Thursday, August 19, 2010

HANDWASHING

Handwashing - single most important procedure for preventing the spread of biological contamination
- one of the most effective way to protect yourself, your patient, and your colleagues from cross infection
- prevents possibility of contamination

When should we wash our hands?
- before eating or handling food
- after using the toilet
- when hands are contaminated by secretions
- after touching public installations or equipments
- after changing diapers or handling soiled articles of young children or the sick
- before touching the eyes , nose and mouth
- after coming in contact with blood or other body fluids

Equipments or Materials Needed:
- faucet/ sink
- soap
- clean towel/ tissue paper

Procedure/ Rationale:
1. Remove all jewelries / Jewelries harbor microorganisms
2. Avoid touching the sink / consider the sink, including the faucet control contaminated
3. Turn the water on
4. Wet your hands and wrists in running water
5. Apply soap into the hands and lather / To remove dirt and organic materials that harbor microorganisms
6. Rub hands for 15 to 20 seconds using firm rubbing and circular movements on all surface of the hands
- palm to palm
- right hand over back of left hand with fingers interfaced
- palm to palm with fingers interfaced
- clasped hands with back of fingers against opposing palms
- rotate right hand around left thumb, then change hands and repeat
- rub fingertips to clean center of palm
- rinse hands thoroughly under a stream of water/ Running water carries away dirt and debris
- dry hands completely with a clean dry towel or tissue paper / To prevent chapping and facilitates donning of gloves
- use a dry paper towel to turn faucet off/ To prevent contamination with the faucet

UPDATE:
I don't actually earn here so if you would like to help feel free to do so. Send it through Metrobank S/A # 2348004756. My account name is Celso Balonzo. From the Philippines Mabuhay and may God bless you always!

Wednesday, August 18, 2010

THORACOSTOMY

Close Tube Thoracostomy/ Chest Tube Insertion- insertion of tube through an intercostal space into the pleural cavity to remove air, drain fluid , drain both air and fluid and to drain blood

- following traumatic injury to the chest, blood or air can accumulate resulting in collapse of the lung. To re-expand the lung, a tube thoracostomy (chest tube) is placed, draining the blood through a one way valve.

Equipment:
- str. kelly
- dressing tray
- kelly curve
- micropore and leukoplast
- thoracostomy tube ( fr 36, 34, 32, 28, 26, 200
- mayo scissor
- glass tubing with rubber
- blade # 10
- sterile bottle #2
- sterile gloves
- connecting tube
- silk 2/0 cn
- lidocaine 2%
- silk strands 3/0
- syringe 10cc
- eye sheet or drape
- needle g 21
- sterile os 4x4

Nursing Procedure:
1. Secure consent
2. Explain the procedure thoroughly
3. Inform OR staff/ ER staff
4. Inform anesthesiologist
5. Preparation of the site
6. Remove dentures/ jewelries
7. Prepare the OR checklist

CHEST DRAINAGE
- the pleural cavity normally has negative pressure. Any drainage system connected to it must be sealed so that air or liquid cannot enter
- such a drainage system, water- sealed drainage or disposable drainage system

Three Mechanisms Used:
1. Positive expiratory pressure - when pleural cavity contains some air or fluid, a (+) pressure develops during expiration this is abnormal, but it does help expel the air and to some extent fluid from the space
2. Gravity - acts as an evacuation force when the tubing is placed so that it descends from the insertion site to the drainage receptacle
3. Suction - used in conjunction with the other two forces in some drainage systems

Kinds of Water-Sealed Drainage System:
1. One-bottle system - a single receptacle receives both the fluid and/or air from the client and seals the system. A combination of fluid from the client and sterile H2O forms the water- seal.
2. Two-bottle system- the air/fluid from the pleural cavity is received into bottle A. The air from bottle A is passed into bottle B. The air then passes through the sterile water and exits from bottle B through the air vent. The fluid from the pleural cavity remain in bottle A.
3. Three- bottle system- fluid from the pleural cavity collects in bottle A which is connected to a tube in bottle B that terminates below the fluid level. Bottle B is then connected to bottle C by a short tube. Bottle C has a manometer tube submerged in sterile water.

