OUR VISION

A community where people of all ages are connected,

valued, and cared for.

OUR MISSION
To inspire hope and contribute to health and well-being by
providing the best care to every trainee through integrated
clinical practice, education, and research.

VALUE
In everything we do, we will conduct ourselves with
integrity, care, and compassion.

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Table of Contents Page

Cover Page
Vision and Mission …………………………………………….…………….1
Table of Contents ……………………………………………….…………....2
Chapter 1- Introduction to Health Care ………………………….…………..3
Chapter 2- Qualities and Duties of a Caregiver ……………….…….……….4
Chapter 3- Handwashing …………………….……………….………………9
Chapter 4- Personal Protective Equipment (PPE) ……………..…………….10
Chapter 5- Self Introduction ……………….………………….……………..14
Chapter 6- Common Illness for Elderly ……………………………………...16
A. Dementia
B. Stroke
C. Alzheimer
D. Parkinson
Chapter 7- Activities of Daily Living (ADL) …………………….….……....18
Chapter 8- Patient Positioning ………………………….….…………………19
Chapter 9- Vital Signs
A. Blood Pressure ………………………………………………21
B. Body Temperature …………………………………………..24
C. Respiratory Rate …………………………………………….26
D. Oxygen Saturation …………………………………………..27
E. Pulse Rate …………………………………………………...28
F. Blood Sugar …………………………………………………30
Chapter 10- Proper Care
A. Oral Care ……………………………………………………32
B. Elderly Bed Bathing ………………………………………...34
C. Dressing / Undressing ………………………………………36
D. Proper Wearing of Diaper …………………………………..37
E. Bed Making …………………………………………………38
Chapter 11- Wound Dressing Management
A. Definition …………………………………………………...39
B. Types of Wounds …………………………………………...41
Chapter 12- Transferring ……………………………………………………..44
Chapter 13- Nasogastric tubes (NGT) Feeding …...………………………....47
Chapter 14- Percutaneous Endoscopic Gastrostomy (PEG) ………………...50
Chapter 15- Colostomy Care …………………………………………………52
Chapter 16- Tracheostomy Care ………………………………….………….55
Chapter 17- Catheterization Care …………………………………………….58
Chapter 18- Charting ………………………………………………………....61
Chapter 19- Common Medical Terminologies ……………………………….62

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 Chapter 1

Introduction to Health
Care
Health care or healthcare is the improvement of health via the prevention, diagnosis,
treatment or cure of disease, illness, injury, and other physical and mental impairments
in people. Health care is delivered by health professionals and allied health fields.
Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology,
psychology, occupational therapy, physical therapy, athletic training, and other health
professions all constitute health care. It includes work done in providing primary care,
secondary care, and tertiary care, as well as in public health.

Primary care:
Refers to the work of health professionals who act as a first point of consultation for
all patients within the health care system. Such a professional would usually be a
primary care physician, such as a general practitioner or family physician. Another
professional would be a licensed independent practitioner such as a physiotherapist, or
a non-physician primary care provider such as a physician assistant or nurse
practitioner. Depending on the locality and health system organization, the patient may
see another health care professional first, such as a pharmacist or nurse. Depending on
the nature of the health condition, patients may be referred for secondary or tertiary
care.

Primary care is often used as the term for the health care services that play a role in the
local community. It can be provided in different settings, such as Urgent care centers
that provide same-day appointments or services on a walk-in basis.

Secondary care:
Includes acute care, necessary treatment for a short period of time for a brief but
serious illness, injury, or other health condition. This care is often found in the hospital
emergency department. Secondary care also includes skilled attendance during
childbirth, intensive care, and medical imaging services.

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Tertiary care:
Is specialized consultative health care, usually for inpatients and on referral from a
primary or secondary health professional, in a facility that has personnel and facilities
for advanced medical investigation and treatment, such as a tertiary referral hospital.
Examples of tertiary care services are cancer management, neurosurgery, cardiac
surgery, plastic surgery, treatment for severe burns, advanced neonatology services,
palliative, and other complex medical and surgical interventions.

Quaternary care:
Is sometimes used as an extension of tertiary care in reference to advanced levels of
medicine which are highly specialized and not widely accessed. Experimental
medicine and some types of uncommon diagnostic or surgical procedures are
considered quaternary care. These services are usually only offered in a limited
number of regional or national health care centers.

Home and Community Care, Public Health:

Many types of health care interventions are delivered outside of health facilities. They
include many interventions of public health interest, such as food safety surveillance,
distribution of condoms and needle-exchange programs for the prevention of
transmissible diseases.

They also include the services of professionals in residential and community settings
in support of self-care, home care, long-term care, assisted living, treatment
for substance use disorders among other types of health and social care services.
Community rehabilitation services can assist with mobility and independence after the
loss of limbs or loss of function. This can include prostheses, orthotics, or wheelchairs.

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 Chapter 2

Qualities and Duties of a

Caregiver
Qualities of a Good Caregiver

A caregiver or carer is a paid or unpaid member of a person's social network who

helps them with activities of daily living. Caregivers most commonly assist with
impairments related to old age, disability, a disease, or a mental disorder.

PERSONALITY TRAITS OF A GOOD CAREGIVER

Patience:
People who need care often take longer to complete simple tasks. They may ask the
same questions over and over. Good caregivers need patience to deal with anything
from a loved one’s memory lapses to angry outbursts. They practice staying calm and
avoiding frustration.

Compassion:
Empathy and understanding are necessary. Even when caring for an abusive person,
caregivers try to remain empathetic and understanding.

Humor:
Finding something to laugh about can make a tough situation bearable. A sense of
humor keeps a caregiver emotionally strong and is a great stress buster.

Being Present:
Good caregivers know the importance of respecting their loved one’s current abilities.
Rather than focusing on what their loved one can no longer do, a good caregiver tries
being in the moment with them — looking at photos, listening to music, cooking a
favorite meal, remembering that they weren’t always sick.

