HOSPITAL CLEANLINESS
➡THERAPEUTIC NURSING CARE AND PROCEDURES
Indian people keep themselves clean but the area around their house like garden, market, platform, school, hospital etc. people feel as if the government has built it only for dumping garbage, the garbage is thrown outside instead of in the dustbin.
A hospital should be an example of cleanliness. Everything in a hospital should be clean and tidy. The nurse should tell the patient or his relative to keep him awake in the hospital. If the hospital is not kept clean, the patient may be freed from one disease and get caught in another disease.
➡CLEANLINESS RULES AND REGULATION
1) The patient coming to the hospital and his relative should be told the rules of hygiene in advance and care should also be taken to see if they behave accordingly.
2) Every ward should be cleaned daily and regularly
3) Before cleaning the ward, sweep should be done and then dusting should be done.
4) Phenyl should be mixed with water before killing itself as it is a disinfectant.
5) Use a brush if the surface is rough
6) The windows and doors of the ward should be kept open so that insects are destroyed even in sunlight.
7) Disinfectant solution should be sprinkled from time to time
8) Ward dustbin should be covered with hospital waste which should be put in that color waste bag.
9) The item used for dusting should be cleaned with soap
10) Equipment used for patient should be clean
11) Ceiling fans should also be cleaned once in a week
12) Asking relative’s boot slippers to be taken out of the ward
⏩BARRIER NURSING AND ISOLATION
When the steps taken as a precaution to prevent infection from one patient to another patient or staff member are called barrier nursing, this can also mean the steps to prevent direct contact of the inflected person.
In such steps, antibiotics are often given to the infected patient. Often the patient’s natural defense mechanism to fight against microorganisms is weakened. The procedure of providing protection against infection to the patient is called reverse barrier nursing.
➡PRINCIPAL OF BARRIER NURSING
1) As far as possible keep the patient in a single room which should have washbasin hot and cold water etc.
2) All surfaces in this room should be washable
3) Anyone attending the patient should first handwash
4) Minimum number of persons should be allowed to enter this room
6) Anyone entering must wear a gown and mask
7) Duty of special nurse should be arranged for patient care.
8) Adequate articles for patient care should be in the room
9) Washable or disposable toys should be given to the child to play with
10) Room cleanliness should be done under the supervision of nursing staff
11) Do not use anything used in this room for other patients without sterilizing it.
12) Disposable items should be used as far as possible
ISOLATION :-
The method of keeping an infected person in a separate room is called isolation. By which the transmission of disease can be prevented. The following points should be kept in mind for proper use of isolation technique.
1) Visitors should be prohibited from visiting such patients
2) Any person attending patient should use gown, madk and gloves.
3) Hands should be washed properly after attending to the patient.
4) Proper disposal of paperbag, tissue paper, solid clothes and discharges should be done.
➡ISOLATION TECHNIQUE
1) RESPIRATORY ISOLATION
Patients suffering from infectious diseases like whooping cough, influenza, diphtheria etc. are isolated.
Microorganisms released by coughing or sneezing of such patients can travel to the body of others. A nurse should wear a mask while treating such a patient and a gown should also be worn if such a disease occurs in a young child as the child may pass the latrine or urine at any time.
Tell the patient to keep a handkerchief or tissue paper over his mouth while coughing or eating, which should be disposed of immediately. The number of such patient visitors should also be limited.
2) INTESTINAL ISOLATION
Patients suffering from cholera, typhoid, dysentery or intestinal disease are isolated. Because microorganisms are spread from their stool and urine
There is no need to wear a mask while treating this patient but it is necessary to wear gloves and an apron while picking up the dirty clothes of the patient.
Dishes should be disinfected before sending the patient’s soiled clothes to the washer.
3) CONTACT ISOLATION
It is also necessary to isolate patients like gangrene, rabbis, std, aids, titanus, etc. While taking care of such a patient, the nurse has burnt the approan.
Wipe the secretion from the injury of such a patient immediately. Clothes should be disposed of properly. Everything used by such a patient should be disinfected
Did the nurse get any wound while taking care of such a patient? Where is the skin cut from? etc. matters should be taken care of.
4) BLOOD ISOLATION
Micro organisms like AIDS, malaria, filaria, etc. are spread in the patient’s blood. This disease is spread through blood. Mosquito net should be specially used for Malaria patient.