Monitoring a Client with Chest Drainage:

Equipments:
- 2 kelly clamp
- sterile gauze with lubricant
- sterile gauze
- sterile drainage system
- an occlusive tape

Nursing Procedure:
Procedure/ Rationale
1. Check all connections are secured with tape / To ensure that the system is alright
2. Milk or strip the chest tubing as ordered / Milking the tubing dislodges obstruction
3. Inspect the drainage in the collection container/ For proper and accurate monitoring of the changes
4. Check the fluctuation of fluid level / Absence of fluctuation may indicate tubing obstruction from a kink
5. Check for intermittent bubbling / It normally occurs when the system removes air from space
6. Inspect the air vent in the system periodically / Obstruction from the air vent causes a pressure in the system that could result in pneumothorax
7. Report drainage on dressing immediately / It is not a normal occurrence
8. Palpate the area around the chest tube insertion site / Indicates that air is leaking into the subcutaneous tissue (s.c. emphysema)
9. Situate the drainage system / To avoid breakage
10. Place the 2 clamps at the bedside / Clamps are used judiciously and only in emergency situations because they can cause tension to pneumothorax
11. Encourage deep breathing and coughing exercise / Facilitate drainage and help the lungs to re-expand
12. Reposition the client every 2 hours / Promote drainage, prevent complications and provide comfort

UPDATE :
I don't actually earn here but if you would like to help feel free please. Send your help through Metrobank S/A # 2348004756. My account name is : Celso Balonzo. From the Philippines, Mabuhay and may God bless you always!

Friday, August 13, 2010

ENEMA

Types of Enema:
1. Carminative enema- done to expel flatus. 60-180 ml of water is introduced
2. Retention enema - introduce oil into the rectum and sigmoid colon. Oil retained in 1 to 3 hours
Instillation- introduction of a liquid (usually mineral oil) into thew colon to facilitate fecal activity
by lubricating effect
3. Return flow enema ( Harris flush/ colonic irrigation) - 100 to 200 ml of fluid is introduced into
and out of the large intestines to stimulate peristalsis and expulsion of flatus

Equipments:
- enema can
- kelly forcep
- IV pole
- solution
- KY jelly
- rectal tube
- gloves
- hose

Nursing procedure/ Rationale
1. Inform the client about the procedure/ To promote cooperation
2. Assemble articles/ For efficiency
3. If using an enema bag, fill it with 750-1000 ml warm tap water / Hot water can burn intestinal mucosa, cold water can cause abdominal cramping
4. Clamp tubing / To keep solution intact
5. Place waterproof pad absorbent/ To prevent soiling
6. Assist client into the left side lying with knee flexed/ Allows enema solution to flow downward by gravity
7. Cover client with bath blanket exposing only rectal area / Provide warmth, allows client to feel more relaxed
8. Lubricate 3-4 inches tip of rectal tube / Provides smooth insertion without irritation and trauma
9. Gently separate buttocks and locate anus / For accurate exposure
10. Instruct client to relax / It promotes relaxation of external anal sphincter
11. Insert tip of rectal tube 3-4 inches / Careful insertion prevents trauma to rectal mucosa
12. Hold tubing in rectum constantly until end of instillation/ Bowel contraction can cause expulsion of tube
13. With container at client's hip level, open regulating clamp and allow solution to enter slowly / Rapid infusion can stimulate evacuation and cause cramping
14. Raise height of enema bag slowly to 30-45cm (12-18 inches) / Raising container too high causes rapid infusion and possible painful distention of colon
15. Hang container on IV pole
16. Clamp tubing if client complains of cramping / Temporary cessation minimizes cramping
17. Tell client that the procedure is completed and that you will be removing rectal tube / Client may misinterpret the sensation of removing the tube as a loss of control
18. Explain feeling of distention is normal. Tell client to retain 5-10 minutes / Solution distend bowel. Longer retention promotes more effective stimulation.
19. Assist to bathroom
20. Instuct client with a history of cardiovascular disease to exhale while expelling enema to avoid valsalva maneuver/ Valsalva maneuver- strenuously trying to move a constipated stool and may result in cardiac arrest
21. Assist client to wash anal area with wearm soap and water / Fecal content can irritate the skin. Hygiene promotes comfort.
22. Do after care

Characteristics of a Good Recording :
1. Accuracy
2. Conciseness
3. Thoroughness
4. Currentness

UPDATE:
Thanks for reading my post . I don't actually earn here so if you would like to help feel free to do so. You may send it through: Metrobank S/A No. 2348004756 . Account name is: Celso Balonzo. From the Philippines thank you and God bless!