head, wrap the
face flannel around the hand, apply soap and
wash the face, neck and ears (front and back).
7. Rinse the flannel and gently wash the
patient's eyes without using soap and dry with
towel.
8. Place bath towel under one arm away from
you, wash the hand, being careful to wash
axilla and between fingers. Attend to pressure

66
 areas, stream hand in basin and dry. Dust the
axilla with powder.
9. Attend to the other arm in the same way.
10. Expose chest and abdomen and repeat
procedure, paying particular attention to
under breast and umbilicus.
11. Change water (water may be changed more
frequent depending on the patient state of
cleanliness or otherwise)
12. Take another flannel and bath towel, expose
the leg further away from you, wash and
attend to pressure areas.
13. Rinse, stream feet in the basin and dry well.
Wash the other leg in the same way
14. Roll patient to one side, arrange towel beside
the back and wash back. Using another
flannel, attend to pressure areas, rinse and
dry, (get soap. lather on hand and massage
pressure areas e.g. sacral area. hip, shoulder
blades etc.)
15. Rinse off and dry, apply powder, unless
ll1continent when zinc or Vaseline IS used.
16. Roll patient back, arrange towel under thigh
and buttocks. Wash vulva, groin and cleft of
buttocks or scrotum and penis, dry carefully.
(The patient may prefer to do this for

67
 himself/herself).
17. Change draw-sheet and bottom sheet if
necessary.
18. Finger and toe nails may be trimmed.
19. Give arm and leg exercises, put on clean
gown to patient.
20. Attend to hair if necessary
21. Allow patient to clean teeth if necessary
22. Make patient comfortable and remove screen
and discard trolley.
23. Wash hands and dry.
NB: Patient may like to use his own pomade,
deodorant or cream. All should be used sparingly
with discretion.

Bathing Babies and Older Children

Definition: A process of body cleansing

of babies ands children to maintain
hygiene.

Purposes
1. To clean the baby
2. To teach mother principles of hygiene
3. To minimize infection
4. To make the baby comfortable
Requirements

68
 1. Bath thermometer
2. 2 jugs, one for hot and another for cold water
3. Bath or bath sunk and stool for sitting
4. Soap dish and soap
5. Baby powder and baby oil
6. Cord powder and cord dressing tray with
mentholated spirit, bandage, scissors cotton
wool swabs etc.
7. Tray for cleaning eyes, face and ears
8. Rectal thermometer
9. Bath towel and clean clothes
10. Mackintosh apron
Procedure - Baby Bathing
1. Place tray in position and arrange clothing in
order of use
2. Prepare bath - pour cold water first, then hot
water (380C)
3. Put on mackintosh apron
4. Undress baby and wrap in hath towel,
exposing the head, wash face, ears and eyes.
5. Tuck baby under the left hand and support
the head
6. Apply soap to the head using the right hand
and rinse off while being held over the bath.
7. Dry the head and unfold the towel
8. Clean buttocks, take temperature and record

69
 9. Soap hands and lather the trunk and limbs,
paying special attention to flexures. hold
baby towards self and apply soap to the back
10. Put baby in the bath, hold baby firm with the
left wrist behind the shoulders supporting the
neck, while the left hand holds the baby's left
upper arm
11. Use the right hand to rinse off the soap from
the body
12. Lift baby out of the bath and place face down
on the towel on the lap
13. Wrap in dry towel and dry
14. Turn baby by rolling towards the Nurse to
avoid the risk of dropping off the knee
15. Oil baby, treat buttocks and apply powder to
the skin
16. Place napkin and dress baby
17. Make up the cot and put the baby to rest

Babies with Cord

1. Clean with mentholated spirit, apply cord

powder, leave exposed or dry according to
method used in the ward.
2. Dress baby, comb and brush hair
3. Wrap baby and make comfortable

70
 4. Take baby back to Nursery
5. Place in prepared clean cot lying on the side
or abdomen with face to one side
6. Tidy up, clean trolley and wash hands
7. Nurse should sing or talk while bathing infant

Older Children

1. Reassure and always talk to child

2. Prepare requirements in bathroom
3. Clean bath bowl
4. Place cold water in, add hot water
5. Check temperature
6. Proceed to bath child, sit child in bath
Bathing Older Children
1. Wash face and head and wipe dry
2. Using foam sponge / flannel, wet and soap -
wash body, hand, paying attention to folds,
fingers, toes, and rinse thoroughly
3. Remove from bath and place towel around
child. Dry thoroughly. Apply powder or oil
4. Dress child and take back to bed
5. Clean bath, tidy up and wash hands

Assisted Bath/Bathroom Bath

Many hospitalized patients will choose to take a tap-

71
bath or a shower. In this case, the Nurse gives
minimal assistance.
Requirements
1. Patient's own sponge case
2. Patient's bath bowel
3. Pomade or talcum powder
4. Hair comb
5. Clean attire/gown
Procedure
1. Prepare bathroom for bath
2. Accompany the patient to the bathroom after
permission for self-bath has been obtained.
3. Ascertain temperature of the water is at the
correct degree (380C – 40 0C)
4. Assist patient to undress and get into bath if
need be.
5. Assist patient in washing if necessary.
Special attention should he paid to the groins
axilla, under breasts (if women) umbilicus
and any abdominal folds in obese patients.
6. Assist patient to sit on a chair and dry
thoroughly
7. Assist in dressing and combing of hair if
necessary
8. Escort patient back to bed, if bed has not
been re-made, do so before making patient

72
 comfortable in bed.
9. Instruct the warder to clean the bathroom.
10. Report abnormalities e.g. Rash, bruises, cuts,
lumps, scars etc.

Care of Pressure Areas

Definition:This is the care given to a part of the

body that is likely to develop a sore if neglected.
Purpose
- To prevent the development of sores by
encouraging circulation and reducing friction
on the sites where the sores are prone to
develop
Requirements: (Tray containing the following)
1. Bowl of warm water (39 0C – 40 0C)
2. Bath towel
3. 2 Flannels
4. Soap in a dish
5. Dusting powder
6. Vaseline or any other Barrier cream
7. Bath thermometer
Procedure
1. Explain the procedure to the patient
2. Provide privacy by screening the bed
3. Prepare tray and take to bedside

73
4. Remove patient's attire and top bed linen
leaving the patient covered with only one
sheet.
5. Turn patient to lateral position with the back
towards the Nurse
6. Fold sheet to expose the back and spread
towel beside the back
7. Using long strokes wash the back thoroughly
and dry with towel
8. Lather the palm with soap rub on skin for few
minutes using circular movement.
9. Rinse off skin and dry thoroughly
10.If patient is incontinent apply cream, and if
not incontinent apply dusting powder.
11.Attend to other pressure areas in a similar
manner, such as occiput under pendulous
breast, back of elbow joints, groins, heels etc.
12. Make patient comfortable and remove screen
and discard trolley

74
 CHAPTER SEVEN: VITAL SIGNS
Vital Signs Observation

Definition: -The cardial signs that tell you the

health status of your client. These are the Body
Temperature, Pulse, Respiration and Blood Pressure

Temperature

Definition: -Is the degree of hotness or coldness of

the body as obtained by a standard scale
(Thermometer).
Terms Used in Describing Temperature
a) Pyrexia (fever): Is the elevation of body
temperature above the normal range. There
are three types of pyrexia namely:
i. Low (from 37.3 0C - 38.20C/ 99°F –
101 0F)
ii. Moderate (from 38.3 0C - 39.40C/ 106
0
F)
iii. Hyperpyrexia (over 41 0C)
b) Hypothermia (subnormal body
temperature): A body temperature below the
average normal range.

75
Types of Pyrexia
1. Continuous Fever: Temperature remains
high, varying not more than 1 0C in a day.
2. Intermittent Fever: Variation is between
normal and subnormal up to high fever or
hyperpyrexia every one, two or three days,
regularly.
3. Inverse Fever: Temperature rises in morning
and falls in evening e.g. in tuberculosis.
4. Remittent Fever: Temperature varies more
than 10C and does not reach normal within 24
hours.
Termination of Pyrexia
1. By Crisis: A sudden drop to normal within
twenty-four hours, accompanied by a
corresponding drop in pulse and respiration
rates.
2. By Lysis: When there is a gradual drop to
normal over two to ten days.

Rigor

Definition: A violent shivering attack due to sudden

disturbance of heat regulating centre (mechanism)
Stages of Rigor

76
 (a) Shivering - rise in temperature
(b) Hot stage
(c) Sweating - fall in temperature

Pulse

Definition: Is the wave of expansion felt in an

elastic artery walls. It corresponds with each heart
beat. It can be conveniently felt wherever a
superficial artery passes over a bone e.g. radial,
temporal, femoral etc.
Terms applied to pulse rate in disease:
1) Tachycardia - Rapid pulse rate.
2) Bradycardia - Slow pulse rate.
3) Arrhythmia - The pulse rhythm is irregular.
4) Intermittent - A normal pulse rhythm is
broken by period of irregularity.

Respiration

Definition: - Is the act of inspiration, expiration and

a pause. During the process, an interchange of gases
takes place in the lungs between the air and
circulating blood.
Terms Used to Describe Types of Respiration
1. Sighing (air hunger) - long deep inspiration.
2. Shallow - Found in diseases of the lungs.

77
 3. Stridor noisy inspiration due to obstruction of
upper air passages. \
4. Stertorous – Noisy, snoring inspiration.
5. Wheezing - Sound made during expiration.
6. Apnoea - Periodic ceasation of respiration.
7. Hyperpneoea - Deep breathing.
8. Dyspnoea - Difficult or laboured breathing
9. Orthopnoea - Advance stage of Dyspnoea.
10. Cheyne-stroke - A gradual increase in the
depth of respiration and then a period of
apnoea.
Purposes of Vital Signs Observation
1. To determine the state of hotness or coldness
of the body
2. To determine the rate, rhythm and character
of pulse and respiration
3. To aid in diagnosis
4. To assess improvement in the patient's
condition
5. To determine the effectiveness of some drugs
Routes of Taking Temperature
1. Orally
2. Skin
3. Rectally
Sites for Palpating Pulse
1. Radial artery

78
 2. Temporal artery
3. Carotid artery
4. Facial artery
5. Femoral artery
6. Dorsalispedis artery
Requirements on a Tray
1. Thermometer in a container with antiseptic
solution e.g. Dettol I-in 40.
2. A watch with second hand or digital.
3. Gallipot with cotton wool swabs.
4. Gallipot containing water.
5. Receiver for used swabs
6. TPR Chart

Taking of Temperature, Pulse and

Respiration

Oral Method

1. Explain the procedure to the client.

2. Prepare tray and take to bed side.
3. Shake down the thermometer to below 35 0C
or 940F and rinse thermometer in the gallipot
containing water.
4. Dry thermometer gently with cotton wool
swabs being careful not to allow your finger
tips to touch the bulb of the thermometer.
79
 5. Ask your client to open his mouth, insert
thermometer under his tongue and ask him to
close his lips and not clinch teeth then
proceed to take pulse and respiration.
6. Leave thermometer for time stated on it
(usually two minutes).
7. See arm is at rest, find pulse at radial artery
and count for one minute.
8. Before removing hand from taking pulse,
count respiration. That is count the number of
times the chest wall rises and falls in one
minute.
9. Withdraw thermometer, read at eye level and
return to container then proceed to record
your observation on TPR chart.
10. Discard tray, then wash hands and dry.

Skin Method

Requirement
1. Thermometer in a container with antiseptic
solution e.g. Dettol I-in 40.
2. A watch with second hand or digital.
3. Gallipot withcotton wool swabs.
4. Gallipot containing water.
5. Receiver for used swabs

80
 6. TPR chart
Procedure
1. Explain the procedure to the client.
2. Prepare tray and take to bed side.
3. Shake down the thermometer to below 35 0C
or 940F and rinse thermometer in the galipot
containing water.
4. Dry thermometer gently with cotton wool
swabs being careful not to allow your finger
tips to touch the bulb of the thermometer.
5. Expose the area where temperature is to be
taken e.g. axilla, groin or popliteal space and
dry with cotton wool swab. Insert
thermometer and then hold arm or leg in
position so that thermometer is in touch with
folds of skin.
6. Leave thermometer for time stated on it
(usually two minutes).
7. See arm is at rest, find pulse at radial artery
and count for one minute.
8. Before removing hand from taking pulse,
count respiration. That is count the number of
times the chest wall rises and falls in one
minute.
9. Withdraw thermometer, read at eye level and
return to container then proceed to record

81
 your observation on T.P.R. chart.
10. Discard tray, then wash hands and dry.
NOTE: You write 'S' (Skin) on the (chart) reading
to indicate route used.

Rectal Method

Requirements - same as for oral except the

following:
1. Rectal Thermometer in a container with
antiseptic solution e.g. Dettol 1-in-40.
2. Lubricant e.g. Vaseline in a container.
3. A watch with second hand or digital.
4. Gallipot with cotton wool swabs.
5. Gallipot containing water.
6. Receiver for used swabs.
7. TPR chart.
Procedure

1. Explain procedure to the patient.

2. Screen bed of patient if he is an adult.
3. Prepare tray and take to bed side.
4. If patient is a child, remove napkin, clean
buttocks and rectal area with dry cotton wool
swabs.
5. Shake down thermometer to below

82
 94°F/36°Crinse in water and dry with cotton
wool swabs and then lubricate thermometer
lightly with Vaseline.
6. Sit down and hold baby face down-wards on
your lap holding legs steady. Insert
thermometer gently into anus, clinch buttocks
and hold in position for time stated (usually
one to two minute).
7. If patient is an older child, it may be possible
to leave him in the cot, but hold the child as
you gently insert thermometer in anus and
keep in position for time stated (1-2 minutes).
8. If patient is an adult e.g. unconscious
patients, place in left lateral position and
insert thermometer in anus for about 2 inches
(5cm) and hold in position for time stated (1-
2 minutes).
9. Remove thermometer gently, wipe, clean and
read at eye level and return thermometer to
antiseptic solution.
10. Replace napkin in children.
11. Record temperature on T.P.R. chart and
indicate route by putting 'R' at the reading.

General Instructions
1. Keep separate thermometer for each isolated

83
 patient.
2. Always take a rectal temperature of
unconscious, delirious or extremely ill
patients or a child under 5 years of age.
3. Never use a rectal thermometer for taking an
oral temperature.
4. Take the vital signs of critically ill patients
and children every 4 hours.
5. Take 4 hourly vital signs of all newly
admitted patients and post-operative patients
for 48 hours.
6. Do not take the patient's temperature
immediately after bath and do not take oral
temperature if patient has taken something
hot or cold through the mouth, wait for at
least 10 minutes before taking the
temperature.
7. Take the vital signs of all patients twice a day
or as ordered for the patient's condition.
8. Report sudden rise in temperature of 100°F or
39°C and below 96°F or 35°C.
9. Take respiration and pulse at the same time
with temperature.
10.Patient must be at rest during vital signs
observation.
11.Any abnormal or subnormal reading of T.P.R

84
 is recorded with red biro on the chart.