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Detail Oriented:
Good caregivers are good managers. They create schedules, plan for emergencies, and
organize information so they don’t have to scramble.

Able to Accept Help:

Asking for help is not a sign of weakness. A good caregiver realizes they can’t do it all
alone. They line up friends, family, or professionals to step in when they need a break.

Willing to Set Boundaries:

A caregiver should respect their own limits and say no to demands when necessary.

Cooperative:
A good caregiver is part of a care team that may include doctors, family, and friends.
Being understanding and flexible goes a long way toward being a successful team
player.

Assertive:
Good caregivers advocate for their loved ones. They ask questions and expect
answers. Good caregivers learn about their loved one’s condition, and they make sure
their loved one gets the care they need.

Cheery Demeanor:
A good caregiver having or showing a good mood or disposition. Demeanor involves
your manner, your non-verbal emotional tone.

Multitasking:
A good caregiver is doing more than one thing at the same time to save time.

Being Able to Think:

A good caregiver is inclined to make sensible decisions very quickly, especially in
dangerous or difficult situations.

Punctual:
A good caregiver knows how to manage his time efficiently.

Willingness to Learn:
A good caregiver is being open to or seeking out, new experience, skills and
information that improves our abilities and enjoyment.

A Good Listener:
A good caregiver focuses on the person who’s speaking, not interrupting or respond
but rather just hear them out.

Doing EXTRA MILE:

A good caregiver is willing to try to do or achieve something.

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Responsible:
A good caregiver is willingness to take full responsibility for their effort, actions and
results. A willingness to take ownership of every step along the way.

DUTIES OF A CAREGIVER

Personal care:
• Sponge bath/bed bath
• Toe nail care
• Skin care
• Monitor for bed/pressure sores
• Dressing assistance
• Medication reminders
Nutrition:
• Prepare meals and snacks
• Encourage fluid intake
• Purchasing vitamins
• Purchasing nutritional supplements - Ensure/Glucerna shakes, Pedialyte, etc
• Meal planning
Companionship:
• Emotional support
• Providing transportation - scenic drives
• Coordinating outings in the community - musicals, shows, zoo, arboretum, etc.
• Accompanying to appointments
• Reading aloud
• Playing games
• Watching videos
Household:
• Laundry
• Dishes
• Gathering and taking out trash
• Decluttering wheelchair pathways
• Picking up mail
• Vacuuming, dusting bedroom, and living area
• Making bed
• Changing sheets
• Organizing medical supplies
• Temperature control - keeping it manageable for heat sensitivity.
• Organizing pantry and fridge - ensuring accessibility
Shopping:
• Prepare grocery list
• Meal planning
• Run errands
• Buy food and supplies
• Purchasing incontinence supplies

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Toileting:
• Assistance with bedpan/in-bed toileting when needed
• Emptying catheter bag when needed
• Assist with commode transfer from wheelchair
Medical:
• Assistance with blood pressure checks
• Monitoring vitals
• Setting up weekly pill organizer
• Filling prescriptions
• Picking up prescriptions
• Coordinating care between doctors and other medical professionals (PT, OT,
etc.)
• Working directly with medical providers
• Communicating with doctors outside of appointments - preparing and asking
questions
• Scheduling medical appointments
• Transportation to medical appointments
• Following medical professional’s care plans
• Calling insurance company
• Advocating for services - in-patient rehab, physical therapy, etc.
Mobility:
• Transfer assistance from wheelchair
• Transfer encouragement (emotional support)
• Assist with home exercises - physical therapy, range of motion
• Supplement exercise

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International Caregiver Training Center 9|Page
PPE – PERSONAL PROTECTIVE EQUIPMENT

Personal protective equipment (PPE):

Refers to protective clothing, helmets, gloves, face shields, goggles, facemasks and/or
respirators or other equipment designed to protect the wearer from injury or the spread
of infection or illness.

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USING PERSONAL PROTECTIVE EQUIPMENT (PPE) CORRECTLY

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INSTRUCTIONS ON HOW TO DISPOSE OF PERSONAL PROTECTIVE
EQUIPMENT (PPE) CORRECTLY

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PROPER WEARING OF STERILE GLOVES

PROPER TAKING OFF THE GLOVES

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 Chapter 5

Self-Introduction
Maintain Eye Contact:
Maintaining eye contact, communicates care and compassion. It can also show
empathy and interest in your patient’s situation. Eye contact and social touch connect
you to your patients and communicates understanding.

Show Empathy:
Empathy is the ability to understand the patient’s situation, perspective, and feelings.
It allows you to deliver more personalized patient care. The empathetic carer
communicates and acts on their understanding of the patient.

Open Communication:
Communication is a key factor in improving patient outcomes. Understanding your
patient’s communication preferences and state of mind will help build rapport.
Informing your patients of new orders or changes in their condition is one way to do
this. Encouraging your patient to share their feelings with you is another.

Make it Personal:
Being a patient can be scary. To help ease their stay, take the time to get to know your
patients. Ask about their friends and family, hobbies, and other important aspects of
their life. This communicates your desire to understand them as a person, not only as a
patient. This is an easy way to learn how to build rapport with your patients.

Active Listening:
Active listening is an essential holistic healthcare tool. It is a non-intrusive way of
sharing a patient’s thoughts and feelings. To practice active listening, follow these
steps:
A. Introducing Yourself
B. Building Rapport
C. Listen to what the patient is saying.
D. Repeat what you heard to the patient.
E. Check with the patient to ensure your reflection is correct.

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Practice Mirroring:
Matching the patient’s demeanor, disposition, and rhythm quickly establishes rapport.
This may even mean raising your voice to match a loud patient to create a
synchronized bond. Then, with a low voice and measured movements, lead the patient
to a better place. Use mirroring to become attuned to the patient during difficult
conversations.