⏩Care of respiratory system :-
➡Inhalation:- Inhalation means that air or vapor is introduced into the lungs through the action of inspiration through the mouth or nose. Drugs are also often given by inhalation. Ex. Amulnitrate is given to relieve pain in ammonia angina pectoris in an attack of fainting.
➡Types of inhalation :-
➡1) Dry inhalation :-
No water is used in this. Ex. Ether, chloroform, menthol, eucalyptus oil, ammonia, spirit etc.
➡2) Moist inhalation :-
Water is used in this. Sometimes inhalation of only boiling water is also given. It is also called non-medicated inhalation. When any medicine is used in inhalation. Then the medicine is called inhalation.
Dry inhalation (oxygen therapy) :–
Oxygen is very necessary to save the patient’s life. Serious patients who have respiratory obstruction are given oxygen inhalation.
⏩Methods of giving oxygen therapy:-
1) Nasal catheter :-
Ward patients are usually given O2 by this method. In which O2 is given to the patient by placing a tube in the nose.
2) BLB mask (booth by lovalance bulbulian) :–
When the patient needs more O2, O2 is given by wearing a mask. The patient who cannot take respiration on his own is also given O2 through a mask. An ambu bag is attached to the other end.
3) Tent method :-
O2 is given by this method especially in children. Ex. Premature baby which is kept in incubator.
➡Oxygen cylinder :-
The color of O2 cylinder is black all over the world. And its upper part is white. It has a pressure meter. Above which the idea of how much pressure O2 is given.
On the upper side there is a lock to open the cylinder which can be opened by a key. In addition, there is a flow meter. which indicates the rate at which O2 is being delivered.
The O2 cylinder has a wolffls bottle. In which there is a butch with a total of 2 openings. It consists of two glass tubes. which are connected to the rubber tube of the O2 cylinder.
Small tubes are also submerged in water. Which is attached to the catheter connected to the patient. The cylinder also has a regulator which is used to vary the flow of O2. As O2 is flammable, no one should smoke near it.
⏩ Things to keep in mind while giving O2 therapy:
1) Do not handle O2 cylinder unless you know how to use it.
2) Adequate care and rigor should be exercised while administering O2 therapy. Even a little carelessness and a small mistake can take the life of a patient.
3) Ward O2 cylinder should be checked daily whether it is full or not, whether it is in working conditions or not.
4) Always keep O2 tray ready.
5) Always keep the O2 cylinder in a cool place.
6) Close the empty cylinder properly and keep it separate from the full cylinder. Marking it with a square.
7) Always bring the cylinder to the treatment room first. Do not start by bringing it to the patient.
8) Catheter should be smaller than nostril so that friction can be prevented.
9) Do not give O2 continuously, because of this there is a possibility of blindness.
10) The material used in the preparation of O2 should be clean.
11) Hand washing should be done before and after giving O2 therapy.
12) A catheter used for one patient is useful for another patient only after washing and boiling.
➡Articles for nasal catheter method :-
Nasal catheter-tongue depressor
Adhesive tape – cotton application
Scissors- kidney tray
Bowl of water – mackintosh
Flash light – jelly
Gauze piece
➡ Procedure :-
If the patient is conscious, explain the procedure to him.
Check the working condition of O2 cylinder.
Lubricate the catheter. At this time, be careful that the tip of the catheter does not get blocked due to the lubricate.
Before inserting the catheter into the nose, open the valve of the O2 cylinder, adjust the flow.
Measure the catheter from nostril to earlobe and mark
Maintain a flow of 2-4 liter/minute O2. Later, insert the catheter into the nostril by rotating it. Take it up to the oropharynx.
Checking the position of the catheter through the patient’s mouth.
Fixing the catheter on the nose.
Giving a comfortable position to the patient.
Change the catheter every 12 hours if long-term O2 is to be given.
⏩Moist inhalation :–
➡Purpose:-
1) To relieve inflammation of the mucus membrane of conditions like acute cold and sinusitis and to reduce congestion.
2) To relieve inflammation, congestion and edema in the larynx.
3) To relieve mucus and coughing.
4) To warm and moisten the inspired air after an operation like tracheotomy.
5) To reduce irritation in conditions like bronchitis and whooping cough.
6) As respiratory disinfection.
➡Solution used :-
1) plain water
2) Tincher benzoin into water
3) mentally in alcohol
4) Eucalyptus oil
➡Method :-
1) Nelson’s inhaler
2) jug method
3) Continuous steam by attention
⏩ Nelson’s inhaler :-
—Articles :-
Nelson’s inhaler with glass mouth piece and cork.