Blood Pressure (BP)

Definition: - This is pressure which blood exerts on

encircling wall of blood vessels.
Purposes
1. To measure the arterial blood pressure of the
patient.
2. To aid in diagnosis.
3. To aid treatment of patient.
4. To observe improvement in patient's
condition.
Terms Used In Describing Blood Pressure
1) Hypertension: This is a persistent rise in
blood pressure above the normal range.
2) Hypotension: This is fall of blood pressure
below the normal range
Sites for Obtaining Blood Pressure
1. Upper arm (Brachial artery) is the commonest
site.
2. Thigh (Poplitial artery)
3. Forearm (radial artery)
4. Foot (Dorsalispedis artery)
Method
1. Palpatory method

85
 2. Auditory or ausucaltory method.
Palpatory Method Requirement
1. Sphygmomanometer (variety of BP apparatus
exist that one has to be conversant with, you
therefore have to refer to their manuals for
operation)
2. Chart
Procedure
1. Explain procedure to the patient and bring
equipment to the patient's bed side.
2. Place the patient lying down in a comfortable
position, unless if the patient is cardiac
condition which will necessitate upright
position.
3. Place BPapparatus carefully in a position
level with the patient's chest.
4. Exposed patient's arm, deflate cuff and wrap
to the patient's arm above the elbow joint.
5. Palpate the radial artery and inflate the cuff
until you can no longer fill the pulsation, then
close valve.
6. Then deflate the cuff until you are able to fill
the radial pulse,
7. Note the point where the pulse is 1stnoticed
( this is the systolic pressure)
8. Remove cuff fold and place inside the

86
 container and make your patient comfortable
9. Record the reading with red biro.
10. Reassure patient and take apparatus back to
the proper place
NB: Only systolic pressure is obtained by this
method.

Auditory OrAusculatory

Requirement
1. Sphygmomanometer
2. Stethoscope
3. Chart
Procedure
1. Explain procedure to the patient and bring
equipment to the patient's bed side.
2. Place the patient lying down in a comfortable
position, unless if the patient is cardiac
condition which will necessitate upright
position.
3. Place BPapparatus carefully in a position
level with the patient's chest.
4. Exposed patient's arm, deflate cuff and wrap
to the patient's arm above the elbow joint.
5. Palpate the brachial artery below the cuff and
place the bell of the stethoscope over it

87
 6. Inflate the cuff until no pulsation then close
the valve.
7. Then deflate the cuff slowly until the first
beat is heard.
8. Note the point (this is the systolic pressure)
9. Continue to deflate until the sound changes
(this is the diastolic pressure)
10. Remove the cuff from the patient's arm and
place in the container and make your patient
comfortable.
11. Record the systolic over diastolic pressure.
12. Record as above (Palpatory method)
13. Reassure patient and take apparatus back to
the proper place.
NB: the students are expected to know those factors
that maintain and influence the blood pressure.

Factors Maintaining Factors Influencing

Blood Pressure Blood Pressure
1. Peripheral 1. Age
Resistance 2. Position
2. Pumping Action 3. Sex
of Heart 4. Exercise
3. Blood Volume 5. Emotional Stress
4. Viscosity of the 6. Ingestion of Food

88
 Blood 7. Sleep/Rest
5. Elasticity of
Blood vessels

Tepid Sponging

Definition: The process of wetting the patient’s

body in order to lower body temperature through
conduction, convection and evaporation.

Purposes

1. To lower elevated body temperature

2. To provide physical and mental comfort to
the patient
Requirements on a Trolley
Top Shelf
1. A large basin for the water
2. Sponges, flannel or soft washing cloth in a
bowl
3. A bowl containing tepid water at temperature
between 25 – 27 0C
4. Bath thermometer
5. Small towel for the patient's face
Bottom Shelf
1. Clinical thermometer and cotton wool swabs

89
 in a receiver
2. Extra linen for the bed
3. Cold drink in a covered jug
4. Clean patient's gown
5. Receptacle for soiled linen
6. Bucket for used water
7. Water proof protection for bed
Procedure
1. Explain the procedure to patient
2. Bring the trolley to the bed side
3. Provide privacy with the use of screen by
patient's bed
4. Take the patient body temperature
5. Remove the top linen and leave patient
covered with one sheet or thin blanket
6. Remove patient gown and place towel
beneath him
7. Prepare water at (25-27 0C)
8. Sponge face and dry it
9. Place sponge in each axilla and one on the
forehead
10. Use one sponge to sponge the body and leave
other in the tepid water until the first
becomes warm, and change water as
necessary as possible.
11. Sponge the upper extremities first; use long

90
 strokes from the shoulder to the finger tips
changing sponges as necessary.
12. As sponging is done bits of water should be
left on the skin to give a cooling effect upon
evaporation.
13. Allow patient to dip his hands in to the bowl
of water after sponging the arm.
14. Change the sponges in the axilla and on the
forehead at frequent intervals
15. Sponge chest and abdomen with
circular movements,
16. Sponge the lower extremities using long
strokes
17. Place the patient's feet in the water, change
the water
18. Turn the patient and sponge the
back with long strokes
19. Treat pressure areas to facilitate good
circulation
20. Remove towel from under the patient and
replace his gown
21. Replace top linen and make patient
comfortable
22. Give patient a cool drink if
possible
23. Clean equipment and place them back in

91
 proper place
24. Take the patient's temperature after ten (10)
minutes and chart the result. A fall of 1-2 0C
is considered normal.

Dilution of Lotion

Definition:This refers to preparing a weaker

solution from a stronger one i.e a certain amount of
strong solution is required to be added to water to
reduce the concentration of the stronger solution.

Purposes
1. To reduce the strength / concentration of a
given solution
2. To avoid undesired effect of a
strong/concentrated solution

Requirement: Tray containing the following:-

1. Lotion to be diluted
2. Measuring cup
3. Jug of water
4. Container for diluted lotion
5. Paper and Biro

Procedure

92
 1. Prepare tray
2. Calculate amount of lotion and water
required using one of the formulae approved
a)
Strength Required Amount Required
× =Amount of Lotion
Stock Available 1
b) Amount Required - Amount of lotion =
Amount of water
c) Measure correct amount of lotion as per
(1) above and pour into container.
d) Measure correct amount of water as per
(2) and add to lotion.

Example: Prepare 1 litre of 2% solution from a 10%

solution.
2 1000
a) × = Amount of Lotion
10 1
2 1000
∴ × =200 ml( Amount of Lotion)
10 1

b) 1000 - 200 = 800mls (Amount of water)

c) 200 + 800 = 1000mls (1 litre of 2%)
Formula 2
a) Express all terms as common fraction
b) Invert the terms of the solution available
c) Multiply by the terms of the solution desired
as well as the amount desired.

93
Example: - Prepare 1 litre of a 2% solution from
10% solution
10 2
a) 10% = , 2% =
100 100
10 100
b) =
100 10
100 2 1000
c) × × =200 ml (Amount of lotion)
10 100 1
d) 1000 – 200 = 800ml (Amount of Water)
1000
c+d= litre of 2% solution
1

94
 CHAPTER EIGHT: SKIN CARE AND
APPLICATIONS
Application of Cold Compress

Definition: A process of placing a cold compress on

part of the body for patient comfort.
Purposes
1. To relieve pain
2. To arrest haemorrhage;
3. To reduce temperature;
4. To relieve or prevent congestion or reduce
swelling.
Requirement on a Tray
1. A bowl of ice or cold water;
2. Receiver containing two single layer of lint or
clean rag.
3. Mackintosh and towels.
Procedure
1. Explain procedure to the patient and screen
bed;
2. Prepare tray and take to bedside;
3. Expose area and place mackintosh and towel
in position;
4. Single layer of lint is soaked in cold water
95
 and wring out lightly and applied to the
affected area;
5. Keep the second lint soaked in the bowl of
cold water in readiness for changing
frequently;
6. If necessary change compress after every
one minute. When application is finished
dry the area and leave patient comfortable;
7. Discard requirement, then wash and dry
hands.

Application of Heat

Definition: A method of heat application to the

body to relieve discomfort.
Purposes
1. To provide warmth during cold weather;
2. To relieve pain;
3. To prevent shock.
Precaution:
Must be carefully performed to prevent burning the
patient, causing further discomfort
Requirements on a Tray:
1. Hot water bottle
2. Hot water bottle cover
3. Hot water in a Jug

96
 4. Bath thermometer
5. Cloth
Procedure
1. Explain procedure to patient;
2. Prepare requirements in the utility room.
Water must be at proper temperature to
prevent burns. (460C –520C).
3. Test hot water bottle for leakage;
4. Fill bottle ½ to ¾full depending on area
where it is to be applied;
5. Place on table to expel air. Apply stopper
(Removal of air makes bottle lighter, more
comfortable and allows it to conform to
contours of body);
6. Wipe and dry with cloth and test again for
leakage:
7. Cover bottle with cloth:
8. Apply hot water bottle to area ordered:
9. Record time, temperature and duration of
treatment and result noted.
(If patient is unconscious it may be safer to have a
layer of blanket between bottle and patient. Change
position of bottle frequently. Watch for redness of
skin. Do not press against the chest.
Refilling
1. Leave cover at bedside:

97
 2. Empty and place on newspaper:
3. Fill and test as before:
4. Replace equipment:
5. Take to patient's bedside on a tray. Replace
cover and re-apply to area.
Cleaning and Storage of Hot Waster Bottle
1. After use the hot water bottle should be
washed with warm soapy water, rinse and
hang upside down to dry.
2. Close in proper manner so that it is filled with
air and keep in proper place.

Medical Fermentation (Hot Application)

Definition: A process of heat application to relief

patient from pain and discomfort.
Purposes
1. To increase blood supply to a part as
superficial blood vessels become dilated due
to heat
2. To relax muscles
3. To relieve pain and congestion
4. To suppress inflammatory processes
Requirement on a Trolley
Top shelf
1. Fermentation bowl

98
 2. Receiver containing cotton wool, bandage or
binder
3. Receiver containing wringer and double piece
of old flannel or wash cloth
Bottom Shelf
1. Hot water bottle (at 20°F)
2. Kettle of hot water
3. Mackintosh and towel
4. Receiver for soiled swab/article
Procedure
1. Explain procedure to the patient and screen
bed;
2. Prepare trolley and take to bed side;
3. Put patient in a comfortable and convenient
position and expose area to be treated;
4. Protect bedding with Mackintosh and
towel;
5. Place flannel or wash cloth inside the wringer
and put into fermentation bowl;
6. Pour hot water over flannel in wringer and
wring the flannel or wash cloth dry;
7. Remove cloth from wringer and shake to let
steam escape;
8. Raise and lower edges of fermentation on the
affected area until heat can be tolerated;
9. Change fermentation every 2 minutes for 20

99
 minutes period if the fermentationis
intermittent. If continuous, change every 1, 2
or 3 hours depending on the Doctor's order;
10. Cover fermentation with plastic or heavier
cloth and place hot water bottle next to this
and secure it with bandage or binder;
11. After the procedure, dry area and make
patient comfortable;
12. Discard trolley and soiled articles and record
the procedure in the Nurses' notes;
13. Wash and dry hands.
Precautions
1. Care should be taken to avoid burning the
patient, especially those whose circulation or
temperature sensitivity is impaired;
2. Skin observation should be carefully done
when replacing an old fermentation with a
new one;
3. Treat only affected area to avoid increasing
congestion.

Application of Splints

Definition: This is the process of immobilizing any

part of the body to avoid causing further injury, i.e.
in cases of fractures.

100
Purpose
- To provide support and rest the affected limb.
Requirements
1. Suitable splint
2. Cotton wool padding
3. Bandage to maintain padding
4. Crepe bandage where necessary
Procedure
1. Explain the procedure to the patient
2. Set your trolley and take to the bed side:
3. The splint is then applied;
4. Safety pins are used to hold the strips in
position on the outside;
5. Apply crepe bandage over the limb and the
splint;
6. Make patient comfortable and discard trolley.

101
 CHAPTER NINE: SKELETAL
Application of Plaster of Paris (POP)

Definition: Plaster of Paris (P.O.P) is a form of

external splintage applied to any part of the body
and it is a white powder made from dehydrated
calcium suphate or gypsum; when water is added to
it, it undergoes a chemical change becominghard
and solid with evolution of heat. It first found in
Montrenole in Paris.
Purposes
1. To immobilize a fractured limb
2. To immobilize a dislocated joint
3. To correct deformity both conservatively and
post operatively
4. To produce an exact model oflimb to be used
in splint making (positive cast)
5. For conservative treatment where open
reduction is not indicated
6. To relieve pain
Types of Plaster of Paris (POP)
1. Walking cast: Used in fracture of tibia and
fibila
2. Bivalve cast: This may be removed for brief

102
 period to allow skin or wound care or
treatment
3. Spica: Used in shoulder or hip
4. Body (Jacket): Applied to the trunck
Principles of P.O.P
1. The basic materials should be by the bed side
2. The cast should be applied directly to skin
surface
3. A high level of skin care should be
maintained during application
4. The cast should not be too light nor too loose
(rightly fitted)
Requirements
To shelf
A tray containing the following: -
1. Plaster of Paris bandage;
2. Orthoban or stockinette cotton wool;
3. Tape measure;
4. Marker and tape:
5. Plaster scissors and plaster shears;
6. Blade or trimming knife;
7. Bowl of warm water.
Bottom shelf
1. A protector;
2. Rubber apron and boots;
3. Covered bowl;

103
 4. Old Newspaper.
Procedure
It is done by an Orthopaedic Doctor or a qualified
Orthopaedic Nurse and is usually applied in a well-
ventilated room.
1. Explain procedure to the patient and reassure
him;
2. Prepare your trolley and take to the bedside;
3. Protect the bed and the floor by using your
mackintosh or old newspaper to prevent POP
drying on the floor;
4. Wear your apron (plastic)
5. Apply stockinette or orthoban to the affected
limb evenly;
6. Pad bony prominences with cotton wool or
orthoban around the limb before applying the
cast;
7. Measure the length of the limb to get the
correct length of slab you need prior to
application.
8. With the correct size of plaster bandage dip
in bucket or bowl of warm water lying flat,
while you hold on to the tip;
9. When bubbles cease to rise and the bandage
is thoroughly saturated, take it out;
10. Hold the tip and compress the ends gently but

104
 do not squeeze or twist;
11. Apply over the padded limb gently and fast.
It must not constrict or have creases;
12. Roll on to fit accurately. Pleat or fold is made
in each turn as is required to make it conform
to the irregular shape of the limb;
13. Each stage the hand is dipped into water and
finger depressing should be avoided
14. In holding the cast the hand must be
constantly moved to avoid digging in 2/3 of
the previous turn are covered by each
subsequent turn;
15. Moulding the shape of the part must be done
rapidly and give a neat polished appearance
when finished;
16. The internal part of the cast is most important
and should be smooth, conform to the
contours of the patient's limb;
17. Trim the edges with the plaster knife or roll
over the stockinette and orthoban carefully
adjust and smooth;
18. The cast should be left open for quick drying;
19. Write the date on the cast with the marker
pencil and any site where there is a wound
which needs inspection frequently:
20. Observe for any complain tightness, swelling

105
 or sharp pain;
21. Tidy up and make patient comfortable by
placing the limb on a protective pillow to
keep it elevated. This aids the venous return
and prevent oedema
22. Remove all items and discard.
Important Observations afterP.O.P Application
1. Circulation
2. Sensation
3. Movement
4. Temperature

Traction

Definition: This refers to the act of pulling and

counters pulling between two points
Types
1. Fixed traction.
2. Balanced traction
3. Combined traction
Methods of Application
1. Skin traction - Clean procedure.
2. Skeletal traction - sterile procedure.
Purpose
1. To relieve pain and promote comfort
2. To prevent or relieve contracture

106
 3. To prevent deformity.
4. To provide rest.
5. To prevent muscle spasms
Indication
1. In cases of fracture to bring the broken bones
in proper alignment.
2. In cases of contracture.
3. In cases of severe pains due to lumbago.
4. In cases of muscle spasm to relieve pain.
5. In osteomylitis in order to confine patient on
bed
6. In cases of arthritis.
7. In severe burns of the lower limbs.
8. In cases of dislocation.
Principles of Traction
1. Floor of patient's bed must be firm; traction
must be uninterrupted and maintained in a
good position.
2. Counter pulling must be effective, foot of the
bed elevated.
3. Friction: - The cord should be friction free
and patient's heels must not be digging in the
mattress.
4. No traction should be released for any
Nursing procedure except e.g. patient with
physiotherapy.