Keep Your Word:

Keeping your word is one of the most effective ways to build rapport with patients. If
you tell them, you will do something, do it. If your ability to complete a task changes,
communicate this with the patient. Don’t over-promise and under-deliver. Keeping
your word with patients not only builds rapport, it also builds trust.

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 Chapter 6

Common Illness for

Elderly
COMMOM ILLNESS

Dementia:
Is a disorder which manifests as a set of related symptoms, which usually surfaces
when the brain is damaged by injury or disease. The symptoms involve progressive
impairments in memory, thinking, and behavior, which negatively affects a person's
ability to function and carry out everyday activities. Aside from memory impairment
and a disruption in thought patterns, the most common symptoms include emotional
problems, difficulties with language, and decreased motivation. The symptoms may be
described as occurring in a continuum over several stages. Consciousness is not
affected. Dementia ultimately has a significant effect on the individual, caregivers, and
on social relationships in general. A diagnosis of dementia requires the observation of
a change from a person's usual mental functioning and a greater cognitive decline than
what is caused by normal aging.

Stroke:
Is a medical condition in which poor blood flow to the brain causes cell death. There
are two main types of strokes: ischemic, due to lack of blood flow, and hemorrhagic,
due to bleeding. Both cause parts of the brain to stop functioning properly.

Alzheimer's disease (AD):

Is a neurodegenerative disease that usually starts slowly and progressively worsens. It
is the cause of 60–70% of cases of dementia. The most common early symptom is
difficulty in remembering recent events. As the disease advances, symptoms can
include problems with language, disorientation (including easily getting lost), mood
swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition
declines, they often withdraw from family and society. Gradually, bodily functions are
lost, ultimately leading to death. Although the speed of progression can vary, the
typical life expectancy following diagnosis is three to nine years.
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Parkinson's disease (PD) or simply Parkinson's:
Is a chronic degenerative disorder of the central nervous system that mainly affects the
motor system. The symptoms usually emerge slowly, and as the disease worsens, non-
motor symptoms become more common. Early symptoms are tremor, rigidity,
slowness of movement, and difficulty with walking. Cognitive and behavioral
problems may occur with depression, anxiety, and apathy. Parkinson's disease
dementia becomes common in the advanced stages of the disease. Those with
Parkinson's can have problems with their sleep and sensory systems. The motor
symptoms of the disease result from the death of nerve cells in the substantia nigra, a
region of the midbrain, causing a dopamine deficit. The cause of this cell death is
poorly understood, but involves the build-up of misfolded proteins into Lewy bodies
in the neurons. Collectively, the main motor symptoms are known as parkinsonism or
parkinsonian syndrome.

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 Chapter 7

Activities of Daily
Living (ADL)
Activities of daily living (ADLs or ADL):
is a term used in healthcare to refer to people's daily self-care activities. Health
professionals often use a person's ability or inability to perform ADLs as a
measurement of their functional status.

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Washing:
This refers to one’s ability to wash their face or body in the bath or shower
independently, as well as physically getting in and out of the shower. While this
is a basic and simple task, it can be quite tiresome and even dangerous for the elderly.

Toileting:
Toileting is the ability to get to and from the toilet, use it properly, and being able to
clean oneself afterwards. This can also mean putting on protective undergarments such
as diapers or surgical appliances unaccompanied if required. As you grow older, you
may also begin to lose control of your bladder and bowel functions and need to use
adult diapers. Since functional disability is associated with falling and seniors are
generally more susceptible to falls, unaccompanied toileting may result in minor or
major injuries for the elderly.

Dressing:
This refers to the ability to choose which clothes to wear, putting them on, and
managing oneself appearance. Dressing also includes securing and unfastening any
artificial limbs, braces, and other medical and surgical appliances, if needed.
Along the way, some elderly adults may lose the ability to dress themselves due to a
number of health conditions like arthritis, a stroke, broken bones, or even cognitive
impairments like dementia, and may need an extra hand when getting dressed.

Feeding:
Feeding refers to being able to feed oneself after the food has been prepared. Over
time, elderly adults with cognitive or physical decline may lose their ability to feed
themselves completely. This could be due to a decline in motor or swallowing
functions. Furthermore, they can also experience dietary and nutritional challenges
such as simply forgetting to eat meals and loss of appetite.

Mobility:
Functional mobility touches on the ability to sit, stand, walk, and move from one place
to another on level surfaces all by yourself. Other mobility-related activities include
getting onto and off the toilet, sitting and rising from the couch or other furniture, as
well as going up and down the stairs.

Transferring:
While it is similar to functional mobility and sometimes used interchangeably,
transferring focuses on all aspects of being able to move from a bed to an upright chair
or wheelchair and vice versa.

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 Chapter 8
Patient Positioning

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 Chapter 9
Vital Signs
Vital signs:
(Also known as vitals) are a group of the four to six most crucial medical signs that
indicate the status of the body's vital (life-sustaining) functions. These measurements
are taken to help assess the general physical health of a person, give clues to possible
diseases, and show progress toward recovery. The normal ranges for a person's vital
signs vary with age, weight, gender, and overall health.

A. BLOOD PRESSURE
Recorded as two readings:
a higher systolic pressure,
which occurs during the
maximal contraction of the
heart, and the lower
diastolic or resting
pressure. In adults, a
normal blood pressure is
120/80, with 120 being the
systolic and 80 being the
diastolic reading. Usually,
the blood pressure is read
from the left arm unless
there is some damage to the
arm. The difference between the systolic and diastolic pressure is called the pulse
pressure. The measurement of these pressures is now usually done with an aneroid or
electronic sphygmomanometer. The classic measurement device is a mercury
sphygmomanometer, using a column of mercury measured off in millimeters.

