Instructions for 'Indwelling catheter care'

1. Take equipment to the bedside, place it in a convenient position, and identify the patient.
2. Provide privacy (close the door and draw the privacy curtains)
3. Wash your hands.
4. Explain the procedure to the patient.
5. Raise bed to the proper height; over the side rail on your working side.
6. Place patient in the supine position and expose the perineal area to visualize the meatus.
7. Open and cuff the plastic bag, and tape to the down-positioned said rail on your right if you are right handed, and to your left if you are left handed.
8. Arrange the sterile kit and equipment on the over bed table, (remember to remove the caps of the Betadine bottle).
9. Unwrap the sterile daily care kit using aseptic technique.
10. Glove the hand that will remain sterile during procedure.
11. Put on a sterile glove on your other hand.
12. For a female; if you are right handed, separate the labia minora with your left hand to expose the urinary meatus. Cleanse the urinary meatus with Betadine using a circular motion and moving from the center towards the outside.
13. For male: separate the prepuce and clean the meatus. Cleanse the catheter with Betadine solution starting as close as possible at the insertion site and down the catheter toward the drainage bag 4-5 inches. (One motion only; do not repeat the motion).
14. Apply Betadine ointment at the meatus and down the tubing for approximately 1 inch.
15. Apply dressing and anchor the catheter to the thigh / lower abdomen to prevent injury to the internal sphincter.
16. Discard the cotton balls in paper or plastic bag; close the bag. Remove gloves.
17. Position the patient for comfort –lower the bed; raise the side rail.

Instructions for 'Immuno-compromised patient's care'

1. Identify the patient who is immunocompromised.
2. Severely immuno-compromised patient should be kept in protective isolation. Explain the need for protective isolation to patient and relatives.
3. Patients placed in isolation should remain in their isolation rooms with the door closed.
4. Remove watch and all hand and wrist jewellery.
5. Take off any white coat or jacket/outside coat.
6. Disinfect hands with alcohol handrub.
7. If undertaking direct care e.g. changing a dressing, giving an injection, wash hands and forearms in dispenser liquid soap for at least 15 seconds.
8. Keep separate stethoscope, sphygmomanometer and other monitoring equipment for the patient.
9. No fresh flowers or plants are allowed.
10. Daily bath or shower; using antiseptic liquid soap.
11. Careful drying after a bath/shower.
12. Report to the doctors any sore areas or breaks in the skin.
13. The number of persons entering the isolation room should be minimal. If visitors are admitted to the isolation room, they should be given detailed instructions. If the visitor has been exposed to a communicable disease or has symptoms of illness, they should not be allowed to visit the patient. People who have been immunized (vaccinated) within the past two weeks should avoid contact with the patient.
14. Health care workers must be extremely vigilant for signs of infection. Because white blood cells counts are usually compromised, normal immune responses often do not occur in these patients. Four hourly temperature readings are vital. – inform the medical staff if the temperature rises above 38ºC or if 37⁵–38C and the patient is unwell and feverish for > 1 hour.
15. Gloves, gown or apron, and masks should be worn and discarded after attending patient.
16. If at all possible, the patient must not be assigned nurses who are looking after patients with obvious infections, particularly infected skin lesions, pneumonia or infective diarrhoea. Except in dire emergency, nursing and medical staff with obvious bacterial or viral infections should not enter the room.
17. Hot food must be served while it is hot, so ad to ensure these patients on the ward are served first.
18. Do not give the patient salads, shellfish or any food containing raw eggs.
19. Avoid unpasteurised dairy products.
20. Ensure fresh fruit is washed and peeled before consumption.
21. Supply with sufficient amount of alcohol hand disinfectant, paper towels and soap dispensers inside and outside the patient’s room.
22. If patients must be transported outside their isolation rooms for medically essential procedures that cannot be performed in the isolation rooms, they should wear surgical masks that cover their mouths and noses during transport. Procedures for these patients should be scheduled at times when they can be performed rapidly and when waiting areas are less crowded.

Instructions for ' Hot application'

1. Confirm doctor’s written order and explain procedure to patient
2. Assess area
3. Check hot water bag for any leakage
4. Check temperature of water with a bath thermometer(temperature should be 105- 115⁰ F for children and 115-125⁰ F for adults)
5. Keep the bag on a flat surface
6. Pour hot water into the bag until it is 2/3^rd full.
7. Expel air by permitting water to come to the mouth of the bag and then close.
8. Hold bag upside down to check for leakage.
9. Wipe outside of bag with duster, put into flannel cover and apply to part.
10. Check tolerance.
11. Check discomfort/burns, redness, and condition of the skin frequently.
12. Remove the bag after 20-30 minutes.
13. Document the procedure, patient’s reaction and effect of procedure

Instructions for 'Hair wash'.