107
 5. Weight must be hanging free above the
ground and should not rest on the bed rails or
anything else.
6. All articles should be sterile i.e in skeletal
traction

Skin Traction

Definition: Skin traction is a traction applied to the

exterior part of a limb with extension strapping for
correction or treatment of contractures or fractures.
Requirements (On a Trolley)
Top Shelf (In a tray)
1. Covered bowl with cotton wool swab;
2. Covered gallipot for ether
3. Covered gallipot for Tinture Benzoin
Compound (TBC)
4. Covered receiver with a pair of dressing
forcep.
5. A tray for shaving.
Another Tray containing:
1. Traction kit comprising: -, strapping spreader
cord, Crepe bandage and safety pin.
2. Orthoban
3. Scissors
4. Tape measure;

108
 5. Bottle of ether and TBC;
6. Cut stripes of flannel if Thomas splints are to
be used for the traction.
Bottom Shelf
1. Bowl of warm water
2. Soap in a soap dish
3. Flannel
4. Towel
5. Sand bags
6. Weight and weight carrier
7. Bed elevator
8. Extension frame (by the bedside)
9. 1pillow
Procedure
This is a clean procedure and two - three Nurses are
required to apply the traction to the limb. One
applies the traction to the limb, the other supports it
while the last person applies the extension strapping.
1. Explain procedure to the patient and re-assure
him:
2. Set trolley and take to patient's bedside and
screen the bed;
3. Arrange bed clothes and expose area for
application of traction.
4. Protect bed clothes with sheet provided;
5. Comfort the patient depending on the

109
 position. Using soap and water, wash the
affected limb and dry;
6. Shave the affected limb ifhairy and dry it
with ether;
7. Pour out some TBC in one of the gallipots to
guide against any skin reaction;
8. Measure the length of the affected limb;
9. Prepare adhesive plaster in the appropriate
size;
10. Assemble spreader and force it in the centre
of the plaster to stick properly;
11. Assemble cord by passing it through the hole
of the spreader, terminate it by making a
strong knot after achieving the correct length
of the cord: if Kit is not available;
12. One Nurse should maintain the manual
traction i.e. maintain the ankle joint at 90°
prior to the application of the adhesive plaster
on either sides of the already shaved area and
then place one of his fingers along the tendon
of Achilles.
13. Apply a layer of orthobanor cotton on either
sides
14. Apply crepe bandage in V shape method
anteriorly to hold firm but it should not be too
tight;

110
 15. Mount weight on the weight carrier and tie
the cord to weigh carrier. Gently let the
weight hang down while the assistant also
gradually lower the limb;
16. Elevate foot of bed to allow counter balance;
17. Check circulation of the foot and see if the
patient can fully flex the foot;
18. Make sure patient is comfortable and re-
assure him;
19. Remove screen and discard trolley.

Skeletal Traction

Definition: This is a sterile procedure done by an

Orthopaedic Surgeon whereby a Kirshener wire or
Steinman's pin is inserted through the bone for
attachment of weight. Examples of sites are the
tibial tuberosity or the upper end of the tibia for
traction on the femur and calcanum for fracture of
tibia.
Purposes
1. In case of dislocation
2. To alleviate pain and provide comfort
3. To prevent contracture
4. To prevent deformity
5. To provide rest

111
 6. To prevent muscle spasm
Indications
1. In cases of fracture to bring broken bones in
proper alignment;
2. In cases of contracture;
3. In bone diseases like Osteomylitis;
4. In severe burns of the lower limbs;
5. To relieve pain in muscle spasm;
6. In cases of Osteoarthritis
Requirements
Top shelf
1. Stainman's pin and drill (in sterile pack)
2. Local anaesthetic e.g. xylocain 1-2%
3. Sterile gloves
4. Syringe and needles
5. Sterile blade
6. Tincture of Benzin compound in lotion tray
7. Gallipots
8. Forceps
9. Receivers
10. Container with gauze pieces
Bottom shelf
1. Stirrup;
2. Long cord
3. Masks
4. Drugs – stimulant (Adrenaline)

112
 5. Bed elevator
6. Fracture board
7. Weight and weight carrier
8. Pulley
9. Suitable splint
10. Tray for shaving
11. Extension frame
Procedure
This is done by the Orthopaedic Doctor. The Nurse
prepares the trolley and assists the doctor.
1. Explain the procedure to the patient and re-
assure him:
2. Prepare trolley;
3. Screen the bed and give patient urinal if
necessary:
4. Bring trolley to bedside
5. Shave the area where the pin is to be
inserted;
6. Inform the doctor
7. The Nurse should watch the patient carefully
during insertion because when the pin is due
to be removed the Nurse can be asked to
remove it
8. The Nurse apply TBC on both ends of the
Steinman's pin after insertion;
9. Fix the stirrup and tie the cord to the stirrup

113
 10. Fix the extension frame to the foot of
the bed
11. Put the prescribed weight on the weight
bearer
12. Pass the cord through the pulley which is
already on the extension cord and tie it to the
weight bearer;
13. Elevate foot of bed;
14. Make patient comfortable and remove
screen;
15. Remove trolley and screen and discard.
N.B.
1. Observe site of insertion of Steinman's pin for
any discharge. If there is, this is a sign of
infection and a specimen should therefore be
taken to the lab for investigation;
2. Daily dressing of the site if infection present;
3. No pillow is allowed for 6 weeks to allow
counter traction in the area;
4. It is important to check patient's temperature
daily;
5. Ensure that the stirrup is not pressing on the
skin to prevent the development of pressure
sore;
6. Ensure quadriceps exercise.

114
Head Halter Traction

Definition: This is one of the types of skin traction

which is applied to the head when there is any
trauma involving the vertebral column. e.g. cervical
fracture.
Indications
1. Fracture of the cervical vertebrae;
2. Dislocation of the cervical vertebrae
compressing the spinal cord;
3. Soft tissue injury along the spine
Requirements
1. A firm bed or fracture bed
2. An adjustable leather frame of the face
3. Hanger (metal)
4. Long cord andpulleys
5. Appropriate weight
6. Cotton padding
7. Bed elevator
8. Sand bags (2)
Procedure (Non-Sterile)
It can be performed by an Orthopaedic Nurse or
Doctor.
1. Explain the procedure to the patient or his
relatives;
2. Set the items needed;

115
3. Screen bed and bring items needed to
bedside;
4. Comfort the patient and adjust his position;
5. Assist in maintaining the position of the neck
then help put the leather adjustable frame on
the face tilted under the patient's chin and to
the sides of the face, then under the occipital
region behind the head;
6. Assemble the metal Hanger through the sided
metal rings;
7. Tie the long cord to the Hanger then over the
pulley and then tie the required weight;
8. Elevate the TOP of the bed to achieve
counter pulling;
9. Put 2 sandbags in either sides of the head to
prevent movement;
10.Put cotton wool padding under the chin and
where necessary to ease pressure;
11.Comfort the patient, remove screen and
discard items.

116
CHAPTER TEN: URINARY PROCEDURES
AND COLLECTION OF SPECIMENS
Giving and Removing the Bedpan and
Urinal

Definition: This is a method of giving a receptacle

to patient for safe elimination.
Purposes
1. To provide the patient with facilities for
elimination
2. To collect specimen for investigations.
Requirements
1. Bedpan or urinal with cover
2. Tissue paper
3. Water in a jug
Procedure
1. Take covered bedpan or urinal to bedside and
screen the bed.
2. Place the bedpan cover between under
mattress and prepare toilet paper.
3. Assist the patient by directing her to draw her
knees up and press her heels against the bed.
Slip your left hand under the pelvis; raise the
hips place helpless or weak patient. (You
117
 may seek the assistance of a 2ndNurse).
4. To remove the bedpan, raise her hips in the
same manner. be careful not to scrape/injure
patient or spill waste on the patient or bed
5. Turn helpless patients on the side to cleanse
with toilet paper.
6. Cover bedpan or urinal and place on bench.
They should never be placed on floor.
7. If patient has soiled his/her hands, wash
hands and make her/his comfortable.
8. Remove screen. Take bedpan or urinal to
utility room for cleaning.
9. Examine contents of bedpan before emptying
it
10. Clean and disinfect bedpan or urinal
according to procedure
11. Observe and record: time, amount
consistency, nature of stool or urine observes
if there are any pains or discomforts.

Changing of Incontinent Patient

Definition: A process of ensuring removal of dirty

or wet linen and replacing them with clean ones.
Purposes
1. To change the patient's linen and gowns

118
 which are soiled by either urine or stool
2. To prevent development of pressure sore
3. To make the patient's bed dry
4. To make the patient comfortable.
Requirements
Trolley procedure
Top shelf:
1. Soap in a dish
2. Zinc/castor oil cream/Vaseline
3. Towel or flannel
4. Tow or non-absorbent cotton wool
5. Jug of warm water.
Bottom shelf:
1. Patient’s towel and flannels
2. Clean bed linens
3. Bucket for used water
4. Receptacles for soiled linens.
The following should accompany the trolley:
a. Bucket with lid for feacal soiled linens
b. Linen bin for non feacal soiled linens
Procedure
1. Explain procedure to the patient
2. Prepare trolley and take to bedside.
3. Screen bed.
4. Strip the bedclothes and put onto two chairs
leaving patient covered with a sheet.

119
 5. Prepare bowl of warm water
6. Remove soiled dress/attire
7. Roll patient on one side and roll wet sheet
into centre
8. Wash patient's buttocks, back and any area,
which is wet using tow or non-absorbant
cotton wool and dry carefully.
9. Lather hand well with soap and massage
pressure areas.
10. Rinse off soap, dry carefully and apply
cream/Vaseline
11. Change bottom sheet if necessary with draw
sheet
12. Give patient clean gown/attire
13. Make patient comfortable and discard trolley

Collection of Specimens

Definition: A careful method of obtaining a sample

of specimen for investigation.

Sputum

Requirements
- Specimen bottle with wide opening and a lid
Procedure
1. Inform patient the night before

120
 2. On waking up, ask him to expectorate into
the special bottle Cover bottle immediately
and label
3. Send specimen with lab form

Faeces

- Ward Examination:
Requirements
As at serving bedpan with the following additional
requirements
1. Specimen bottle with wide opening
2. Wooden spatula
3. Writing material (biro)
Procedure
 Inform patient and screen bed (or take patient
to toilet with bedpan)
 Allow patient to pass urine then discard (for
males urinal and a bedpan can be served
simultaneously).
 Take sample of stool (from all parts of the
stool), with spatula and place in the middle of
the specimen bottle
 If whole of the stool is needed a special
receiver has to be used to empty the stool,
which is then covered immediately with a

121
 cloth soaked in antiseptic.
 Label the bottle and send to Laboratory at
once.

Urine

Indication
1. Newly admitted patients
2. Patients with renal, Bladder or Urethral
disorders
3. Diabetes mellitus
4. Pregnant mothers
On Admission
N.B: All new admissions need to have their urine
tested for routine examination.
Requirements
1. A clean vessel (beaker)
2. A urinal or bedpan may be needed.
Procedure
- Give beaker to patient and lead him to toilet
with instruction to pass urine in the vessel,
label container properly and take for testing.
Morning Urine Specimen
Same as above but urine must be collected before
breakfast and before patient passed any urine that
day.

122
24 Hour Urine Specimen:
Requirements
1. Clean beaker (urinal)
2. Winchester bottle with cover.
Procedure
1. Urine collected at 8:00 a.m. is discarded.
2. Any other urine passed is then collected in
the Winchester bottle and covered.
3. Last urine at 8:00 a.m. next day is also
included in the bottle
4. Take whole or sample for Laboratory
examination.
Midstream Urine Specimen
Requirements on a Tray
1. Specimen bottle (sterile)
2. Receiver with sterile swab
3. Receiver for used swabs
4. Antiseptic lotion in gallipot
5. Guaze/hand gloves
6. Bowl for collecting urine.

Procedure

1. Explain procedure to patient

2. Screen bed/if patient is unable to go to toilet.
3. Swab the glans of penis thoroughly with

123
 swab and antiseptic. Swab the genitalia for
female and ask patient to pass urine freely
4. Interrupt flow by placing sterile specimen
bottle amidst flow.
5. Allow some amount into the bottle and cork
6. Label bottle and send with form to the
Laboratory
7. Discard equipment, wash and dry hands

Urine Testing

Definition: This is the process of determining the

presence of abnormal substances in the urine, namely
sugar protein and acetone.
Purposes
1. To observe and test urine for sugar, albumin,
acetone and any other abnormality like pus,
blood etc.
2. To assess progress in patient's condition
3. To assess the effect of some drugs
4. Before administration of certain drugs e.g.
injection insulin
Observations
Before carrying out chemical tests, certain
observations should be made.
1. Colour: Normal range of colour is pale straw

124
 to deep amber. It depends on standing and
varies usually with the concentration.
a. Smoky or red indicate blood.
b. Greenish, orange or brown indicate the
presence of bile pigments
c. Various colours as a result of drugs
and other substances which have been
ingested.
2. Deposits: May cause turbidity or sediments
a. Mucus: -If small amount - very slight
hazy
b. Pus: Yellowish dense mass which lies
at the bottom of the urine glass as a
result of inflammation of any part of
the urinary tract.
c. Urates: Appear in concentrated acid
urine as a white or pink deposit
d. Uric Acid: Brownish deposit in
concentrated acid Urine
e. Phosphates:- in alkaline urine, shows
as white gray deposit
3. Odour:
a. Normal characteristic odour –
Aromatic.
b. Acetone: - Produced when fat
metabolism is deranged and abnormal

125
 amount or breakdown products (acids)
accumulate in the blood and are
excreted in urine - (Sweet smell).
c. Pus: - Fishy offensive odour.
4. Volume: - Average adult - 1,200 - 1.500
milliliters in 24 hours. Urination depends
upon the fluid intake output and weather.
5. Reaction:- Tested by the use of litmus paper.
Normal acidic turns blue litmus paper to red.
Red litmus paper turns blue in the presence of
alkaline. Purplish colour neutral to litmus.
Other indicator tests papers show various PH
ranges. Normal reaction is acidic.
6. Specific Gravity (SG):- This is the ratio
between the weight of a given volume of
urine and the weight of an equal volume of
distilled water at room temperature. It varies
with the nature and quantity of food eaten
and the amount or water or other fluid taken.
It is measured by a urinometre which
averages 1.010- 1.025.