Therefore, elevated blood pressure (hypertension) is variously defined when the

systolic number is persistently over 140–160 mmHg. Low blood pressure is
hypotension.

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Blood Pressure Chart:

Part of Sphygmomanometer

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Parts of Stethoscope

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B. BODY TEMPERATURE

Body temperature is a measure of how well

your body can make and get rid of heat. The
body is very good at keeping its temperature
within a safe range, even when temperatures
outside the body change a lot.

Hyperthermia:
Also known simply as overheating, is a condition in which an individual's body
temperature is elevated beyond normal rate. When extreme temperature elevation
occurs, it becomes a medical emergency requiring immediate treatment to prevent
disability or death.

Hypothermia:
Hypothermia is defined as a body core temperature below 35.0 °C (95.0 °F) in
humans.

Hypothermia has two main types of causes. It classically occurs from exposure to cold
weather and cold-water immersion. It may also occur from any condition that
decreases heat production or increases heat loss.

Types of Thermometers

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C. RESPIRATORY RATE

The respiratory rate in humans, is

measured by counting the number
of breaths for one minute through
counting how many times the
chest rises. Respiration rates may
increase with fever, illness, or
other medical conditions.

Tachypnea:
Also spelt tachypnoea, is
a respiratory rate greater than
normal, resulting in abnormally rapid and shallow breathing.

Bradypnea:
Is abnormally slow breathing. The respiratory rate at which bradypnea is diagnosed
depends on the age of the person, with the limit higher during childhood.

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D. OXYGEN SATURATION

Oxygen saturation (symbol SO2):

Is a relative measure of the concentration
of oxygen that is dissolved or carried in a
given medium as a proportion of the
maximal concentration that can be
dissolved in that medium at the given
temperature. It can be measured with a
dissolved oxygen probe such as
an oxygen sensor.

Oxygen saturation can be measured

regionally. Arterial oxygen saturation (SaO2) is commonly measured using pulse
oximetry.

Hyperoxia:
Occurs when cells, tissues and organs are exposed to an excess supply of oxygen (O 2)
or higher than normal partial pressure of oxygen.

Hypoxemia:
Are low levels of oxygen in your blood. It causes symptoms like headache, difficulty
breathing, rapid heart rate and bluish skin. Many heart and lung conditions put you at
risk for hypoxemia. It can also happen at high altitudes.

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E. PULSE RATE / HEART RATE

The pulse rate is a measurement of the heart rate, or the number of times the heart
beats per minute. As the heart pushes blood through the arteries, the arteries expand
and contract with the flow of the blood. Taking a pulse not only measures the heart
rate, but also can indicate the following: Heart rhythm Strength of the pulse.

Your pulse rate, also known as

your heart rate, is the number of
times your heart beats per
minute. A normal resting heart
rate should be between 60 to
100 beats per minute, but it can
vary from minute to minute.

Bradycardia:
Also sinus bradycardia, is a slow resting heart rate, commonly under 60 beats per
minute (BPM)

Tachycardia:
Also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In
general, a resting heart rate over 100 beats per minute is accepted as tachycardia in
adults. Heart rates above the resting rate may be normal (such as with exercise) or
abnormal (such as with electrical problems within the heart).

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F. BLOOD SUGAR

Glycaemia:
Also known as blood sugar
level, blood sugar
concentration, or blood glucose
level is the measure
of glucose concentrated in
the blood of humans and other
animals.

Hyperglycemia:
Is a condition in which an excessive amount of glucose circulates in the blood plasma.
This is generally a blood sugar level higher than 11.1 mmol/L (200 mg/dL), but
symptoms may not start to become noticeable until even higher values such as 13.9–
16.7 mmol/L (~250–300 mg/dL). A subject with a consistent range between ~5.6 and
~7 mmol/L (100–126 mg/dL) (American Diabetes Association guidelines) is
considered slightly hyperglycemic, and above 7 mmol/L (126 mg/dL) is generally held
to have diabetes, mmol/l (millimoles per liter)

For diabetics, glucose levels that are considered to be too hyperglycemic can vary
from person to person, mainly due to the person's renal threshold of glucose and
overall glucose tolerance. On average, however, chronic levels above 10–12 mmol/L
(180–216 mg/dL) can produce noticeable organ damage over time.

Hypoglycemia:
Also called low blood sugar, is a fall in blood sugar to levels below normal, typically
below 70 mg/dL (3.9 mmol/L). Hypoglycemia may result in headache, tiredness,
clumsiness, trouble talking, confusion, fast heart rate, sweating, shakiness,
nervousness, hunger, loss of consciousness, seizures, or death. Symptoms typically
come quickly.

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A fasting blood glucose test (used to test for diabetes) – you may be asked to fast for 8
to 10 hours before the test. You will be told not to eat or drink anything (other than
water) beforehand. You may also be told not to smoke before your test.

HbA1c:
Is short for glycated hemoglobin. The test is also sometimes called hemoglobin A1c.
Hemoglobin (Hb) is the protein in red blood cells that carries oxygen through your
body. HbA1c refers to glucose and hemoglobin joined together (the hemoglobin is
'glycated').

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 Chapter 10
Proper Care
A. ORAL CARE

Mouth care or oral hygiene means the

practice of keeping mouth and teeth healthy
and clean by brushing and flossing to
prevent bad odor and dental problems by
regular brushing and cleaning. The mouth
is important for eating, drinking, taste,
breathing, speech, communication, and the
immune system.

Purposes:
1. To keep mucosa clean, soft, moist, and intact.
2. To keep the lips clean, soft, moist and intact.
3. To prevent oral infections.
4. To remove the food debris as well as dental plague without damaging the gum.
5. To alleviate pain, discomfort and enhance oral intake with appetite.