Gauze piece, wrap around the mouth piece.
To plug in cotton, air, inlet.
A bottle of inhalant
Mini glass
Boiling water in a kettle
Paint measure
Kidney tray
➡Procedure:-
Explain the procedure to the patient.
Giving proper position to the patient.
Installing a screen around the cot.
Mix Inhaled in water. Usually 25 ml is mixed in a pint of water.
2/3 of the inhaler is filled with boiling water.
Close the mouth piece with cork and wrap gauze around it
Cover the inhaler with a towel.
Place the inhaler in the basin and take it to the patient.
Make the patient sit with a backrest. Keeping cardiac table.
To close doors, windows, fans.
Cover the patient’s head with a sheet.
Keep the inhaler on the cardiac table and arrange the air inhaler in the opposite direction to the patient.
Remove the cotton swab from the air inlet and put it in the kidney tray. Remove the cork too
Give the inhaler to the patient. Keeping the mouth in the mouth piece, tell the steam to be taken in through the mouth and out through the nose.
At this time, check the pulse and respiration of the patient.
Ask the patient to spit into a sputum mug if he coughs.
Telling to wipe with perspiration napkin.
If the patient is disturbed, stop giving inhalation.
Stop the procedure when steam stops coming after at least 15 to 20 minutes.
Remove all equipment and give the patient a comfortable position.
➡Scientific principles:-
Steam inhalation causes artery dilation. So its circulation increases. Due to this, its inflammation is reduced and pain is reduced.
Exhaling the steam through the nose through the mouth gives a shake to the entire respiratory system.
Lungs feel cough thinned out.
As the action of Benzoin is antiseptic and anti-inflammatory, the growth of organisms stops.
Put 1:20 strength pemon in sputum mug so that sputum organisms die.
Steam is light in weight so it moves upwards. This principle is used in Nelson’s inhaler.
It is necessary to remove the cotton plugged in the air inlet while giving inhalation.
As the inhaler is made of Chinese clay, cover it with clothes. So that the water does not cool down quickly.
⏩Collection of specimen of sputum for examination:-
A) Give the patient a water proof disposable sputum mug the previous evening. Telling to collect the cough which comes out as sputum in the early morning. Do not collect saliva.
B) Clean the patient’s mouth with plain water and give antiseptic mouth wash to the patient.
C) Collect the sputum in a laboratory bottle and close it properly and put a label on it.
D) Sending the specimen to the laboratory for examination.
⏩CARE OF GENITO-URINARY SYSTEM :-
➡Perineal care :-
Definition :- Perineal care is a type of aseptic irrigation of perineum. Which is done after the act of defecation after delivery and after the operation of birth canal perineum, urinary and anus.
—->Purpose:-
1) To clean the skin of the perineum and the mucous membrane of the vulva.
2) To prevent the growth of bacteria by applying antiseptic drugs in these parts.
3) For ulcer healing of these parts.
4) To prevent itching in this area.
What kind of patient needs special perineal care?
1) post partum patient
2) Genito urinary tract operation
3) Surgery or ulcer in the perineal area.
4) Catheterized patient
5) Patient with excessive vaginal discharge
6) Patients who have complaints of incontinence urine / stool.
7) Genito urinary tract infection
8) The patient is not able to do perineal care by himself
➡Articles:-
—> a sterile tray;
Jug with warm water / antiseptic solution
Sterile cotton swab in small bowl
Antiseptic swabs in small bowl
Medicine as per instructions
Long artery forceps
Sterile dressing/napkin
Paper bag / kidney tray
—> a tray ;
‘T’ bandage
Mackintosh and drawing sheet
Bedpan
➡PROCEDURE:-
-Explain the procedure to the patient, so that he gets his co-operation.
––>Urine:-
Usually morning specimen is collected. Examination requires 4-6 ounces of urine. Often the patient’s 24 hour urine is collected for examination which is usually collected to check specific gravity in case of acute nephritis and sugar and acetone level in diabetes. The following points should be kept in mind for urine collection.
—>Stool:-
1.Giving bedpan to pass urine first.
➡Catheterization (Female patient) :-
A catheter is inserted into the urinary bladder through the urethra for drainage of urine. It is called catheterization.