The following precautions should be taken when

measuring S.G:

1. The urinometer should be checked

126
 periodically.
2. The urinometer must float freely in the urine
and should not touch the sides or bottom of
the vessel.
3. The reading is taken at eye level.
4. The urine must be allowed to cool to the
room temperature, before reading is made
(800F).

Test for Abnormal Constituents

1. Protein:
a. Albustix reagent strips: - Dip Albustix
in urine and remove immediately,
Compare colour of dipped end with
colour scale.
b. Result:
i. Negative: No colour change.
ii. Positive: moistened and turned
green or blue at once. The
colour scale is a guide to the
amount of protein present.
c. Salicylic sulphoric acid test:- Place
5mls of urine in a test tube, add 2 to 3
drops of 20% salicylic sulphoric acid.
If a cloud appears albumin is present.

127
 The intensity of the cloud varies with
the amount of albumin present.
d. Esbach's Test:- Urine filtered ,
Reaction taken. If alkaline, a little
acetic acid is added. If specific gravity
is over 1010, dilute and adjust reading.
Tube filled with urine to area mark 'U',
Esbach's reagent to area mark ‘R’.
Tube is closed with a cork, inverted
and put into stand and left for 2 hours.
Reading is taken after 24 hours.
e. Hot Test:- Heat over a mentholated
spirit lamp the top of a test tube. full
of urine, turning the tube in the
fingers at the same time. Urates will
disappear on heating. Add a few
drops of Acetic acid after boiling
and phosphates will disappear. Any
cloud left is due to the presence of
coagulated albumen.
2. Sugar:
a. Ames Test - Clinistix: - One end
of a specially treated thick paper
strip about the size of a match box, is
dipped into the urine and withdrawn.
The end of the strip changes colour

128
 within one minute if glucose is
present, if the stick is still colourless at
the end of this time; there is no
significant glucose in the specimen.
Compare strip with the colour char on
the bottle.
b. Clintest Reagent Tablets:- Place 5
drops of urine in the test tube and
add10 drops of water holding dropper
in an upright position. NB: In order to
obtain a standard size of drop, the
Clintest dropper must be used. Drop
one Clintest table into the test tube and
do not shake the mixture while it is
bubbling. Wait 15 seconds after
bubbling stops and shake the mixture
then compare with the colour chart.
c. Result:
i. Negative: If solution turns blue.
ii. Positive: If colour varies from
green, yellow, orange, brick
red, greenish brow
d. Hot Test: Benedict's test. Put 5cc of
Benedict's solution into a test tube and
add 10 drops of urine. Boil for 5
minutes. A positive reaction show

129
 similar colour changes as in test 2
above.
3. Acetone:
a. Acetest Reagent Tablet: Place one
acetest tablet on a clean white surface
then put one drop of urine on the
tablet. Take reading after 30 second
then compare the colour of the tablet
with the colour chart.
b. Result: If acetone is present the colour
of the tablet varies from lavender to
deep purple according to the amount
present.
Points to Remember
1. All equipment for testing the urine should be
assembled. These include:
a) Urine testing set/rack, test tubes, test
tube holder, dropper or pipette.
b) Fresh specimen of urine in a conical
glass, urinometer, spirit lamp and
matches.
c) Litmus paper both red and blue.
d) 5mls syringe, container for clean
water, Benedict’s solution. Acetic
acid, salicylic sulphoric acid and
various reagent tablets and strips.

130
 e) Receiver for waste and colour chart for
reading results.
2. Collect a clean urine specimen in a clean
conical glass and observe urine for any
visible sign of blood or others.
3. Wash and dry hands, check acidity of the
urine by the use of the litmus papers.
4. Check specific gravity by using urinometer
and proceed with specific tests which are
desired.

131
 CHAPTER ELEVEN: RECTAL
Rectal Examination

Definition: This is a procedure of examining the

rectum to detect abnormality.
Requirement (on Tray)
The following in a suitable container:
1. Gloves and powder
2. Lubricant e.g. Vaseline
3. Spatula
4. Cotton wool swabs
5. Proctoscope
6. Torchlight
7. Mackintosh and towel
8. Receiver for used swab
Procedure
1. Explain the procedure to the patient
2. Prepare tray and take to bedside
3. Screen bed
4. Turn down bed clothes and place patient in
left lateral position with buttocks at the edge
of the bed
5. Insert mackintosh and towel under the
patient's buttocks

132
 6. Assist Doctor in carrying out the procedure
7. Once examination is finished remove
mackintosh and towel and wash all
instruments.
8. Remove screen and make patient comfortable

Rectal Insertion of Suppositories

Definition: It is a method of introducing

medicament into the rectum for easy absorption.
The following in suitable containers:
1. Gloves and powder
2. Lubricant and spatula
3. Suppositories
4. Cotton wool swab.
5. Mackintosh and towel
6. Receiver for used swab
7. Prescription card
Procedure
1. Explain procedure to the patient
2. Prepare tray and take to bedside
3. Screen the bed
4. Place patient in left lateral position.
5. Insert mackintosh and towel under the patient
6. Put on gloves and lubricate the tip of the
suppository and gloved index finger

133
 7. Insert suppository high up with the index
finger
8. Instruct the patient to hold for some time so
that it can melt and act.
9. As finger is removed, hold anus with a swab
until the urge to defecate is gone
10. Remove mackintosh and towel
11. Make patient comfortable and remove screen.

Administration of an Enema

Definition: - Is the introduction of a solution into

the rectum and colon and is either retained or
returned.
Types
a. Evacuant enema sometimes called enema to
be returned
b. Retention enema / enema to be retained
Evacuant Enema
This is an enema to be returned. It is given to relieve
constipation and to empty the bowel. Examples of
returned enema are:
1. Evacuant enema in which soap and water,
olive oil. glycerine, hypertonic saline or plain
water can be used.
2. Purgative enema in which castor oil is used.

134
 3. Anthelmintic enema, which is used in the
treatment of internal parasites.
4. Carminative enemata - to relieve flatulence.
Retention Enema
Definition: This is an enema to be retained. The
fluid injected into the rectum has to be retained to
increase body fluid as a form of sedative. Substances
used as retained enema include:
a. Normal saline which is stimulating
b. Avertin as an anaesthetic
c. Paraldehyde as a sedative
Purposes of Giving Enema
1. To relieve constipation and empty the bowel
2. As pre-operative care, and after certain
operations
3. To obtain a specimen of stool
4. Before and after certain radiological
examinations;
5. To introduce anaesthesia;
6. To introduce food
7. Before a vaginal or rectal examination.
Requirement For Giving An Enema
Trolley Procedure
Top Shelf
1. Required quantity of the fluid in a jug at the
temperature of 38 0C

135
 2. A glass or enema can/funnel a piece of tube
of about 24 inches with a connector and a
rectal tube in a bowl of warm water.
3. A lubricant e.g. petroleum jelly
4. A clip for the rubber tubing
Bottom Shelf
1. A receiver for soiled swabs and soiled
catheter
2. A dressing mackintosh and dressing towel
3. A warm covered bedpan.
Procedure
1. Explain procedure to the patient
2. Prepare trolley and take to bedside
3. Screen the bed
4. The apparatus is filled with already prepared
fluid and air removed from the tubing and
then clipped.
5. Place the patient in left lateral position
towards the edge of the bed and expose the
buttocks
6. Lubricate rectal tube or catheter separate
buttocks and gently insert tube into the
rectum about 8 - 10 cm.
7. Open the clip and allow the solution to flow
in slowly keeping close watch on patient until
required amount of solution is injected

136
 usually 600 - 900m1.
8. The rectal tube is removed and disconnected
from the rest of the apparatus and placed in a
receiver and the patient is asked to retain the
fluid for 2 - 3 minutes.
9. Turn patient onto back and give bedpan –
staying with the patient if necessary.
10. After using the bedpan, the patient is cleaned
and dried and all equipment removed and
patient made comfortable.

Nurses Responsibility, Before, During And

After Administration Of An Enema

It is the responsibility of the Nurse to ensure the

followings:
1. To make sure the fluid is at the correct
temperature and correct dose given
2. To differentiate whether it is a retained or an
evacuant enema
3. To ensure privacy and patient's understanding
with regards to the procedure
4. To make sure all air is removed from the
tubing and the catheter does not disconnect
from the tubing during the procedure.
5. The Nurse must never allow the funnel to

137
 become empty of fluid until the completion
of the procedure.
6. On emptying the bedpan, the fluid must be
measured to ensure that the whole amount of
fluid administered has been returned (in case
of evacuant enema),
7. Careful observation and reporting of
procedure and result
8. All requirements should be taken care of by
cleaning
Complications:-
1. Shock
2. Injury to the rectum
3. Burns if fluid used is too hot

Passing of Flatus Tube

Definition:This is the process of passing a flatus

tube in order to relieve abdominal distention.
Purposes
1. To relieve abdominal distention
2. To make patient comfortable
Requirements
A tray is set with the followings:
1. Flatus tube in a bowl of warm water
2. A lubricant, e.g. K. Y. Jelly

138
 3. A gallipot with wool swabs
4. A receiver for soiled swabs and rectal tube
5. A mackintosh and dressing towel
6. A bowl of warm water.
7. Clean gloves
Procedure
1. Explain procedure to the patient
2. Wash hand and don clean gloves
3. Set tray and take to bedside
4. Screen bed and place patient in left lateral
position and place mackintosh and dressing
towel under the buttocks.
5. Lubricate tube and insert into the rectum for
about 4 5 inches while the distila end of the
tube is placed invertedly in the bowl of water.
6. Observe the water in the bowl, if flatus is
expelled, bubbling will be seen in the water.
7. Leave the tube in position for about ten
minutes or longer ifresults are obtained,
8. Remove the tube, mackintosh and towel and
make the patient comfortable.
9. Clean the equipment and make ready for use.
10. Remove gloves and wash hand
11. Record treatment done; chart the time.

139
Rectal and Colonic Washout

Definition: This is a process of washing out

colon/rectum with large quantities of solution to
clear colon of faeces.
Purpose: For cleansing the colon and rectum
1. In chronic colitis, diverticulitis and dysentery
2. Before operation on the lower part of the
large intestine
3. Before sigmoidoscopy and barium enema
Precautions
1. Air must not enter the apparatus at any time
during the procedure as this will not only
impede the flow of the fluid, but will also
cause discomfort to the patient. To prevent
this, the funnel must never run empty during
the inflow of the fluid nor must it be raised
above the level of the rectum until it has been
refilled.
2. The bowel must drain properly before fresh
irrigating fluid is run in.
Observations to be made
A report on the presence of sloughs, mucus, pus and
blood must be made. If the patient is being treated
for colitis, dysentery or diverticulitis.
Requirements

140
 1. Requirements as for enema plus: A large jug
containing 3 litres fluid at a temperature of
400C. This fluid can be normal
saline/bicarbonate of soda.
2. 1 litre jug
3. Bucket
4. Rectal catheter/or tube
5. Connection glass
6. Tubing
7. Large mackintosh for the floor.
Procedure
1. Prepare patient as for rectal examination
2. Prepare equipment as for enema
3. Place bucket on the floor.
4. Insert rectal catheter into rectum 9 - 10cm
5. The whole of the tube will be inserted in
stages when doing a high colonic washout
6. Pour 300mls of fluid into the funnel and
allow it to flow into the patient slowly.
7. Invert funnel over bucket and allow fluid to
flowout.
8. Repeat as necessary until the returned fluid is
clear
9. On completion,assist patient to go to toilet,
commode or bedpan
10. After care of patient as stated for enema

141
 11. Measure fluid in bucket
12. Measure fluid left in jug
13. Report result to Ward in-charge.
NOTE: This procedure is very tiring so the patient
must be reassured. The amount of fluid returned
should be equal to the amount of fluid poured.

142
 CHAPTER TWELVE: STERILE
PROCEDURES
Administration of an Intramuscular
Injection

Definition: A form of parenteral administration of

medication, where a drug is injected into a deep
muscle tissue.
Purposes
1. To speed up action of drugs
2. To prevent digestive juices from altering the
potency of drugs e,g, insulin:
3. To estimate the exact amount of drugs which
is absorbed
4. In cases of patients who cannot take drugs
orally
Requirements (Tray Procedure)
Sterile Tray with cover containing:
a) Receiver with cover containing 2ml or 5ml
syringe
b) 2 gallipots for sterile swabs and antiseptic
solution
c) Receiver for soiled swabs
d) Small bowl containing the bottle or ampoule
143
 of drug and an ampoule file
e) Prescription sheet or patient bed head ticket
or medication card
NB: Trolley could be used if 2 or more patients are
to be injected i.e
i. The top shelf should contain only the sterile
equipment as per the tray above
ii. The bottom shelf should contain
 Receiver for used syringes and swabs
 Container for new syringes
 Bowl of water
 Soap in a dish and towel for washing and
drying hands
Procedure
1. Explain procedure to the patient and screen
bed
2. Ensure privacy of the patient
3. Prepare tray and take to the bedside
4. Wash hands and don gloves
5. Check the prescription from the bed head
ticket and select the correct drug in the
presence of a second Nurse who will cross
check at the same time serve as a witness
6. The rubber cap of the bottle is swabbed with
an antiseptic swab. If an ampoule is to be
used the neck of the ampoule is swabbed

144
7. If the drug is in an ampoule
i. Flick the ampoule file, scratch the
neck of the ampoule, then protecting
the fingers with a wool swab break the
ampoule at the neck;
ii. If the ampoule has a line around or a
dot on its neck, it can be broken off
without using the file.
8. If the drug is in a bottle/vial - Invert the bottle
upright and draw the required amount into the
syringe, and if air has entered the syringe,
hold the bottle with the needle up and inject
out the air while the point of the needle is
covered by the bottle or empty ampoule.
9. The syringe is placed inside a sterile receiver
and is taken to bed side. An antiseptic swab
and a sterile dry swab is placed inside the
receiver.
10. The Nurse who will administer the injection
should be accompanied by another Nurse
who will check the drug
11. The name and dose of drug and the name of
the patient should be checked with the written
prescription to avoid mistake.
12. Call patient by his name so that he responds
and explain to him again what you are about

145
 to do.
13. Choose the area to be used and cleanse with
an antiseptic swab. The commonest sites used
are the upper outer quadrant of buttocks, the
lateral aspect of the anterior surface of the
thigh and the deltoid muscle if small quantity.
14. If the site of the injection is the gluteal
muscles place the patient in a prone or lateral
position, choose and clean the area as in No.
12above.
15. Take fold of skin or stretch with thumb and
forefinger and insert the needle vertically into
the muscles at an angle of 9011 to the skin
surface. Care should be taken if the patient is
emaciated.
16. Withdraw the piston/flunger of the syringe
slightly to ensure that the needle is not in a
blood vessel and then inject the drug gently.
The needle is removed quickly and the area
massaged with a dry swab.
17. Make patient comfortable and record drug(s)
in the drug given sheet.
18. Discard tray/trolley, wash hands and dry.