Materials:
In a clear tray container or table
1. Sterile dressing tray.
2. Toothpaste.
3. Toothbrush.
4. Mouth wash solution.
5. Cup of water.
6. Face towel.
7. Sponge cloth.
8. A tongue depressor/spatula.
9. A pair of gloves
10. Gauze pieces.
11. Emollient.
12. Kidney tray.
13. A bowl with clean water

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Procedure:
1. Explain the procedure to the patient.
2. Wash hands.
3. Gather all materials near the patient’s side.
4. Discuss procedure with patient.
5. Wear clean gloves.
6. Assess oral mucosa, teeth, and throat.
7. Take the patient to the edge of bed in a semi-fowler position (if possible).
8. Put the face towel on the patient’s chest and tuck it under the chin.
9. Place kidney tray against the cheek and directly under the mouth.
10. Raise the head end of the bed to 45 degrees.
11. If the patient is unconscious, use a tongue depressor, gently open the jaw.
12. Examine the patient’s oral cavity completely with the help of torch, tongue
depressor or spatula and gauze.
13. Pour antiseptic gauze into a cup soak gauze in solution, and squeeze with help of
artery forceps.
14. Clean teeth from incisors to molars using up and down movement from gums to
crown.
15. Use one clamp to pick up gauze and the other to clean. Rationale: to avoid cross
contamination.
16. Clean oral cavity from proximal to distal using one gauze for each stroke with wet
gauze.
17. For supportive and oriented patients, tooth brush might be used to clean the teeth.
18. Discard used gauze into the basin.
19. Provide a tumbler of water and instruct the patient to gargle mouth.
20. Position K- basin properly.
21. Clean tongue from inner to outer aspect folding rag piece in such a way that the
tip.
22. Provide water to rinse the mouth.
23. Lubricate lips using swab stick.
24. Wipe face with a towel.
25. Rinse used articles and replace equipment.

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B. PONGE BATH/ ELDERLY BED BATH

EBB is used to bathe people who are

bedridden or unable to bathe on their
own due to health reasons. Giving a bed
bath involves washing and rinsing the
entire body one section at a time while
the patient remains in bed. It is
important to gather all the supplies
needed before you begin so you do not
have to leave the patient unattended. A
good bed bath will leave the person
feeling clean and comfortable.

Procedure:
Fill two basins or washtubs with warm water.
One is used for washing, and the other for rinsing.
The ideal temperature for your bath is somewhere between 90° F and 105° F (32° C –
40° C), which is just above the average body temperature. You want it to be
comfortable to the touch, but not too hot not too cold.

Materials you will need for a bed bath.

•Four or more face cloths or bath sponges.
•Cotton Swabs & balls
•Three or more towels.
•Two wash basins (one for soapy water, one for rinsing).
•Soap (a bar of soap, liquid soap, or wipes).
• “No-tears” or baby shampoo or no-rinse shampoo.
•Unscented body lotion. Preferably a moisturizer for aging skin.
•A waterproof cloth to keep the bed dry.
•A table or stand to hold the materials.

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Cleaning the eyes:
•Place a bath towel under the head, and on the chest to manage splashes.
•Use a moist cotton ball (or swab) or face cloth and gently wipe from the inner eye to
the outer eye.
•Do not use soap, as it can be irritating to the eye.
•Soak any crusts on the eyelid for 2-3 mins with a moist hand towel before attempting
removal.
•Dry the eyes with care

Cleaning the Upper body:

•Use lukewarm water
•Wash, rinse, and pat the
forehead, cheeks, nose, neck,
and ear dry with a moist hand
towel or bath sponge.
•Clean the insides of the ear
and nose more thoroughly
with cotton sticks
•Clean the skin folds of the
neck carefully as it is more
susceptible to collection of
dirt.
•Place a towel under the arm to prevent getting the bed wet.
•Support the patient’s arm with your palm under his elbow.
•Clean the arms from the shoulder to the elbow with firm, long strokes.
•Dip the patient’s hands into a basin of water to wash.
•Clean under the fingernails with a cotton stick.
•To clean the chest area, lift the blanket or bath towel carefully without exposing the
patient’s body. Reach under and clean the chest.
•Help the person roll on his or her side so you can wash the back side. (If you can’t
roll a person by yourself, get someone to help you so that you don’t hurt your back.)
Then help the person roll on his or her back.
•Pat dry with a clean bath towel.
•Determine if a dry shampoo treatment or a wet shampoo is needed.
•Apply dry or wet shampoo.
•NOTE: Follow the package instructions, especially for dry shampoo.
•Make sure hair is completely dry after the shampoo.

Cleaning the lower body:

•At this point ask your care recipient if they need a short break before continuing.
•Change the water in the two basins.
•Do the same thing you did with the chest area with the abdomen and clean the navel
with a little lotion applied onto a cotton swab.
•To clean the legs, bend the knee and support the leg with your hand to wash his legs.
•Dip the feet in a basin of water to wash them, taking note to wash between the toes
thoroughly.

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•Use a cotton stick to clean under the toenails.
•Apply lotion to the feet if they are dry, but keep areas between toes dry to prevent
fungal infection.
•To clean the genital areas for uncircumcised males, draw back the foreskin, rinse and
dry. For females, spread her external folds and wash thoroughly.
•Pat dry to complete:

C. DRESSING / UNDRESSING

When taking out clothing, remove the sleeve from the unaffected arm first as the
person can bend his hand. - put on clean clothing by slipping in the sleeve from the
weak side first. Tips: Place the sleeve of the shirt as high as possible on the person's
shoulder of the affected arm to facilitate dressing or undressing.

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D. PROPER WEARING OF DIAPER

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E. BED MAKING

Principles of Bedmaking:
Techniques vary but principles are the same).
1.Have everything ready on hand before starting.
2.Remember that the bed is made for use, for durability and comfort and that it should
have a finished appearance.
3.Place all linen on perfectly straight line
on the bed, otherwise, it would be
impossible to make bed tight and free
from wrinkles.
4.All coming should look neat, smooth
and firm.
5.Throughout the procedure, the nurse
should study her movements to avoid waste of time and energy
6.When finished inspecting the bed and see if it measures to the highest standard.
Note: Do not use torn linen and in private rooms avoid stained linen.