1. Explain the procedure to the patient.
2. Fold mackintosh to form a trough.
3. Position the patient diagonally on the bed with head positioned at the edge of the bed, and shoulder placed on pillow. Top end of trough is supported by the shoulder and bottom end of it is placed inside iron bucket.
4. Loosen hair and remove tangles.
5. Plug ear with non-absorbent cotton.
6. Place sponge cloth (folded) on forehead.
7. Wet hair in sections.
8. Ensure that water does not spill out of trough.
9. Apply shampoo evenly on hair and scalp.
10. Massage scalp by using pads of fingertips.
11. Scrub hair along total length.
12. Rinse hair thoroughly.
13. Dip hair in basin at end of procedure, by placing basin close to the patient’s neck.
14. Rinse hair and squeeze thoroughly.
15. Fold mackintosh into bucket.
16. Secure hair with bath towel.
17. Remove the non absorbent cotton from the ears and discard it.
18. Replace the sponge cloth from forehead.
19. Wipe face with towel.
20. Keep patient comfortable .
21. Dry hair.
22. Replace articles.
23. Discard dirty water and wash hands.
24. Document the procedure.

Instructions for 'Prevention of bedsores'

1. Identify the patients who are particularly prone to develop bedsores.
2. Keep the patient clean by daily sponging and daily observation of bed ridden patients.
3. Wash the back with warm water to stimulate circulation.
4. Keep the patient dry always. Apply talcum powder. If the patient perspires profusely, change the linen frequently and wash the patient well.
5. Change patient’s position frequently at least once in two hours or as often as necessary and encourage patient to move in bed as far as possible.
6. Use water bed/ripple bed to remove pressure on susceptible sites.
7. Observe carefully for the presence of any reddened areas or skin abrasions and report promptly and see that the appropriate measures are taken to prevent the progress of information of the ulcer.
8. In case of severe bedsores, dressing is to be done and procedure is to be documented.
9. All bedsores (both developed in the hospital and patient admitted with bedsore) are to be reported to the treating Consultant/Nursing Superintendent.

Instructions for 'Glycerine Mag-sulph application'

1. Procedure is explained to the patient.
2. Wash hands before performing the glycerine magsulph compress.
3. Take bottle containing lotion of mag sulph.
4. Check the temperature of the lotion(if lotion thermometer is available), if the temperature of lotion is higher than that can be tolreated, keep it until the steam clears.
5. Take the gauze pieces and soak the gauze in the lotion.
6. Place mackintosh around the area where the solution is to be applied.
7. Take the soaked gauze pieces from the glycerin magsulph bowl and apply on the area completely.
8. Apply roller gauze over the glycerine magsulph application.
9. The lotion is apply for 15 to 20 min until the heat lost.
10. If the application is to be continued, the temperature of the lotion is maintained by adding hot lotion.
11. Document the procedure.

Instructions for 'Gluco-test'.

1. Explain the procedure to the patient.
2. Select the finger for the prick, squeeze the finger tip.
3. Clean the tip with spirit swab. Allow it to dry.
4. Prick at the lateral aspect of the finger tip with 26.G needle.
5. Obtain a drop of blood from the finger tip and apply to the reagent strip.
6. The strip is inserted into a meter that gives a digital reading of the blood glucose value.
7. Note the value, remove the strip and discard to kidney tray.
8. Apply pressure to the puncture site with a dry swab.
9. Several newer blood glucose monitors are available where the strip is placed in the meter first before blood is applied to it. Once the blood is placed on the strip, the meter automatically displays the blood glucose level.
10. Replace all the articles.
11. Document the glucose level in the diabetic chart and Inform the doctor.

Instructions for 'Giving and taking of bed-pan'

1. Assess the patient’s condition for the level of consciousness and limitations in movements.
2. Explain the procedure to patient/relatives.
3. Provide privacy.
4. Encourage the patient to assume normal position for defaection(if possible).
5. Elevate the head end of bed, if the patient is alert.
6. Roll away draw sheet towards one side of the bed.
7. Place dry bedpan under the patient’s buttocks by following any of the methods mentioned below;
   1. Flex the patient’s knees and bring heels towards buttocks, assist the patient to lift buttocks by supporting “small of back” with left hand, instruct and assist the patient to lift the buttocks by under buttocks, make sure that the wide and flat surface of bedpan is placed under buttocks and the patient's gown is out of the way.
   2. Turn the patient to one side and place the bedpan firmly close to buttocks, roll the patient on the bedpan.
8. Keep the patient covered well to maintain the privacy of the patient.
9. Give enough time to pass motion/urine.
10. Once the patient has finished, permit to clean by herself/himself. Assist\by pouring water.
11. Use measured quantity of water if output is to be maintained.
12. If the patient is unable to clean, pour water and clean using long artery clamp and cotton balls/rags pieces.
13. Remove the pan by lifting the patient carefully.
14. Avoid dragging of bedpan from under the patient.
15. Cover the pan immediately.
16. Dry mackintosh if wet.
17. Secure draw sheet and position the patient comfortably.
18. Provide water and soap to wash hands, if the patient has washed. Note the color, amount and consistency.
19. Empty the bedpan.
20. Note the date and time.