146
Intravenous Infusion

Definition: This is the act of introducing fluids into

the venous system of the patient.
Purpose
- To supply/replace the body with nourishment
where patient cannot take orally, or has lost
too much fluid.
Requirement
1. Sterile pack containing receptacle with two
forceps, I dressing towel, gallipot for lotion
and a bowl with cotton swabs and gauze;
2. Sterile scissors in a covered receiver, giving
set and 20mls syringe with needle:
Bottom Shelf
1. Bowl for used swabs;
2. Prescribed I.V. infusion;
3. Antiseptic lotion;
4. Tourniquet
5. Strapping, bandage and scissors;
6. Specimen container;
7. Newly padded splint;
8. Drip stand should at the bed side
Procedure
1. Explain procedure to the patient/ ensure that
patient eases himself prior to the procedure;

147
 2. Screen bed and take trolley to bedside;
3. Expose the limb for infusion;
4. Place the tourniquet in position firmly but not
tightly.
5. Assist the doctor;
6. At the end of the procedure, remove the
tourniquet and leave the patient comfortable
with the arm supported on the splint secured
with bandage making sure the limb is not
constricted above infusion site;
7. Record time and the amount of fluid on the
fluid balance chart:
8. Note the rate at which the infusion is to run;
9. Watch for leakage or for infusion
running into tissues or for change in
rate.
10. Make patient comfortable and discard trolley,
Method II:
Discontinuing an infusion
Requirements
- Tray containing bowl of sterile swabs,
scissors and adhesive strapping
Procedure
1. Wash and dry hands;
2. Close clip;
3. Loosen strapping;

148
 4. Place sterile gauze over needle, press firn1ly
and withdraw needle.
5. Strap gauze firmly in position to prevent
leakage of blood.

Blood Transfusion

Definition: Administration of compatible whole

blood or any of its components to correct/treat any
clinical condition. This is Doctor’s procedure,
however, the Nurse assist in preparing the trolley,
during the procedure and in discarding the trolley
after.
Purpose
To Supply blood of the same group into the various
System of a patient as in:-
 Anaemia
 Severe heamorrhage
 Before, during and after major operation;
Requirements:
1. Bottle of Blood;
2. Transfusion set
3. Equipment as for l/V infusion.
Procedure:
1. The bag is turned upside down gently 5
times;

149
 2. Method of setting up the blood transfusion is
the same as setting up an I.V infusion;
3. ¼ hourly T P.R. should be taken for the first
hour of each bottle of blood and then ½
hourly.
4. Maintain fluid balance chart.
Precautions
1. Blood should be collected from the blood
bank half an hour before use on the Ward or
in theatre and should never he warmed prior
to transfusion.
2. Blood not used within half an hour must be
discarded, as the risk of contamination and
multiplication of micro-organisms in this
ideal medium is too great to allow the blood
to be returned to cold storage for use at a later
date.
3. Collection of blood from the blood bank is a
responsible task. The patient name, hospital
number, ABO and rhesus group and serial
number of the blood unit should be carefully
checked against the patient's records
accordingly. The blood unit is then carefully
carried upright to the ward to avoid damage
to the red blood and checked again at the
patient's bedside with a second senior Nurse

150
 or any trained Nurse or a trained medical
professional.
4. Vitamins, drugs and electrolytes should never
be introduced or added into the blood for
transfusion.
5. A patient receiving blood transfusion requires
careful observation particularly in the first
hour of the transfusion. Signs of
incompatibility, allergy, infection, or
overloading of the circulation should be
reported immediately.

6. It is advisable to maintain a quarter (1/4) to

half hourly recording of the pulse and
respiration rates, to record the temperature
hourly and to maintain an accurate fluid
balance chart for the patient.
7. On completion of the transfusion the
unwashed blood bag is retained for laboratory
test (if need be) should reaction occur.

Wound Dressing

Definition: Is a procedure carried out to clean a

wound and apply a new dressing. OR is a process of
cleansing a wound or incision and applying sterile
protective covering using aseptic technique.
151
Purposes
1. To protect the wound from further injury
2. To prevent the contamination of the wound
by pathogenic micro-organisms.
3. To provide pressure on the wound so as to
control bleeding
4. To keep the wound clean and 'dry by
absorbing discharges
5. To keep the edge of the wound in proper
alignment
6. To provide for local application of drugs
Principles of Wound Dressing
1. It is a trolley procedure which must be
carried out under strict sterility
2. A trolley is to be prepared for each patient
3. Two Nurses are required to carry out the
procedure
4. Nurses must put on mask before starting
5. Close the nearby windows, put off fan and
control/traffic
6. Clean wound should be attended to first
before dirty wounds
7. Minimize communication

152
Method I:

Requirement (Trolley procedure Boiling Method)

Top Shelf
1. A medium size tray with cover containing the
following which must be sterile
a. 2 Gallipots for lotions
b. 3 Pairs of dissecting and dressing
forceps each in a receiver
c. A probe or sinus forceps (if required)
2. A bowl containing sterile gauze lint cotton
wool swabs and dressing towels the bowl
must have a cover.
3. A stitch removing scissors or clip remover
ina container (if required)
Bottom Shelf
1. Bottles of lotion for cleaning the skin and for
application to the wound e.g. savlonEusol,
G.V. etc.
2. Tray containing bandages, adhesive plaster
scissors and dressing mackintosh
3. Receiver for soiled dressings
4. Receiver for used instruments
5. Receiver for dressing towels
6. Two mask containers, one for clean mask and
the other for used masks.

153
Procedure for Wound Dressing
1. Explain procedure to the patient and screen
bed
2. Wash hands, put on mask, wipe trolley with
an antiseptic solution and set all equipment
accordingly.
3. Take trolley to bedside and ask the Assistant
(2ndNurse) to pour lotions, position and make
patient comfortable for the procedure.
4. Ask the assistant to place the dressing
mackintosh in position and remove the outer
dressing, using hands. He should then wash
his hands thoroughly and dry.
5. Using hands, pick a dissecting and dressing
forceps and gently remove inner dressing
(moisten if necessary).
6. Discard dressing and the forceps in
appropriate receivers on the bottom shelf.
7. Using your hands, pick pair of dressing and
dissecting forceps and use them to spread
dressing towel around the wound.
8. Clean the wound using the same forceps (in 7
above) using as many swabs as possible. The
cleaning should be done from inside
outwards.' using the swab once and discard
method.

154
 9. Discard both forceps and pick another pair.
10. Use gauze to dry wound and cover the wound
with suitable dressing.
11. Discard forceps and apply the bandage or
apply strapping with hands.
12. Make patient comfortable and tidy the bed.
13. Discard trolley, wash re-sterilize instruments.
14. Wash and dry hands.

Method II (Using Dressing Pack)

Requirements (Trolley Procedure)

Top Shelf
Sterile pack containing:
1. Small boi1 containing cotton wool and gauze
swabs.
2. 2 gallipots for lotions
3. A kidney dish with 3 pairs of dressing and
dissecting forceps.
4. One sterile drape I dressing mackintosh.
5. One sterile hand towel.
Bottom shelf
The same requirements as per method above
N.B: Sterile scissors may be included if needed to
cut the sterile dressing and it should therefore be at
the top shelf in a receiver with antiseptic lotion

155
receiver.
Procedure
1. Explain procedure to the patient.
2. Wash and dry hands and put on mask.
3. Disinfect the trolley and place dressing pack
in the centre of the trolley) appropriately.
4. Close nearby windows, turn off fans and
screen the bed.
5. The Dresser and his assistant should wash
and dry their hands.
6. Take trolley to the bedside and place patient
in a comfortable position and ask the assistant
to wash her hands.
7. The Dresser washes her hands while her
assistant removes the tape from the sterile
pack and discard.
8. The Assistant now opens the outer flap and
exposes the sterile towel.
9. The Dresser then opens the inner flaps of the
pack and arranges the receiver and gallipots.
10.The Assistant then pour cleansing and
dressing lotions into appropriate gallipots.

11.The Assistant removes the outer dressing and

place in the receiver for soiled dressing and
then wash and dry hands.

156
 12.The Dresser should place the sterile drape in.
position
13.Same as for method procedure from 5 - 14.

Removal of Sutures

Definition: Is a process of removing skin

sutures/staples usually 1 – 2 weeks after surgery.
Purpose
- To remove the skin sutures after the wound
has healed.
Requirements
1. Sterile tray containing:
 Receiver
 Sharp scissors/staple remover as
indicated
 Dissecting forceps
 Gauze swabs
2. Mackintosh and towel
3. Bottle or mentholated spirit
4. Dressing equipment if dressing is to be
reapplied.
Procedure
1. Same as for wound dressing (method 1) up
item number 9.
2. When wound is cleansed place one gauze

157
 swab near wound ready to receive sutures.
3. Take toothed dissecting forceps and stitch
scissors and take hold of knolls of stitch with
dissecting forceps and cut stitch close to the
skin. Pull out stitch being careful NOT to pull
any of the stitches.
4. Place stitch on gauze swab.
5. Continue 3 above until all stitches are
removed.
6. If wound is good spray as per ordered and do
not cover if necessary cover with any
dressing and plaster.
7. Make patient comfortable.
8. Remove screen and discard
N.B. Follow instructions. it may be that only
alternate stitches are to be removed. And also
always be for removing stitches check wound is
satisfactory and suitable for stitches to be removed.

Venous Cut Down

Purpose: Is an emergency procedure in which the

vein is exposed surgically and then a cannula is
inserted into the vein under direct lispon.
Requirements
Same as for intravenous infusion with the addition

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of the followings:-
1. Kidney with cover containing 2% or 1 %
plain cut gut, needle, cannula or polythene
turbing as selected.
2. Instrument drums containing:
 Curved cutting needle
 Nylon thread or silk
 Needle holder
 2 pairs of scissorsone of which should be
fine and sharp pointed
 2 pairs of fine dissecting forceps , 1
toothed, 1 non toothed
 2 pairs of mosquito forceps
 A neurysmneedle
 Blunthook retractor
 2 towels - One for drying hands and one
to place under patient’s limbs.

NB: A local anaesthetic is needed

Chest Aspiration/ParacentesisThoracis

Definition: This is a procedure where the chest wall

is punctured for the purpose of withdrawing fluid
from the pleural cavity. The procedure is usually
performed by Doctors.
Purpose
159
 1. Relieve discomfort
2. For diagnostic purpose
Requirements: (Trolley procedure)

Top Shelf

1. Sterile syringes (2cc and 5cc) and needles

with cannula
2. Aspiration syringe (20 - 50cc)
3. Three (3) ways tap with rubber tubing
attached
4. Graduated jug
5. One pair of dissecting forcep
6. Gallipot containing antiseptIc solution
7. Gallipot containing cotton wool swabs
8. Vital signs observation tray.
Bottom Shelf:
1. Mackintosh
2. Specimen bottle
3. Local anaesthetic agent
4. Injection adrenaline (stimulant)
5. Skin cleansing agent (savlon or hibitane)
6. Strapping and scissors
7. Gloves.
NB: Cough depressant is given Y2 an hour before
procedure and shaving is done if patient is hairy (in

160
which case a shaving tray may be needed).
Procedure
1. Explain procedure to the patient
2. Take trolley to bed side and screen the bed.
3. Observe vital signs (TPR)
4. Put the patient in a comfortable position,
preferably leaning over table with a pillow
5. Assist doctor in every way possible during
the procedure
6. Observe the pulse and respiration during the
procedure.
7. Instruct patient not to cough or talk during
the procedure or should take permission
before doing that
8. After the procedure seal the area and make
patient comfortable
9. Send specimen to lab if any
10. Clear away instruments
11. Observe patient for the next two (2) hours
after the procedure
NB: After procedure observe the patient for pain,
cough or symptoms of shock. Then watch sputum
for presence of blood, which suggest injury to the
lungs tissue
Complications:
1. Shock

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 2. Infection
3. Bleeding from the lungs
4. Injury to the lungs.

ParacentesisAbdominis

Definition: Is a procedure of removing of fluid from

peritoneal cavity through a small puncture made
through the abdominal wall sterile conditions.
Purpose:
1. To relieve pressure due to ascitis
2. To obtain peritoneal fluid for diagnostic
study
3. To drain exudates in peritonitis
4. To prepare for procedures like peritoneal
dialysis
Requirement on a Tray
1. Gallipot, swabs, paper towel, forceps, trocar
and cannula or dialysis catheter and
introducer, scissors, scalpel handle and blade.
2. Syringe and Needle
3. Needle holder, needle and silk
Supplementary Items
1. Gloves, drainage tubing and bag
2. Specimen bottles, laboratory forms, antiseptic
Adhesive plaster

162
 3. Local anaesthesia
4. Many tailed binder Masks
Procedure
1. Ask patient to empty bladder
2. Assist patient into fowler's (sitting) position
with many tailed binder in positionbehind
patient
3. Nurse - puts on mask, washes hands, open
pack and gloves
4. Doctor puts on mask, washes hands puts on
gloves and opens inner pack
5. Nurse - pours solution
6. Doctor cleans skin and arranges towel
7. Nurse offers anaesthetic, doctor draws up and
injects same and then inserts the cannula into
position and connect drainage tube and bag.
8. Dressing Position:
a. Nurse - applies many tailed binder.
This should be tightened at intervals as
f1uid drains out.
9. Measure volume of fluid
10. Doctor may specify volume of fluids to be
drained in a given time.
11. Observe patient for signs of shock.
12. Maintain intake and output chart
After the procedure, make patient comfortable and

163
record procedure appropriately and report to the In-
charge Nurse.