Materials Needed:
•2 large sheets
•Rubber sheet
•Draw sheet
•Pillowcase
•Bath towel & wash cloth
•Pillow & mosquito net (if
needed)
•Woolen blanket top sheet
•Extra pillow with pillowcase
•Hand towel
•Bedspread or coverlet

Reminders:
1.Wash hands before proceeding.
2.All bedding must be clean.
3.Protect mattress, pillows, and rubber sheets from getting in contact with patient’s
body.
4.Avoid contact with beddings with floor and other patient’s Unit.
5.Remove each piece of linen separately so that valuables will not be accidentally
discarded.
6.Smooth tight bed with well-made corners.
7.Smooth flat pillows with cases evenly fitted.
8.Keep unit orderly during procedure.
9.Check unit for standard equipment and see that patient’s personal effects are in good
order.
10.Place hand bell or signal cord within easy reach of patient.

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 Chapter 11
Wound Dressing
Management
Wound:
Is a rapid onset of injury that involves lacerated or punctured skin (an open wound), or
a contusion (a closed wound) from blunt force trauma or compression. In pathology, a
wound is an acute injury that damages the epidermis of the skin. To heal a wound, the
body undertakes a series of actions collectively known as the wound healing process.

Dressing:

Is a sterile pad or compress applied to a wound to promote healing and protect the
wound from further harm. A dressing is designed to be in direct contact with the
wound, as distinguished from a bandage, which is most often used to hold a dressing
in place. Many modern dressings are self-adhesive.

Materials needed for wound care.

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Wound Cleaning and Dressing Procedure

1. Hand Hygiene
2. Put on Clean Gloves
3. Gather Necessary Materials
4. Prepare the Environment
- Patient Position
- Adjust Bed
- Lights
- Wound Dressing table
5. Prepare Sterile Field
6. Add Necessary Sterile Supplies
7. Pour Cleaning Solution
8. Prepare the Surgical Tape (Medical Tape)
9. Prepare The Patient and Expose the Dressed Wound
10.Discard Clean Gloves
11.Put on Sterile Gloves
12.Assess the Wound (least contaminated area is clean first)
13.Using the Sterile Cotton or Gauze, clean the wound starting at the center toward
the outer part of the wound. (Repeat, if necessary, until the wound is completely
clean)
14.Wipe or Pat Dry any excess Cleaning Solution
15.Apply Medicine (prescribe by the doctor)
16.Cover the Wound with Sterile Gauze
17.Secure the Gauze with Medical Tape
18.Apply outer dressing if required.
19.Assist Patient in Comfortable Position
20.Properly Dispose of Used Materials
21.Discard Sterile Glove and Perform Hand Hygiene

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B. TYPES OF WOUNDS

• Abrasion
- a wound consisting of superficial damage to the skin.

• Avulsion
- in which a body structure is detached from its normal point of insertion, either
torn away by trauma or cut by surgery.

• Incision
- a cut made through the skin and soft tissue to facilitate an operation or
procedure.

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• Laceration
- a deep cut or tear in skin or flesh. Most lacerations are the result of the skin
hitting an object, or an object hitting the skin with force.

• Puncture
- a penetrating wound caused by pointy objects as nails or needles.

• Bedsore
- also called pressure
ulcers and decubitus
ulcers — are injuries
to skin and
underlying tissue
resulting from
prolonged pressure
on the skin. Bedsores
most often develop
on skin that covers
bony areas of the
body, such as the
heels, ankles, hips,
and tailbone.

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Stages of Bedsore:
Stage 1. The area looks red and feels warm to the touch.
Stage 2. The area looks more damaged and may have an open sore, scrape, or blister.
Stage 3. The area has a crater-like appearance due to damage below the skin's surface.
Stage 4. The area is severely damaged, and a large wound is present.

How to prevent bedsore:

1. Keep the skin clean and dry.
2. Frequently change the position in bed ever 2 hours
3. Patients in wheelchairs change position every 15 minutes.
4. Daily skin inspection.

CAUSES:
1. Spend a lot of time sitting in a chair or lying in bed
2. Wear a prosthesis or surgical appliance
3. Wear ill-fitting shoes or clothing with elastic

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 Chapter 12

Transferring
Precautions:

1. Think through the steps before you act and get help if you need it. If you
are not able to support the patient by yourself, you could injure yourself
and the patient.

2. Make sure any loose rugs are out of the way to prevent slipping. You may
want to put non-skid socks or shoes on the patient's feet if the patient
needs to step onto a slippery surface.

3. If your loved one will use a wheelchair, you need to know about
transfers. For safety’s sake, learn how to help your loved one in and out
of the wheelchair. One basic method is shown here.

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 Chapter 13

Nasogastric tubes (NGT)

Feeding

Nasogastric Tube:
A tube that is passed through the nose and down through the nasopharynx and
esophagus into the stomach. It can be used to remove the content of the stomach,
including air to decompress the stomach, or to remove small solid objects and fluid
such as poison from stomach.

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TYPES OF NGT TUBE

1. Levin Tube:
Is a rubber or plastic tube that has a single
lumen, a length of 42” to 50”
and holes at the tip and along the side.

2. Salem Sump Tube:

Is a double lumen tube (one for suction and
drainage and small
one for ventilation) made of clear plastic and has a
blue sump port(pigtail) that allows.
atmospheric air to enter the patient’s stomach.

3. Moss Tube:
The most tube (usually inserted during surgery) has a
radiopaque tip and three lumens. The first, positioned
and inflated in the cardia, serves as a balloon
inflation port. The second is an esophageal aspiration
port. The third is duodenal feeding port.