—->Purpose:-
➡-Articles:-
—> a sterile tray;
-Sterile catheter, straight articles, Foley’s malla cot
––> a clean tray ;
-small macintosh and drawsheet
-kidney tray
Preparation of the patient :-
1) Explain the procedure to the patient.
2) Bring the patient near the edge of the bed and give dorsal recumbent position.
3) Fold the patient’s top linen three times and place it towards the foot end, cover the patient with another sheet.
4) Place mackintosh and draw sheet under patient’s buttocks.
5) Arranging the focus of the light in the right place.
6) To arrange the screen around the cot
➡Procedure:-
1) Hand washing like surgery procedure.
2) Arrange the autoclave sheet on the abdomen in such a way that the part of the perineum is exposed.
3) Open the sterile tray with antiseptic techniques.
4) Wear gloves.
5) Place a sterile towel under the buttocks
6) Place sterile kidney tray between 2 thighs.
7) Dip the swab in antiseptic lotion and clean the labia majora and minora with the help of artery forceps.
8) To clean the part up to the clitoris anus. Use a swab only once while cleaning.
9) Clean the right side of labia majora upwards to downwards and then clean the left side in the same way.
10) Then clean the labia minora.
11) Separate the vulva with the help of a swab with the finger and thumb of the left hand and clean the meatus canal with the help of forceps directly with the swab.
12) After cleaning, put the forceps in the kidney tray.
13) Place a swab lightly in the vaginal orifice. Which prevents contamination of the catheter. Prevents the catheter from entering the vagina. It also prevents the discharge from spreading from above.
14) Arrange the kidney tray on the towel close to the vulva.
15) Inspect the urinary meatus carefully. For which separate the labia minora with the 4 fingers and thumb of the left hand.
16) Take the catheter from the tray with the right hand and hold it 7.5 CM above the eye end.
17) Lubricate the tip of the catheter.
18) Then insert the catheter gently and carefully in the upward and backward direction about 5 to 7.5 CM into the orifice. Instruct the patient to breathe through the mouth.
19) If any obstruction is found, do not force to insert the catheter. At this time, withdraw the catheter a little and insert it again slowly.
20) Discard the catheter if it becomes unsterile before introducing it. And take another sterile catheter.
21) First, let the flow go into the kidney tray, then if you want to take the specimen, keep the end of the catheter in the bottle or test tube. The last flow of urine should be collected in the culture test. It is suitable for examination of pus cells and organisms.
22) If there is no urine flow after inserting a catheter of 5 to 7.5 cm, rotate the catheter.
23) Hold the end of the labia minora with two hands in such a way that the catheter does not sink into the urine of the kidney tray. Maintain this position until catheterization is complete.
24) If there is an indwelling catheter, inflate the balloon by injecting 5 to 30 ml of sterile water with a syringe, this will prevent the catheter from coming out and remains safe.
25) When the flow of urine stops, gently pinch and remove the catheter.
26) In acute urinary retention, do not take out more than 750 ml of urine at one time because there are chances of the patient going into shock due to sudden relief.
27) Make sure the bladder is empty or not.
28) Remove swab from vagina.
29) Clean the meatus with a wet swab and dry the passage.
30) Wipe the external part with the towel used for draping.
31) Take all articles to utility room.
32) Arrange bed clothes and give comfortable position to the patient.
33) Urine amount measurement and recording.
34) Note other observation in case paper.
35) Label the specimen and send it to the laboratory.
⏩Special points to be remembered for retained catheter:-
1.Maintain strict aseptic techniques.
⏩CATHETERIZATION FOR MALE PATIENT:-
In the male patient hold the penis and retract its skin keeping it at 90° from the leg and insert the upward to downward catheter. After inserting the catheter, retract the skin to its place.
➡Bladder irrigation:-
Bladder is called bladder irrigation if the fluid is taken out in the same way as some kind of solution is put in the bladder.
—–>Purposes:-
1) To clean the bladder before and after the operation
2) To reduce pain and infection
3) To apply medicine
4) To give heat
——>Articles:-
Take catheterization article
Sterile aseptic syringe or irrigation can & tube
Sterile pint measure
bucket if needed
➡Solution:- Boric solution 1 dram in 1 pint or normal saline
➡Procedure:-
➡ Special point to be remembered:-
1) Maintaining strict aseptic techniques
2) Using sterile solution
3) Enter the solution only by removing air from the syringe.