Lumbar Puncture

Definition: Is the insertion of a cannula into the

subarachnoid space of the 2nd or 3rdlumba vertebra to
obtain spinal fluid or relieve pressure or for
therapeutic purpose.
Contra Indication
1. Suspected subdural infection
2. Severe psychiatric/nerotic problem
3. Chronic backache
4. Intra-cranial bleeding
Purposes
1. To obtain specimen for examination or
diagnosis;
2. To relieve intracranial pressure;
3. To introduce drugs
4. To introduce radio-opaque substance for the
purpose of radiological exams.
Requirements (Sterile Procedure)
A sterile tray with -cover containing the following:-
1. Cannula (Sterile)
2. Bowl of sterile cotton wool and gauze swabs;
3. Sterile 2cc and 10cc syringes;

164
 4. Sterile dressing towels;
5. Sterile dressing forceps;
6. Gallipot with savlon;
7. Manometre;
8. Sterile Specimen bottle;
9. A pair of sterile gloves;
10. Receiver forused swabs;
11. Anaesthetic agent and any other drug to be
administered;
12. Plaster and Scissors:
13. Lab form

Tray 1 (Sterile) Tray 2(Clean)

1. LP needle with 1. Mackintosh &
stillete towel
2. Sponge holding 2. Spirit, iodine
forcep tincture benzoin
3. Small bowl 3. Lignocaine 2%
4. Specimen bottle 4. Sterile normal
5. Cotton buds, saline
gauze etc 5. Plaster and scissors
6. Dressing articles 6. Sterile gloves,
gown and mask
7. Syringe and needle
for local

165
 anaesthesia

Note: The procedure must be done with two trays,

because the procedure is sterile but some of the
requirements are not sterile e.g plaster, manometer
Procedure
1. Explain procedure to patient and screen bed
and ask patient to avoid
2. Bring tray to bedside and prepare patient
3. Instruct patient not to move during the
procedure
4. Check BP and respiration of the patient
5. Place the patient in the left lateral position
with his back at the edge of the bed and knees
almost touching his chest or alternatively, the
patient should sit flexed with his lower jaw
touching both knees.
6. Expose back and maintain position and
support the patient
7. Open tray and assist doctor whenever
possible
8. Fluid is collected (into the sterile bottle) or
measured.
9. Specimen taken and labeled
10. Needle removed and area sealed

166
 11. Make patient comfortable. Lay him in the
dorsal position without pillow to avoid post
puncture headache
12. Remove tray, wash articles and send to
appropriate place for sterilization
13. Wash and dry hands.
14. Send specimen to lab with appropriate
form
15. Observe patient for the next 2 hours.
Complications
1. Shock
2. Infection
3. Post-puncture headache
4. CSF leakage
5. Hematoma

Care of Colostomy

Definition: Is a procedure to ensure maintenance of

hygiene by regular emptying of colostomy bag and
cleaning colostomy site.
Purposes
1. To teach the patient how to give
himself/herself colostomy care.
2. To remove faecal matter through the
colostomy opening

167
 3. To prevent excoriation of the patient's skin
4. To promote comfort of the patient
Equipment on a Tray
Top Shelf:
1. Basin with warm water
2. Clean flannel and towel
3. Receiver to place at patient's side
4. Mackintosh
5. Gauze in a bowl
6. Lint in a bowl
Note: Maintenance of a pleasant professional
attitude and complete abstinence from showing
signs of distaste to the patient are essential.
Procedure
1. Explain procedure to patient and gather the
equipment.
2. Screen the patient to provide privacy
3. Wash hand and don glove
4. Place protective material (mackintosh) under
patient's side
5. Arrange equipment. Place curved basin at
patient's side
6. Remove soiled dressings (or bag) with hands,
cleansing as much as the faecal drainage from
the skin as possible. Do not wipe roughly as
this may cause bleeding, place dressing in a

168
 bucket.
7. Place flannel in water and wring out slightly
8. Hold flannel above stoma of the colostomy
and squeeze out excess water. Allow drainage
to flow into curved basin.
9. Wash area around colostomy gently with
soap and water.
10. If ointment or Vaseline is to be used, apply
gently.
11. Use gauze to form a cuplike dressing over
stoma and cover with larger pieces of lint.
Use wider bandage to tie round to prevent
changing the strapping every time. (Apply
bag if such is being used).
12. Make patient comfortable
13. Remove equipment and wash carefully.
Return them to proper place
14. Record treatment.

Catheterization

Definition: Is a process introducing a catheter into

the urinary bladder through urethra using aseptic
technique for the purpose of emptying the bladder.
Indications
1. To collect urine specimen

169
 2. To relieve Urine retention
3. Surgery
4. Unconscious patient/incontinency
Requirements (it is a trolley procedure)
Top Shelf
1. Pack containing sterile receivers
2. Pack containing dressing forceps
3. Receiver with sterile gauzeswab, cotton wool
swab and towels
Bottom Shelf
1. Protective sheet and towel
2. Container with pre-sterilized catheters
3. Torchlight
4. Specimen bottle
5. Laboratory request form
6. Antiseptic solution
7. Receiver with sterile water
8. Measuring jug
9. Receiver for used instruments
10. Receiver with spigot syringe and galipot
Procedure
For female Patient
1. Explain procedure to the patient
2. Provide privacy
3. Prepare requirements and take to the bed side
4. Wash hand and put on mask

170
5. Remove cloth and leave patient covered with
only one top sheet
6. Put patient in dorsal position, and roll up bed
sheet to the level of umbilicus
7. Put protective sheet and towel under buttocks
8. Place light in position if necessary
9. Wash and dry hand
10. Pour lotion in a galipot
11. Place sterile towel over abdomen and second
one over patient’s right thigh
12. Put instruments, specimen bottle, spigot and
catheter in a receiver and put on bed in
between the patient’s legs
13. With fingers of the felt hand on, separate the
labia and swab the vulva with swab using the
right hand.
14. When labia are separated, they should never
be allowed to touch again, and vulva should
be swabbed from front to back.
15. Discard forceps
16. With second pair of forceps or sterile gauze,
pick up the eyelet of catheter and insert into
urethral orifice, push catheter for 5 – 7.5cm,
until urine is obtained.
17. When urine is obtained, remove catheter
gradually

171
 18. If ordered otherwise, insert spigot
19. Swab and dry vulva
20. If balloon catheter is used, use syringe and
sterile water to fill the balloon
21. Remove receiver, protective sheet and towel
22. Make patient comfortable
23. Remove screen and discard trolley
24. Take specimen, measure and record amount
of urine.
25. Fill laboratory form and arrange for specimen
to be taken to laboratory
For Male Patient
1. Same with female patient up to point 12
2. In positioning, male patient can be put in
semi-recumbent position
3. With finger of left hand on swab, hold penis
4. Swab the glans of penis with sterile swab
using forceps in the right hand
5. Use gauze to hold the penis, and pick up
catheter with forceps or gauze and insert into
the urethral orifice.
6. Insert for about 12cm until when urine is
obtained
7. From here, same as in female patient up to
last point.

172
173
 CHAPTER THIRTEEN: SPECIAL
CARE/PROCEDURE
Administration of Oxygen

Definition: This is the act of giving oxygen to a

patient in order to increase the content of inspired
air.
Indication
1. Cardiac patients;
2. Patients with diseases of the lungs,
pneumonia, emphysema etc.
3. Patients in severe shock;
4. Patients with severe haemorrhage;
5. Pulmonary embolism;
6. Carbon monoxide poisoning;
7. Maternal and foetal distress;
8. Pre mature babies;
9. During surgical operation (patient on general
anaesthesia)
Required
Methods of Oxygen Administration:-
1. By use of nasal catheter;
2. By the use of Tudor Edward's spectacle
frames, (Nasal tubes attached);
174
 3. Face mask (B.L.B. face mask);
4. By the use of oxygen tent.
Requirements
Trolley containing the followings:-
(The below mentioned requirements are for all
methods except the tent method)
Top Shelf
1. Swabs in a gallipot;
2. Boracic lotion or sodium bicarbonate;
3. Water in a gallipot to serve as lubricant;
4. Artery and dissecting forcep in a receiver;
5. Strapping and scissors;
6. Oxygen key, rubber tubing and Nasal catheter
or B.L.B. race mask depending the method to
be used.

Bottom Shelf
1. Receiver for soiled swabs.
2. No smoking cards

At the bed side:

Oxygen cylinder with humidifier, flow meter and
pressure gauge attached.
1. Explain procedure to the patient;
2. Screen bed;
3. Assemble parts;

175
 4. The catheter or tube is lubricated and passed
along the floor of the nose;
5. Use strapping to keep tubing in position;
6. Release Oxygen and regulate flow per minute
as prescribed.
N.B Requirements and procedure depends entirely
on the method used and the method itself is chosen
from the type of patient and condition.
Precaution to be taken during oxygen
administration
1. Always ensure having a spare full
cylinder;
2. Make sure the cylinder in use contain
oxygen;
3. Watch for sign of distress;
4. Use no grease in the cylinder;
5. Avoid naked flame from smoking etc.
6. Place a notice at the door indicating oxygen
administration is in progress;
7. Keep fire extinguisher or bucket of sand for
eventuality.
8. Avoid synthetic fabrics.

Moist/Steam Inhalation

Definition: Is the process of deep breathing of warm

176
and moist air (vapour) into the lungs fro local effects
on the air passages or for a systemic effect.
Purposes
1. To liquefy mucus
2. To facilitate easy breathing
3. To provide antiseptic action on the
respiratory tract e.g by using tincture benzene
4. To provide moisture and heat to prevent
dryness of respiratory tract after surgery like
tracheotomy.
Requirement
1. Nelson's inhaler with cover
2. Mouth piece and gauze or jug and towel
3. Jug of boiled water
4. Jug of coldwater
5. Measuring jug
6. Towel
7. Tea spoon
8. Bottle of TBC
Procedure
1. Prepare all requirements and inform patient
2. Reassure the patient and place in upright
position with bed table in front.
3. Mix hot and cold water. Usually 4 measures
of hot water and 1 measure of cold water in a
jug.

177
 4. Add 1 tea spoon of TBC and mix
5. Put cover on inhaler and place it in a bowl
making sure the air inlet is opposite the
mouthpiece which is covered with gauze.
6. Instruct patient to place mouth on the mouth
piece and breath in and then out, outside the
inhaler.
7. Stay close by to supervise the patient.
8. After 10-15 minutes, remove the inhaler and
empty, then clean with menthelyted spirit.
9. Make patient comfortable and discard tray.

Physical and Neurological Examinations

Definition:
Is an organized systemic process of collecting
objective data based upon health history and head to
toe or general systems examination.
Purposes
1. To obtain baseline physical and mental data
on the patient
2. To supplement, confirm or question data
obtained in the history taking
3. To evaluate the appropriateness of the
nursing interventions in resolving the patients
identified pathophysiological problems,.

178
 4. To investigate the efficiency of the Nervous
system, sensory, motor and reflex, such as
sight, hearing, taste, smell, and sensitivity to
touch, pain, heat and cold and also degree of
mental alertness.
NB: Where a more detailed examination is required
it is done in the appropriate department e.g.
Ophthalmic, ENT department etc.
Requirements
Tray or trolley procedure, depending on the type of
examination: however, the following items are
required:
1. Sphygmomanometer and stethoscope
2. Diagnostic set
3. Patella Hammer
4. Tuning fork or sound box
5. Skin pencils
6. Pins
7. Cotton wool swabs in a bowl
8. Test tubes containing hot and cold water
9. Tape measure
10. Sugar and salt solutions
11. Bowl of water and receiver
12. Various different shapes, i.e. coins, pen key
etc
13. Coloured wool, chalk, book or colour chart

179
 14. Snellen's chart
15. Container with spatula, torchlight or padded
orange sticks
16. Receiver for used articles
Procedure
1. Prepare Tray/Trolley
2. Explain procedure to patient
3. Procedure is to be carried out in the ward,
screen bed and bring trolley
4. A divided bed will be helpful
5. Conduct physical examination from head to
toe.
6. Make patient comfortable at the end of the
procedure
7. Remove screen and discard trolley

Apical Heart Beat

Definition:This is listening of heart beat directly

from the apex of the heart
Requirement:
1. Stethoscope
2. Chart
3. Watch with seconds’ hand.
Procedure
1. Explain the procedure to the patient.

180
 2. Ensure privacy by screening
3. Place the patient in a comfortable position
4. Expose the chest and instruct the patient to
breath normally
5. Place the bell of the stethoscope over the
apex (Locate in the 5th intercostal space and
approximately 8-9cm or 3.5 inches from the
middle of the sternum and 2-3 inches below
the left nipple) and count the rate for a full
minute.
NB:The second Nurse may count the pulse
simultaneously and both rates are recorded.
6. Chart and indicate that the rate is apical heart
rate, and if the pulse is checked
simultaneously, then distinguish between the
radial pulse rate and the apical heart rate on
the chart.
7. Make patient comfortable.
8. Put away equipment and report any
abnormality

Fluid Intake and Output Recording

In health the amount of fluid in the body and its

composition remains remarkably constant, in spite
of variations in intake, but in almost every case of

181
serious illness or extensive surgical operation the
balance can be gravely disturbed and may need
restoring urgently. For this reason one of the Nurse’s
most valuable contribution to the treatment of
patient is an accurate 24 hour record of all fluid
going into the patient and all fluid output,
including the volume, the route and the type of
fluid.
High risk patients or patients already having
difficulty with meeting their fluid needs are placed
on intake and output recordings and daily weighing
to monitor their progress.
These measurements should be done with as much
accuracy as possible. Weight taking is done at the
same time each day using the same scale with the
patient dressed in the same type of clothing.
The key things that are recorded as intake include:-
1. Any fluid taken orally
2. Any tube feeding
3. Any water used to clear the tube before or
after tube feeding
4. Any fluid introduced into the tube but not
completely withdrawn
5. Any fluid the patient consumed as part of oral
hygiene.
6. Intravenous (I/V) fluids.

182
The output to be recorded include:-
1. Urine
2. Vomitus
3. Aspirations
4. Diarrhea
5. Excessive discharge from wounds. Others to
be recorded as approximation include
perspirations incontinence.
For complete understanding of fluids and electrolyte
balance, student is advised to refer to notes on the
subject in Med/Surg. Nursing on fluid and electrible
regulation.

Last Offices

Definition: The process of caring for dead body of a

patient usually within 30 to 45 minutes.
Purposes
1. To care for the human body after death in a
respectful way, and to prepare it for a proper
burial
a. Show respect for the dead
b. Keep beddings tidy and clean
c. Reduce spread of infection
d. Console relations of the deceased
2. To show sympathy to the bereaved relatives.

183
 3. To maintain normal body alignment before
rigor mortis sepsin.
Requirements
Top Shelf
1. Bowl of hot water
2. Flannel and towel
3. Soap in a dish
4. Hair brush and comb in a receiver
5. Tray containing the following:
 Cotton wool swabs
 Scissors and bandages or strapping
 Dressing forceps.
6. Paper to label patient's full name, ward,
hospital number, sex, address, time of
death, date and patient's religion.

Bottom Shelf

1. Sheet and burial cloth (mortuary sheet

or shroud)
2. Receiver for soiled swabs
3. Receptacle or bucket for soiled linens with
a disinfectant solution e.g Dettol 1:20
Procedure
1. Inform relatives of the deceased and screen

184
 bed
2. Prepare trolley and take to bed side
3. Remove all bed covers and pillows except
one thin blanket or sheet, do not expose the
body
4. Close the eyes and mouth, wet gauze swab is
placed over the eyes if necessary;
5. Straighten out the limbs as well as the body
6. If dressings are present, change if necessary
7. Wash and dry the body well
8. Plug body orifices e.g Nose, mouth, ear, anus
and vagina with cotton wool
9. To prevent any discharge
10. Brush hair and arrange neatly
11. Tie the two toes and two thumbs to each
other
12. Put burial cloth or wrap sheet over patient's
body and label with identification
information.
13. Carry the body to the mortuary or release to
the relatives.
14. Release all personal effects to the relatives.
15. All beddings to be sent to the laundry
immediately
16. Wash bed, locker and mattress thoroughly
with antiseptic solution.

185
NB:
1. Patient's culture and religion should be
considered and the consent of the relatives
should be sort.
2. The personal effects to be released should be
done by at least two Nurses.

186
 CHAPTER FOURTEEN: OPHTHALMIC
Examination of the Eye

Definition: Is the process of examining the eye to

detect any abnormality, sub normality or foreign
body.
Indication
1. Patient with eye problem
2. Patient with foreign body in the eye
3. Client how visited eye clinic
Purposes
1. To rule out any abnormality in the eye
2. To remove the foreign body
Requirements
Trolley with the following:
1. A bowl containing cotton wool swabs and
eye pads.
2. Pen touch light
3. Ophthalmoscope
4. A gallipot with normal saline
5. Flouresceine drops
6. Normal saline drops
7. Mydriatic drugs e.g. Homatropine - to dilate
pupils

187
 8. Miotics e.g. pilocapine
9. Topical local anaesthesia e.g. Novesine
10. Cornealloupe
11. Sterile lid speculum and lid retractor in a
receiver
12. Snellens's, Jeager's and Colour Test charts
with pin hole
13. Receiver for used swabs
14. Plaster and or bandage.
Procedure
1. Explain procedure to the patient
2. Place patient in a comfortable position either
sitting or lying and if it is a child, blanket is
used to restrain him.
3. The history of the patient's condition is taken.
4. The visual acuity is then assessed.
5. Examination of the structure of the eye is
done and the findings recorded.
6. The eye is examined from outside to inside in
the following order:
a. Facial Characteristics
b. Lids
c. Conjuctiva
d. Lacrimal apparatus
e. Cornea
f. Anterior chamber

188
 g. Pupil
h. Iris
i. Lens
j. Symmetery
k. Fundoscopy
7. All findings are recorded appropriately
8. Make patient comfortable and take necessary
steps toward treating the patient.