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Purposes:
1. Enteral Feeding
2. Administration of medication
3. Gastric aspiration & decompression (this is not being covered within this
session)

Note: Many NG tubes are inserted each day without incident. However there
is a small risk that NG tube can be misplaced during insertion or displaced after
successful insertion. Should this occur and not be recognized serious harm could be
experienced by the patient.

MATERIALS:
1. Clean gloves
2. Towel
3. 60 ml bulb syringe
4. feeding formula
5. measuring cap
6. a container filled with water
7. 50ml plain water

PROCEDURE:
•Perform hand hygiene.
•Provide privacy or verify the
patient ID.
•Introduce yourself (explain the
procedure)
•Elevate or adjust the bed at 45
degrees angle.
•Put on gloves
•Check or aspirate the residual
tube feeding into the patient
stomach,
•First flush 20ml of water
•Feeding formula 250ml to 350ml (depending on Doc. Prescription)
•Final flush 30ml of water
•Note: if medication is needed - should follow Doctor prescription.
• Document the patient chart

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 Chapter 14

Percutaneous
Endoscopic Gastrostomy
(PEG)
PEG:
A tube inserted through the wall of the abdomen directly into the stomach.
It allows air and fluid to leave the stomach and can be used to give drugs and liquids,
including liquid food, to the patient. Giving food through a PEG tube is a type of
enteral nutrition. Also called gastrostomy tube and percutaneous endoscopic tube.

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How to check gastric residual (PEG feedings only):
"Residual" refers to fluid/contents that remain in the stomach. Only those fed through
a PEG tube should have a residual.

1. Connect a syringe to the PEG tube.

2. Gently draw back the plunger of the
syringe to withdraw stomach contents.
3. Read the amount in the syringe.
4. Inject the contents back into the
feeding tube (It contains important
electrolytes and nutrients).
5. Use the syringe to rinse the feeding
tube with 30 ml of water.
6. If the gastric residual is more than 200 ml, delay the feeding.
7. Wait 30 - 60 minutes and do the residual check again. If the residuals continue to be
high (more than 200 ml) feeding cannot be given, call your healthcare provider for
instructions.

PROCEDURE FOR PEG TUBE FEEDING:

1. Greet the client
2. Explain the procedure to gain cooperation
3. Wash hands, prepare the required equipment and feed
4. Prepare the client
- Position the client with elevation of head 30°
- Cover the client clothes to avoid soiling with food/fluid
5. Wash hands with soap and water. Dry your hands (put on clean gloves)
6. Release the spigot from the gastrostomy tube. Clean the tip of the tube with a clean
swab.
7. Connect the syringe to the gastrostomy tube.
8. Release the clamp on tubing to allow fluid into the gastrostomy tube.
9. Check the tube patency by flushing 30ml of plain water in the tube.
10. Start feeding the client
-Pour the feed in the syringe
-Place the syringe in an appropriate height (client's chest level) to control
the flow of fluid.
-Pour the feed gently into the syringe and allow it to flow according to
gravity
-Do not allow air in the tube
11. Rinse the tube with 30ml of plain water. Flush in after the feed.
12. Cover the spigot.
13. Asses the stoma area for any skin irritation. Clean the stoma with damp clean
cotton swab.
14. Secure the tube on client's abdomen.
15. Asses the client if comfortable.
16. Clean the equipment
17. Complete documentation (time, amount of feed, any reaction)

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 Chapter 15

Colostomy Care
COLOSTOMY:
Surgically created opening in the abdominal wall through which digested food passes.

COLON:
Known as large bowel or the large intestine.
An operation to the right side of the abdomen that connects to the colon or the large
intestine through the abdominal wall.

ILEOSTOM:
Operation to the left side of the abdomen that connects to the last part of small
intestine.

ILEUM:
Final section of the small intestine

URUSTOMY:
Surgical opening in the belly (abdominal wall) that made during surgery it directs
urine away from the bladder. Surgery to remove the bladder is called
CYSTECTOMY.

STOMA:
An artificial opening created to the surface of the body Greek word mouth or opening.

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TYPES OF COLOSTOMIES:

1.Ascending colostomy-right side of belly.

2.Transverse colostomy-across middle of the abdomen.
3.Descending colostomy-left side of the abdomen.
4.Sigmoid colostomy-most common type of colostomy located at lower left side of the
abdomen.

PURPOSE:
TO TREAT
-cancer
-obstruction of bowel disease
-diverticulum
-traumatic injury

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TYPE OF COLOSTOMY BAG:

1.One piece system-fit around

stoma and is attach with a gentle
Adhesive

2.Two-piece system-base plate fit

tightly around stoma, and you
attach a bag to it.

3.Close bag-best used with firm

stool

4.drainable bag- best used for

very liquid stool

CHANGE YOUR COLOSTOMY BAG:

l. Removes soiled pouch using adhesive skin barrier paste.
2.Empty pouch discarding it in a plastic bag.
3.Cleanse skin with warm water and mild soap, rinse skin and pat dry.
4.Note: stoma color and skin condition.
5.Use measuring guide to check size of the stoma
6.Cut to fit pouch or flange.
7.Remove backing from pouch.
8.AppIy a bead of skin barrier pastes around the stoma base
or around the opening of the pouch allow the air dry 1-2
minutes
9.Center the pouch over the stoma and press the adhesive.

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 Chapter 16

Tracheostomy Care
Tracheotomy:
Is a surgical airway management procedure which consists of making an incision (cut)
on the anterior aspect (front) of the neck and opening a direct airway through an
incision in the trachea (windpipe). The resulting stoma (hole) can serve independently
as an airway or as a site for a tracheal tube or tracheostomy tube to be inserted, this
tube allows a person to breathe without the use of the nose or mouth.