Instructions for 'Gastric lavage'.

1. Explain the procedure to the patient.
2. Screen the patient or provide privacy.
3. Assemble the equipment to the bedside.
4. Place the mackintosh and towel around the patient’s neck and shoulder.
5. Wash hands and return to bedside
6. Remove dentures if any and place in a bowl containing cold water.
7. Give the patient a towel/gauze piece to wipe the secretion flowing from the mouth during the procedure.
8. Place the kidney tray in a convenient place.
9. Take the tube from the bowl and lubricate with glycerine.
10. Stand to the side and slightly behind the patient.
11. Instruct the patient to keep the head slightly forward, pass the tube along the roof of the mouth and taking care to prevent the tube from striking the pharynx, instruct the patient to swallow.
12. Allow the stomach content to drain.
13. Fill the funnel with irrigation solution and allow the solution to run in slowly, about 500 ml solution should be allowed to run before it is siphoned back.
14. Continue the treatment by introducing the fluid into the stomach and permitting it to run back until the return flow is clear,
15. Remove Ryle’s tube.
16. Make the patient comfortable.
17. Record and document the treatment.

Instructions for ' Collection of urine specimen from catheter'

1. Clamp tubing for about 15- 30 minutes before obtaining sample
2. Disconnect bladder drainage tubing.
3. Cover distal end of drainage tube with sterile gauze till procedure is over.
4. Clean tip of urinary catheter with antiseptic.
5. Release clamp and collect urine in container.
6. Remove gauze and discard in K-basin.
7. Reconnect tubing.
8. Label container and send immediately to laboratory along with lab request.
9. Record date, time of collection specimen and characteristic of specimen. Specify lab to which specimen is sent.

Instruction for 'collection of 24 hour urine specimen'

1. Obtain lab request slip and get 24- hour urine container with proper label and reagent.
2. Explain about the method of urine collection to patient.
3. Before beginning 24 hour urine collection,,patient is asked to void. This sample is discarded, and time noted.
4. Document time when collection was started on label as well as in nurse’s record.
5. Instruct patient to void as usual and collect urine into specimen container.
6. Advice not to spill urine.
7. All urine passed over next 24 hours is collected in the container, labeled with patient’s name and marked for particular test ordered.
8. At the same time after exactly 24 hours, patient is instructed to void and specimen is included
9. Document time and date of finishing on label and nurse’s record.
10. Send specimen to lab immediately along with lab request slip.

Instructions for 'Cold Application'

1. Assess the patient’s temperature
2. Explain the procedure to the patient
3. Cover pillow with mackintosh and towel
4. Fill 2/3^rd of ice cap with ice cubes and expel air before closing cap
5. Add a pinch of salt to ice cubes before closing.
6. Check for any leakage.
7. Cover bag with flannel cover after drying with duster.
8. Place on the desired area.
9. Apply for ½ hour and then continue with one hour gap in between if temperature is still high.
10. Observe patient’s reaction (bluish skin discoloration, mottling or chills).
11. Recheck the patient’s temperature
12. Record the time, duration of ice application, and the patient’s reaction and response.
13. Replace the ice cap after emptying and drying it upside down. Once it is dry, blow it to prevent its sides from sticking together.

Work Instructions for 'Care of Eye'

1. Check doctor’s order for eye care
2. Explain procedure to patient
3. Place patient in supine position
4. Ensure good lighting arrangement.
5. Wash hands
6. Stand near the head end of patient
7. Plug ear with non absorbent cotton
8. Turn patient’s head slightly to affected side
9. Keep K-basin below the ear at the affected side
10. Instruct the patient to keep the eye open.
11. Gently pull lower eye lid with two fingers
12. Take saline in irrigator and irrigate the affected eye. Or take saline in syringe, fix irrigating cannula, check patency of cannula.
13. Irrigate eye, flow to be in continuous stream.
14. Direct the fluid along the conjuctive over the eyeball from inner to the outer canthus.
15. Instruct patient to move the eyeball.
16. In case of chemical burn,irrigation needs to be continued for about 30 minutes
17. Remove earplug
18. Clean the eye with wet cotton
19. Make patient comfortable replace articles
20. Document patient’s complaints and the condition of eye