Swabbing of the Eye

Definition: The process of dressing eye or apply the

medication by using swab.
Indication
1. Patient with pus in the eye
2. Patient with foreign body in the eye
3. Patient with medication of the eye
Purposes
1. To clean the eye from pus/discharge; dirt; or
foreign body
2. To make the patient comfortable
3. In preparation for of drugs instillation.
Requirements
A tray containing the following:-
1. A gallipot with normal saline
2. A gallipot with cotton swabs

189
 3. A receiver for used swabs.
Procedure
1. Explain procedure to the patient
2. Prepare tray and take to bedside
3. Place patient in a comfortable position, wash
and dry hands.
4. Stand behind the seated patient, take a swab
in the right hand for the right eye and left
hand for the left eye.
5. Soak the tip of the swab in normal saline,
clean the eye from inner cantus tothe outer
cantus using a swab only once and discard
method until the eye is properly cleaned.
6. Dry the eye with a dry swab, make the patient
comfortable and discard your tray or proceed
on other procedures e.g. instillation of drops
or application of ointment etc.

Irrigation of the Eye

Definition:Is the process of washing the eye with

warm fluid in order to clear the eye and conjuctival
sac.
Indications
1. Any foreign body;
2. Purulent discharge from the eye;

190
 3. Irritants/chemicals in the eye;
4. In case ofPre-op preparation for ocular
surgery.
Purposes
1. To prevent infection
2. To prevent further injury/damage to the eye
3. To make patient comfortable.
Requirements
A tray containing the following:-
1. Undine in a stand;
2. Fishers dish/receiver;
3. Bowl of swabs and eye pads (if needed)
4. Receiver for soiled swabs;
5. Lotion thermometer;
6. Mackintosh cape and towel;
7. Jug containing lotion at 37.8 0C
Procedure
1. Explain procedure to the patient.
2. Set tray and take to bedside.
3. Patient could be lying down on the couch or
seated with the head tilted back or to the side
of the eye to be irrigated.
4. Protect the patient with the mackintosh cape
and dressing towel.
5. Stand behind the seated patient and swab the
eye.

191
6. Instruct the patient to support the fishers dish
against the cheek on the affected side.
7. Fill the undine ¼with the lotion at the correct
temperature of 37 .8°C.
8. Hold down the lower lid of the affected eye
and take the undine with solution in the other
hand and inform the patient that you are
going to start.
9. Allow a little of the lotion to flow over the
patient's cheek before directing it on the
lower conjuctival (fomix) sac and toward the
medical canthus. The flow should be kept
constant by controlling the inlet of the undine
with the thumb.
10. Instruct the patient to look up, down and
sideways.
11. The solution must not be instilled from a
great height and not directly on the cornea.
12. The upper lid is everted and irrigated. The
eye lid and cheek are swabbed.
13. Remove the fishers dish mackintosh cape and
the dressing towel make patient comfortable
and clear away the equipment.
14. Chart procedure and result.

192
Instillation of Eye Drops

Definition:Is the process of putting topically

prepared drugs in the form of eyedrops into the eye.
Indication
- Patient on eye medication
Purposes
1. To dilate the pupil (mydriatics);
2. To constrict the pupil (miotics)
3. Induce local anaesthesia
4. Constrict the superficial blood vessels
5. Detect corneal damage ( diagnostic dye)
6. To lubricate the eye (artificial tears)
7. To instill medicinal preparation e.g.
antibiotics, steroids etc.
Requirements
A tray containing the following
1. A gallipots with normal saline
2. A gallipots with sterile cotton wool swabs
3. A receiver for used swabs
4. Medication as ordered
Procedure
1. Explain the procedure to the patient
2. Prepare tray and take to bedside
3. Stand behind a seated patient or by the side of
the bed if patient is lying down

193
 4. Take a swab moisten it with normal saline
and swab the eye
5. Take another swab (dry) and hold down the
lower lid with the kit hand, ask patient to
look up, instill one to two drops into lower
fornix and ask the patient toclose the eye
gently and should not squeeze the eye.
6. Wipe away the excess and make patient
comfortable.
7. Clear away the apparatus.
Precautions
1. Avoid putting drops directly on the cornea.
2. Do not touch the eyelid with the nozzle of the
dropper to avoid contaminatiol1
3. Do not warm the drugs because it will change
its potency.
4. Do not put more than two drops into the
fornix to avoid wastage and Irritation
5. Never instill the drops ifin doubt of the exact
eye to avoid mistake.
6. Never instill the drops without label and
check the prescriptiol1s.
7. Ascertain expiration date

194
Application of Eye Ointment

Definition: It the process of applying topical drugs

in the form of eye ointment to the eye.
Indication
- Same as for instillation of eye drops
Purpose
- Same as for instillation of eye drops. It stays
longer in the eye than the eye drops.
Requirements
A tray containing the following
1. A gallipot with normal saline
2. A gallipot with sterile cotton wool swabs
3. A receiver for used swabs.
4. A prescribed tube of ointment
5. A glass rod for children

Procedure

1. Explain the procedure to the patient

2. Set tray and take to bedside.
3. Place patient in a comfortable position.
4. Stand behind a seated patient or by the
bedside jf patient is lying down
5. Take a swab moisten it with normal saline and
swab the eye

195
 6. Take a dry swab and hold the lower lid with
the left hand and the tube of ointment in the
right hand for the right eye and vice versa.
7. Ask patient to look up, squeeze the tube of
ointment into lower fornix horizontally from
the inner cantus.
8. Release the lid and ask the patient to blink the
eyes gently in order to spread the ointment
round the eyeball.
9. Clean the excess ointment; make the patient
comfortable and clear away apparatus.
10. Chart the procedure appropriately.
Precautions
- Same as for instillation of eye drops.

Application of Heat to the Eye (Warm

Compress)

Definition: This is the process of applying heat to

the eye (either dry or moist).
Purposes
1. To increase blood supply to the eye.
2. To relieve pain and congestion in the eye.
3. To hasten the absorption of drugs
Types
1. Moist heat which include

196
 a. Hot spoon bathing
b. Hot fomentation
2. Dry heat which includes
a. Maddox electric heater
b. Short wave diathermy
Indications
1. Stye
2. Hyphaema
3. Chalezion
4. Iritis
5. Blepharitis
6. Hypopyon
7. Iridocyclitis
8. Uveitis
9. Orbital cellulitis

Hot Spoon Bathing

Requirement (Tray)
1. A bowl containing almost boiling water
2. Padded wooden spoon
3. Small bowl containing wool swabs
4. Receiver for used swabs
5. Cape mackintosh and towel
Procedure
This procedure is to be carried out by the patient

197
himself under the super visionofaNurse.
1. Explain the procedure to the patient
2. Prepare tray and take to bedside.
3. Place mackintosh and towel in position.
4. Instruct the patient to dip the padded spoon
into almost boiling water.
5. Excess water should be removed by pressing
the spoon against the side of the bowl.
6. The patient is instructed to hold the padded
spoon near his closed eye and allow the
steam to circulate over the eye.
7. The procedure lasts for 10-15 minutes and
can be repeated 3 times.
8. Swab eye by wiping from inner canthus
outward using each swab only once.
9. Dry the eye by using cotton swab.
10. Make the patient comfortable.
11. Clean equipment properly and return to its
place.
12. Chart procedure in the Nurses notes.
Precautions
1. Eye drops or ointment: should be
instilled/applied before the procedure
2. Observe patient and ensure that he does not
touch the eyelid with the spoon.
3. Ensure that the patient's eye is properly

198
 closed.

Epilation

Definition: Is the removal of an offending eyelash

that is rubbing on the eyeball.

Indications
1. To prevent corneal ulceration.
2. To make patient comfortable.
3. To minimize the risk of infection in the eye.
Purpose
- To remove offending eye lash
Requirements
A tray containing the following:
1. A gallipot with normal saline
2. A small bowl with cotton wool swabs
3. Receiver for used swabs
4. Epilation forcep in a receiver.
5. Cornealloupe.
Procedure
1. Ensure good source of light
2. Explain procedure to the patient.
3. Set tray and take to bedside.
4. Wash and dry hands, place patient in either
sitting up position or lying down on a couch
5. Ensure good source of light. put on the
199
 corneal loupe and take a swab and swab the
affected eye (see swabbing)
6. Invert the upper eyelid with a swab held over
the fingers, take the epilation forcep111 the
other hand and get hold of the base of the
offending eyelash and pull it out sharply.
7. Allow the lid to lay on its normal position
to see the offending lashes, then repeat
above until all the offending lashes are
removed.
8. Make your patient comfortable and clear
away equipment.

200
 CHAPTER FIFTEEN: ENT PROCEDURES
Examination of the Ear, Nose and Throat
Patient
All patients with ear, nose and throat diseases should
be politely welcomed. 'Warmth may be provided
depending on the weather and the patient's
condition.

Ideally, the examiner and all attendants should be

masked. The examination is best performed when
the examiner and the patient are seated comfortably.
It is distressing to see a patient seated while the
physician or the Nurse stand, screwing their spinal
columns into contortions and perilously grasping an
otoscope.

This is likely to be unproductive and hazardous.

Therefore, sit comfortably at the patient’s level.

Positioning of Patient and General Set Up

Before History Taking

1. Explain the procedure to the patient

201
2. Assemble ENT examination equipments by
the right side of the Surgeon and the left side
of the patient.
3. Position Bull’s lamp behind the patient and at
the level of patient’s left shoulder to allow
good reflective illumination from bull’s lamp
to head mirror which will reflect it to the site
of examination.
4. Both examiner and patient sit on a
revolving/rotating chair or stool.
5. Position theExaminer’s seat to face the main
entrance to the consulting room.
6. A translator of language in language barrier.
7. Sit patient in erect position.
8. It is unethical to sit knee to knee when
examining an opposite sex.
9. Wash hand and dry with towel
10. Put on mask
11. Put on gloves
12. If a child is to be examined, spend few
minutes in gaining his or her confidence to
avoid struggles.
13. If the Nurse is required to hold the child; the
following are important:
 Hold the child's legs between the
thighs

202
  Hold the hands across the chest with
one hand
 Maintain the head in position with the
other hand

Syringing the Ear/Ear Irrigation

Definition: This is the process of washing out or

bathing the ear canal

Objectives

1. To keep the ear canal clean and clear of

infection
2. To rid the ear canal of anything that may
impede passage of sound.
3. To remove foreign body

Indications

1.Impacted wax in the ear

2.Non-vegetative foreign body in the ear
3.Fungal debris in the canal
4.Presence of corrosive chemicals in the ear
canal
Contra-indications

1. Perforated Drum: Patient having quiescent

or inactive otitis media with unhealed
203
 peroration should never have his or her ear
syringed for risk of reactivation.
2. Scarred Drum: A patient with previous
otitis media with Otorrhoea that has been
followed by the healing of the membrane
with a thin scar should not have the ear
syringed since this may be ruptured.

Purposes

1. Removal of imp acted wax

2. To apply heat to the ear
3. Cleanse the external auditory canal
4. Removal of non-vegetative foreign bodies
like beans, corn etc.
5. To clear the canal of fungal infection before
application of drugs.

Requirement

Top Trolley

1. Sterile metal aural syringe with a removable

nozzle in a sterile kidney dish or a sterile
Higginson's Syringe with a straight
Eustachian catheter.
2. Sterile kidney dish containing Jobson's aural
probe, Tilley's aural dressing forcep.

204
 3. Gallipot containing sterile dry cotton wool
swab.
4. A gallipot containing sterile gauze squares.
5. Otoscope

Bottom Shelf

1. Lotion in a jug, normal saline solution or salt

and sodium bicarbonate solution (5mls of
each dissolved in litre of water at temperature
of 37 0C ).
2. Kidney dish containing lotion thermometer
3. Receiver for used lotion-this may be a kidney
dish, bowl or may be specially shaped.
4. Paper bag for soiled swabs
5. Receiver for soiled instruments
6. Mackintosh cape
7. Dressing towel
8. Head light, or head mirror.

Procedure

1. Explain the procedure to the patient to obtain

consent
2. Sit patient with the earto be treated towards
the Nurse
3. Fix mackintosh cape and towel over the
patient's shoulder
205
 4. Put on head lamp or head mirror to reflect
from bull' s eye or similar light to the
patient's ear
5. Instruct patient to hold the receiver close
against the check under the ear to catch the
irrigating solution
6. Wash and dry hands
7. Fill syringe with lotion and expel air

Instillation of Ear Drops

Definition:This is the process of applying liquid

drugs into the car.

Indications

1. Impacted wax in the ear.

2. Inflammations conditions of the ear.
3. Foreign body inear e.g. Live insect.
4. Ear infections e.g. Otomycosis etc.

Purposes

1. To produce local effect (anaesthesia)

2. To destroy micro-organisms (antibiotics). To
destroy an insect lodged in the ear canal.
3. To soften earwax (wax solvent).
4. To inhibit inflammatory reaction (steroid)

206
Requirement

A tray with the followings:

1. Ear drops to be instilled

2. Gallipot containing sterile
3. Cotton wool swabs
4. A receiver for used swabs

Procedure

1. Explain the procedure to the patient to obtain

consent
2. Wash hand very well
3. Instruct patient to either lie on his side with
the ear to be treated upper most, or sit upright
on a chair with the car to be treated facing the
Nurse.
4. Use one hand to hold the pinna and gently
pull upwards and slightly backward for
adults, so as to straighten the ear canal.
5. Instill the drops into the canal and place a
piece of cotton woolinto the entrance of the
ear canal.
6. Instruct the patient to remain in the same
position for abou1 five minutes so that the
drops can be absorbed.

207
 7. Make patient comfortable and discard the
tray.

Aural Toileting /Dressing

Definition: A process of cleansing the ear to remove

purulent discharges. This procedure forms a corner
stone in the treatment of patients with discharging
ears. Chronic suppurative otitis media happens to be
among the most ENT Conditions in Nigeria.

Indication

- Discharging ear i.e Otitis Externa, Otitis

Media

Instruments

A trolley is set for ear dressing and toileting with: -

1. Ear dressing forceps

2. Gallipot
3. Kidney receiver
4. Jobson Horne Probe / orange stick.
5. Suction machine
6. A pair of scissors
7. Gauze strip
8. Cotton wool
9. Ear drops / ointment
208
Technique

1. Patient sits as in otoscopy

2. The discharging ear is cleared repeatedly
with cotton tipped orange sticks or Jobson
Horne Probes (dry mopping). Alternatively,
ifthe discharge is copious, it can be sucked
with a fine catheter using a suction machine.
3. Stripped gauze is impregnated with car
drops/ointment to form a wick. The wick is
inserted into the external auditory meatus by
the use or the aural dressing forceps. Any
excess wick is cut off with scissors. The wick
is covered with dry cotton.