Purpose of suctioning:

1. To remove the thick mucus.

2. Maintain a clear airway
3. Avoid tracheostomy tube blockages.

Note:
Non-touch technique gently introduces the suction catheter tip into the tracheostomy
tube to the pre-measured depth. Apply finger to suction catheter hole & gently rotate
the catheter while withdrawing. Each section should not be any longer than 5-10
seconds.

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Procedure:
1.Gather the following equipment and supplies:
•Suction machine
•Connecting tubing
•Disinfected suction catheter One non-sterile, clean glove
•Distilled water
•Clean, small paper cup
•Clean basin
2.Position the patient comfortably with his or her head and neck well-
supported.
3.Wash your hands with soap and water and dry with a clean towel.
4.Fill the small paper cup about half-way with distilled water.
5.Place the clean glove on your dominant hand (if you are
righthanded, place the glove on your right hand).
6.If the patient has a cuffed tracheostomy tube, check to see if the cuff
is properly inflated.
7.Open the suction catheter package.
8.Pick up the hard plastic end of the catheter with your gloved hand and attach it to the
connecting tubing. (Only touch the connecting tubing)
9. Contamination of the catheter
10.Turn on the suction machine with your ungloved hand.
11.Expose the patient's tracheostomy opening.
12.With your finger off the suction vent (so that you are not applying suction), gently
insert the suction catheter into the tracheostomy opening. Slowly advance the
catheter a maximum of 6 inches or until you feel resistance.
13.Cover the suction vent with the thumb of your ungloved hand to apply suction.
14.Withdraw the catheter and rotate, using a slow and even motion, roll the catheter
between the thumb and forefinger of your gloved hand. Apply suction as you
withdraw the catheter.
15.Do not apply suction for longer than 10 seconds,
16.Clean the catheter and connecting tubing between each suction pass: dip the
catheter into the small paper cup, place your finger over the suction vent and
draw up a small amount of distilled water through the catheter. Empty the
contents of the catheter into the collection basin.
17.Allow the patient 20 to 30 seconds to rest between suction passes.
18.When the patient's airway is clear and you are finished suctioning, fill a clean basin
with distilled water.
19.Thoroughly flush the distilled water through the catheter and connecting tubing.
20.Turn off the suction machine.
21.Slide the catheter back into the package and disconnect it from the connecting
tubing.
22.Hang the connecting tubing on the suction machine with the tip pointing up.
23.Rinse the suction catheter and store it with the other equipment to be disinfected.
24.Wash the basin with soap and warm water. Dry it with a clean towel and put it
away.
25.Take off your glove and discard it properly, along with the paper cup.

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26.Wash your hands with soap and water and dry with a clean towel.

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 Chapter 17

Catheterization Care

Urinary Catheterization:

A latex, polyurethane, or silicone tube known as a urinary catheter is inserted into the
bladder through the urethra. Catheterization allows urine to drain from the bladder for
collection. It may also be used to inject liquids used for treatment or diagnosis of
bladder conditions.

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TYPES OF CATHETERS:

Foley Catheter
is a flexible catheter that is removed after each use.
Unlike the Foley catheter, it has no balloon on its tip and
therefore cannot stay in place unaided. These can be
non-coated or coated (e.g., hydrophilic coated and ready
to use).

Intermittent catheter/Robinson catheter

is a flexible catheter that is removed after each
use. Unlike the Foley catheter, it has no
balloon on its tip and therefore cannot stay in
place unaided. These can be non-coated or
coated (e.g., hydrophilic coated and ready to
use).

Coudé catheter, including Tiemann's catheter:

Is designed with a curved tip that makes it easier
to pass through the curvature of the prostatic
urethra.

Condom Catheter:
Can be used by males and carries a lower risk of
infection than an indwelling catheter. A condom
catheter is a urine (pee) collection device that fits
like a condom over your penis, but also has a tube
that goes to a collection bag strapped to your leg.

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Purpose of Urinary Catheterization:
• Relieve Urinary Retention
• Obtain a sterile urine specimen from female patient.
• Measure residual urine.
• Empty the bladder before, during or after surgery.
• Allows accurate measurement of urine output.

CATHETER CARE
1. Clean, drainage and change bag every day
2. How often clean the catheter its twice a day morning and evening
3. Some every two to four hours (if needed).
4. Urinary catheter change depends on their type like foley catheter 30 days
5. Silicon catheters generally 60 to 90 days.

PREVENTING INFECTION:
1.Always keep the drainage bag below the level of your bladder and off the floor.
2.Keep the catheter secured to your thigh to prevent it from moving.
3.Don't lie on your catheter or block the flow of urine in the tubing.
4.Shower daily to keep the catheter clean.
5.Clean your hand before and after touching the catheter or bag.

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 Chapter 18

Charting
Charting:
Is a documented medical record of services provided during a patient's care, including
procedures performed, medications administered, diagnostic test results and
interactions between the patient and healthcare professionals.

Charting Sample:

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 Chapter 19

Common Medical
Terminologies
Medical Terminologies:
In the medical field, this language is used for precisely describe of human being
component, condition affecting on its procedure performed upon it.

ABBREVIATION MEDICAL ENGLSIH

P.O BY MOUTH OR ORALLY
P.R RECTALLY
P.V VAGINAL
STAT IMMEDIATELY
P.R.N A REQUIRED/ AS NEEDED
S.O.S IF NECESSARY
O.D EVERYDAY / ONCE A DAY
B.I.D/ BD 2X A DAY/ TWICE A DAY
T.I.D/ TDS 3X A DAY
Q.I.D/ QDS 4X A DAY
Q.A.M EVERY MORNING
Q2H EVERY 2 HOURS
HS AT THE BEDTIME
P.C AFTER MEAL NOT ON EMPTY STOCMACH
A.C BEFORE MEAL
QHS EACH NIGHT
N.P.O NOTHING BY MOUTH NOTBY ORAL
QD EVERYDAY

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