Advantages of Ear Dressing:

1. Allows a long contact time of antibiotic

(drops/ointment) with micro-organisms.
2. The ear wick absorbs pus and helps in
cleaning and clearing off purulent material.
3. Belter patient's compliance since it is done
once daily or on alternate days.
4. More economical compared to instillation of
Ear drop.
5. For antiseptic effect
6. To remove wax

209
Instillation of Nasal Drops

Definition: This is the process by which a liquid is

introduced into nasal cavity drop-by-drop.

Indication

- Cases such as Rhinitis and Rhino sinusitis

Purposes

1. To provide vasoconstriction (Decongestant)

2. To treat allergies
3. To treat sin of infection
4. To give local anaethesia
5. To treat nasal decongestion

Requirements

1. Prepared medication with clean dropper

2. Pen light
3. Clean gloves
4. Facial tissues
5. Small pillow
6. Kidney tray
7. Folder of patient

Procedure

210
 1. Explain the procedure to the patient
2. Review physical order
3. Sit patient with head forward.
4. Determine whether patient has allergy to
nasal installation.
5. Use a glass dropper from the medicine
container to with draw the solution.
6. Instruct patient to breathe through the mouth
and clear his nose by blowing gently unless
contra indicated to increase in the cranial
pressure.
7. Instill nasal dropinto nostril after supporting
patient head with non-dominant hand and
holding dropper at 1cm.
8. Compress the other nostril with a finger
9. Tilt the chin up, h1l1 not too far, otherwise
the drops will run down the floor ofthe nose
into the Pharynx and swallowed.
10. Replace back the dropper immediately to
avoid contamination
11. To supplement the use or drops, pledgets of
wool dipped in the lotion may be inserted
under the middle conchae and left for short
time.
N.B.: Drops can also be instilled with the patient's
head lying down beyond the edge of the bed, or

211
pillow. For steroid drops the most effective method
or administering drops is when the patient is in
"Mecca" position

In this position the steroids reaches the ethmoid

cells.

Spraying the Nose

Definition:A process of nose spray preparation to

surgical intervention.
Purposes

1. For prophylaxis
2. For anaesthesia (before surgical procedure to
the nasal cavity)
3. To treat nasal congestion
4. To treat allergies
5. For treatment of sutus infection

Requirements

1. Prepare medication with clean dropper

2. Pen light
3. Clean gloves
4. Facial tissues
5. Medication card

Procedure
212
 1. Explain the. procedure to the patient
2. Ensure sterile ofthe glass part of the spray
3. Fill the spray with the lotion and expel air
4. Instruct patient to breathe through the mouth
5. Position the patient's head forward over a
receiver
6. Insert nozzle into the nostril
7. Gently, compress the rubber bulb and inject
the fluid with very slight force and allow It to
flow down the nostril
8. Make patient comfortable and record
findings.

Note:Oily fluids and antiseptic solutions are rarely

used for nasal drops and sprays oil may be inspired
into the lung and cause Pneumonia. Antiseptics
solutions and strong salt solutions have beenfound to
interfere with ciliary action.

Packing the Nose

Definition: A process of introducing a ribbon gauze

at the outer surface of nostril.
Indication

1. Epistaxis
2. Nasal cavity examination and or operation

213
Purposes

1. To arrest obstinate haemorrhage

2. Toanaethetize the nasal cavity during or
before examination and or operation.

Requirements

On the trolley:

1. Ribbon gauze, 13mm wide and 1m long, one

for each nostril in a sterile receiver
2. Gauze plugging in a receiver
3. Nasal forceps in a receiver
4. Dissecting forceps in a receiver
5. Dressing wool carrier
6. Sterile wool swabs in a receiver
7. Receiver
8. Scissors
9. Head lamp
10. 1:1000 adrenaline solution
11. 10% iocanic lotion

Procedure

1. Explain the procedure to the patient

2. Sit the patient to face a good light source
3. Put on face mask

214
 4. Wash and dry hands
5. Give receiver to the patient to spit into it
whatever fluid finds its way into the throat
6. Pick up the end of the plugging soaked in
anaesthetic solution with the nasal forceps or
Gauze impregnated with Bismuth and
Iodoform Paraffin Paste (BIPP) in the case of
haemorrhage.
7. Support the other end ofthe plugging with
dissecting forceps. Place one end ofthe
plugging into the nostril straight along the
1100r of the nose to the back ofthe nasal
cavity
8. Pack the nostril firmly and gently, passing the
plugging under the inferior turbinate and then
under the middle turbinate.
9. Pack the other nostril in the same way.
10. Be careful not to push the pack into the
nasopharynx to prevent swallowing.

Note:

 Each nostril should be packed with one piece

only.
 If more are used, there is danger that one
piece may be left behind when the packing is

215
 removed. This would set up irritation,
infection and possibly ulceration.

Removal of Nasal Packs

Definition: It is a method of removing nasal pack

following control of nose bleeding.
Nasal packs can be of different types.

1. Ribbon gauze impregnated with petroleum

jelly or BIPP Glove finger packs
2. Petroleumjelly gauze ("trousers")

Requirements

A suction machine with sterile suction catheter

Four (4) Tray containing:

1. Tilley's nasal dressing forceps in a receiver

2. A kidney dish or similar bowl
3. Some gauze squares to make a bolster

Other items include:

1. Adhesive tape to secure the bolster

2. Chiron lamp
3. A plastic apron to protect patient’s clothes

Procedure

216
For most operations, it is usually possible to remove
the packs before breakfast the following morning.
The patient will also enjoy breakfast more if the
packs are out.

1. Explain the procedure to the patient.

2. Put the patient in a sitting or erect position.
3. Encourage patient to take regular deep
breaths through his mouth while the packs are
being removed.
4. Attend to one side of the nose at a time.
5. Put on plastic apron on the patient.
6. Instruct patient to spit out whatever is going
down the back of the nose into the kidney
dish.
7. With the Tilley's nasal dressing forceps bring
out the pack gently.
8. Arrest bleeding by applying pressure or small
ice pack on the nose.
9. Instruct patient not to blow the nose because
this can start the bleeding again.
10. Apply a piece of gauze swab folded (bolster)
under the nose.
11. Apply adhesive tape up to the cheeks to
anchor the dressing.
12. Estimate the amount of blood loss.

217
 13. Make patient comfortable.
14. Document findings

Suction Displacement Therapy

Conditions of chronic maxillary sinusitis present

difficulties of treatment, due to the anatomical
structure of the maxilla. It is possible, however, to
admit fluid to the sinus, by applying suction to the
nose when the patient's read is in such a position that
the opening of the sinus is below the level of the
fluid. The result is that air is drawn from the cavity,
and the fluid replaces it.

Procedure

1. Explain the procedure to the patient

2. Make patient comfortable
3. Life patient on the back a pillow under his
shoulders, neck straight and on the back of
his head
4. Squeeze the rubber bulb as the patient says
"kick"
5. This raises the soft palate and shuts off his
nasal cavities
6. Instruct patient to breathe through the mouth
and to continue saying "kick kickkick".

218
 7. Keep the end ofthe syringe inside the nose
8. Release the bulb as the patient stops to
breathe
9. With a Dakin or proetz syringe draw 5ml of
warm 1/2 percent
10. Ephedrine or tuaminesulphate in Normal
Saline
11. Instruct patient to sit up and rest
12. Document findings

Steam Inhalations

Definition:Is the process of taking in hot water

vapour through the mouth and bringing it out
through the nose orvice versa.

Indications

1. Rhinitis
2. Sinusitis etc

Purposes

1. To increase local blood supply to upper

respiratory tissues and reduce inflammation
2. To loosen and assist in expulsion of secretion
thereby lessening the pain brought about by
repeated sinusitis.

219
 3. To acts as bronchodilator and mucolytic
agents
4. To improve clearance of pulmonary
secretions

Requirements

A trolley procedure with the following:

1. Nelson inhaler / Jug with spout

2. A bowl of gauze swabs or box of paper
handkerchief
3. Jug of hot water 71°c (160°F)
4. Lotion thermometer
5. Large bowl
6. Small towel
7. A flannel sheet and disposable bag for used
gauze swabs as required
8. A teaspoon in a receiver to measure
prescribed drug
9. Prescribed drug e.g. Tincture of Benzoin
Compound, Menthol Crystals or Eucalyptus
Oil

Method of Preparation

This is a clean procedure

220
 1. Wrap a small towel around the inhaler and
place it in the large bowl.
2. It tincture of benzoic compound (friar’s
balsam) is used, put a teaspoon of the drop on
a piece of gauze.
3. Put gauze into the Nelson inhaler and pour
one pint of hot water (600mls) at 71 0C. If it
is menthol crystals, pour hot water 71 0C into
the Nelson inhaler and pour in one pint
(600mls) of hot water and add two to three
crystals.
4. If Eucalyptus oil, pour 15-30mls into the
inhaler before pouring the hot water.

Procedure

1. Explain the procedure to the patient

2. Bring prepared inhaler to bed side
3. Instruct patient to blow the nose
4. Screen bed for privacy
5. Assist patient into upright position and
support with pillows
6. Cover shoulders with flannel sheet if
necessary
7. Give the inhaler to the patient making sure
that the air inlet in away from the patient
body.

221
 8. Instruct patient to put his lips around the
protected mout piece, take a deep breath
through his mouth and breath out through the
nose.
9. Make patient inhale the steam, for ten
minutes after which the equipment is cleared
away and the patient is made comfortable.

Examination of the Throat

Thelarynx cannot normally be seen by direct vision.

By passing illuminated scope, the soft tissues of the
throat can be displaced so that the interior of the
larynx and its surrounding parts can be seen. The
procedure is called "direct laryngoscopy" usually
done in the theater "indirect laryngoscopy" is
another throat examination by meansofmirrorcalled
laryngeal mirror, done in the outpatient department.

Indirect Laryngoscopy

Indications

1. Routine E.N.T examination

2. Taking specimen for laboratory
investigations

Requirements

222
 1. Chiron Lamp
2. Local anaesthetic spray
3. Head mirror on the table
4. Spirit lamb and a box of matches on the table

A tray containing the following

1. Receiver for used gauze squares

2. Tongue depressor
3. Protective goggles
4. Receiver for sterile gauze squares
5. Gallipot for hot water
6. Laryngeal mirrors of various sizes
7. Gloves
8. Receiver for patient to hold
9. Facemask

Procedure

1. Explain the procedure to the patient

2. Record findings
3. Sit the patient so that he does not back away
from the surgeon
4. Warm the mirror in hot water or flame of
spirit lamp
5. Do not place the tongue depressor too far

223
 6. If examining with a torch only, place a
tongue depressor over the centreofthe tongue,
pushing it gently down,
7. Obtain a good source of light
8. Hold the tongue forward with a gauze
9. Test the heat in the mirror on the back. of
your hand before placing it in the patient's
mouth.
10. Instruct the patient to say "ee - ee" to
approximate the vocal cords.

Spraying the Throat

Definition: A process of spraying the throat to

relieve patient from discomfort and as pre-
medication.

Indications

1. Before posterior Rhinoscopy and endoscopy

(Bronchoscopy)
2. Before dissection of tonsils

Purposes

1. To provide local anaesthesia

2. Act as bronchodilator and mucolytic agent

224
 3. To relieve congestion and inflammation of
mucous membrane

Requirements

1. Chiron lamp
2. Head mirror on the table

A tray containing:

1. Tongue depressor
2. Spray containing local anaesthetis agent
3. Head mirror on the table
4. Receiver for used gauze
5. Warm saline mouth wash in a receiver
6. Receiver containing sterile gauze
7. Receiver for patient to hold

Procedure

1. Explain the procedure to the patient

2. The throat can be anasthetized by giving a
tablet of benzocaine or Amethocain to suck
20 minutes before the examination.
3. Hold the tongue gently down while the
pharynx and epiglottis are sprayed
4. Give mouth wash with warm saline after the
procedure.

225
 5. Spray the tongue gently with the anaesthetic
agent

Taking Post Nasal Swab

Definition: A process of obtaining some nasal

secretions or sterile swab for laboratory findings.
Indication

- This procedure is carried out on patient

suspected of carrying meningococcal
meningitis.

Requirements

1. A sterile swab mounted on a bent wire.

2. A good source of light.
3. A local anaesthesia (xylocain spray).
4. A receiver containing tongue depressor.
5. Areceiver for used items.

Procedure

1. Explain the procedure to the patient

2. Put the patient in a suitable position (sitting
upright).
3. Instruct the patient to open the mouth and
spray a local anaesthetic

226
4. Depress the tongue with a tongue depressor
and insert the bent wire mounted with swab.
5. Direct the swab to the exact area without
touching the sensitive uvula and saliva.
6. Withdraw the swab wire gently and put it in
the container.
7. Label the container and sent to the laboratory
immediately.
8. Instruct patient not to eat some hours until the
effect of local anaesthetic has gone.
9. Make patient comfortable.

227
 APPENDIX
Commonly Used Terms and Abbreviations

It is important to use correct spellings and

acceptable abbreviations in charting or recording.
The use of abbreviations depends on the regulations
of the hospital or agency.

The lists below are some of the abbreviations in

common use. The students are advised to refer to the
Nurses' dictionary.

Abd - Abdomen

Am - Morning

Amb - Ambulatory, walking

Amt - Amount

Approx - Approximately (about)

Au - Auxillary (armpit)

BM - Bowel movement

B.P. - Blood pressure

228
0
C - Celcius (centigrade)

C - With

Ca - Cancer

Cc - Cubic centimeters

CD - Communicable diseases

CCF - Congestive cardiac failure

c/o - Complain of

C.V.A. - Cerebro Vascular Accident

Dist - Distilled

ECG - Electro Cardiogram

Exam - Examination

C. S. R. - Central Sterilisation Room

NPO - Nil per oris

F - Fahrenheit

Nss - Normal saline solution

OR - Operation Room

229
Abbreviations of Medical Terms as Used in
Prescriptions

Term Latin English

Aa ana of each

a.c. antecibum before meals

ad. Lib ad libitum to the desired amount

Bal. balneum Bath

b.d or. B.i.d bis in die twice a day

c.m. Crass mane Tomorrow morning

c.n. Crasnocte Tomorrow night

Ext Extractum Extract

Gutt Gutter Drop or drops

h.n. Hacnocte Tonight

Hor. Decub Hora decubitus At bed time

M. Miscc Mix

Mist Misturs Mixture

230
Mit Mitten Send

o.m. Omni mane Every morning

o,n. Omni nocte Every night

p.c. Post cibum After food

p.r.n. Pro re nats Whenever necessary

q.d. or q.i.d. Quarter in die four times a day

R Recipe Take

Rep Repetatur Let it be repeated

S.o.s. Si opns sitIf necessary hut once only

SS or Fs Semi Half

Sig Sqnetur Let it be labeled

Stat Statim At once

S/v Syrup Syrup

t.d.s./tid Ta die sumendum Three times a day

Nng,0C Nngmentum Ointment

Po Per os By mouth

231