FUNDAMENTAL OF NURSING, UNIT-10

1. PREPARED BY-JYOTI
MHA

2.  Hospitals patients are often fearful and confused and these
feelings may impede recovery. Every effort should be made to
make the hospital stay as unthreatening, comfortable and
stress free as possible.
 The interior design plays a major role in this effort to create a
therapeutic environment.

3.  The place should not be densely populated.
 Hospital site should be elevated from surrounding.
 Independent access to a street.
 Away from nuisance such as dust, smoke, bad odour, noise, and
traffic.
 Adequate lighting.
 Natural ventilation.
 Safe drinking water facility.
 Control of noise.
 Collection of safe disposal of refuse and excreta.
 Good drainage system.
 Control of arthropods, vermin and animal pest.

4.  Walls and floors- should be nonabsorbent, non-porous, shock
absorbing, attractive, and fire resistant, durable easy to clean
and damp proof.
 Slippery floor are dangerous.
 The walls and floors should be free cracks and crevices to
prevent breeding of insects.
 The windows and door should be placed in such a way that
natural lighting is available in Room with cross ventilation.
 The rooms should be constructed in such a way that it
facilitates thermal control fumigation.

5.  Roof:
 Flats roofs: They provide protection against weather, roofing
materials used are Tiles, Asbestos, cement, metal.
 The latrines are placed in such a way that it does not cause
bad odour and unpleasant scenes to the patients and public. It
should be placed where direct sunlight enters.
 The receptions counters and out patient Department
should be near to the main entrance of the hospital. For easy
access of public and in patient department can be towards the
back of building.

6.  The kitchen and dinning rooms should be away from the
hospital wards and fly proof.
 There should be central corridor connecting the different
departments and wards.
 There should be provision for the isolation of patient having
infectious disease.
 Emergency doors are to be provided for the protection of
patient in case of fire hazards.
 There should be railings along the open corridors and
staircases to prevent accidents by falling.

7.  There should be provision for recreational and divisional
activities.
 Centralized work rooms helps to economies materials,
energy & time.
 The staircases, ramps and elevators should be centrally placed.

9. TEMPERATURE
A room temperature ranging from 20 to 22
degree C is considered comfortable. The
person should not feel chilly, but it should be
sufficiently warm.

10.  Patient care unit should be designed with appropriate ventilation
system and minimize the microbial contamination in the air.
 Ventilation means replacement of the warm or stagnant air and
control the quality of incoming air with reference to temperature,
humidity and purity.
 In the operation rooms and critical care source of natural
ventilation are avoided as they spread airborne pathogens.
 Air filtration systems designed to control the physical and
chemical condition, clean the air and adjust the temperature of
particulate air in high risk areas.
 Critical parameters for air quality include: maintenance of
filters, air movement, temperature and humidity should be
maintained b/w 20-22 degree C and 30-60%, respectively to
inhibit bacterial multiplication.

11.  Natural light is important in the care of the sick.
 Sunlight usually brightens the area and helps to improve the mental
wellbeing of the patient.
 However, light can be a source of irritation if it shines directly on the
patient’s eyes or produces a glare from the furniture, linen or walls.
 Whenever possible, provide a bed lamp for the patient.
 A dim light is valuable as a comfort and safety measure at night. This light
should be situated as not to shine in the patient’s eyes and yet provide
sufficient light along the floor so that all obstructions can be seen.
 A night light may help to orient elderly patients, if they are confused as to
their surroundings upon awakening.
 Use shades and drapes to control bright, natural light whenever necessary.
 Provide adequate light for reading

12.  To maintain a healthy climate, good ventilation is necessary in
controlling and eliminating disagreeable odors.
 In cases where airflow does not control odors, room
fresheners should be discretely used.
 Offensive, odor- producing articles (such as soiled dressings,
used bedpans and urinals) should be removed to appropriate
disposal and disinfecting areas as soon as possible.
 Good personal hygiene practices should be maintained to
controlled the objectionable odors (such as bad breath or
perspiration of patients).

13.  Noise control is another environmental element that requires
attention.
 The large number of people and the amount of equipment
traffic in a facility serve to create a high noise level that must
be monitored.
 Residents easily disturbed by unfamiliar noises.
 Noise produces irritability, restlessness, fatigue and
exhaustion in acutely ill patient.
 Noise disturb the sleep.
 Staff should avoid loud laughter and loud talking.
 Control the use of radio, television during the rest.

14.  Pest control is the responsibility of hospital housekeeping by
maintenance and repair of building as cracks and defects in sanitary
pipes or in construction leads to the development of pest in the
hospital.
 So appropriate training for pest control should be given to the
housekeeping staff and there should be regular sprays and
disinfection of the patient care units.
 Regular use of insecticides and pesticides are used in hospital to
ensure a clean and pest free hospital environment.
 Remove open food left in units that will attract ants and roaches, as
well as microorganisms.
 Family and visitors should consult with charge nurse before
bringing in food for residents.
 Ensure proper disposal of food and waste materials.

15.  In addition to the general safety concerns of all buildings,
hospitals have several particular security concerns:
1. Protection of hospital property and assets, including drugs.
2. Protection of patients, including incapacitated patients and
staff.
3. Safe control of violent or unstable patients.
4. Vulnerability to damage from terrorism because of
proximity to high vulnerability targets.

16.  Maintaining cleanliness is a major responsibility of all
members of the healthcare team.
 Cleanliness not only provides for patient comfort and a
positive stimulus, it also has an impact on infection control.
 The nurse is often directly responsible for the maintenance of
patient care areas.
 The management of cleanliness in patient care areas is
conducted concurrently and terminally.
 Concurrent cleaning is the disinfection and sterilization of
patient supplies and equipment during hospitalization, whereas
Terminal cleaning is done after discharged from the unit or
hospital.

17.  Aesthetics are closely related to create a therapeutic environment.
 It is important in enhancing the hospital’s public image and thus an
important marketing tool.
 Aesthetic consideration include:
1. Increased use of natural light, natural material and textures.
2. Use of network.
3. Compatibility of exterior design with its physical surroundings.
4. Flower vase, picture and curtains add to the pleasant outlook of
the room.
5. Research has shown that the use of color is calming and restful
to the patient and rest is very important healing agent in any
kind of illness.

18.  There may be different types of injuries which pose a threat to
the comfort of patients, and thus are considered as crucial
factors determining their safety needs. Some of these injuries
are:
1. Mechanical injury
2. Thermal injury
3. Chemical injury
4. Radiation injury
5. Bacteriological injury
6. Allergen- induced injury
7. Injury induced by small insects, pests and vermin

20. MECHANICAL INJURY
Injury caused by machines, falls and blows. This involves injury by
fall from a bed or window, fall while standing or walking, by
tangled cords or tubing, by the movement of
wheelchair/stretcher/walker or by inadequate protection while
being lifted or moved.

21. THERMAL INJURY
Injury caused by fires and burns that includes trauma,
asphyxia, burns etc. or injury caused by other sources of heat,
e.g. application of a hot water bottle, electric heating pads, a
steam inhaler etc. Other causes can be smoking in bed,
defective wiring, explosion of gases or flammable liquids etc.

22. CHEMICAL INJURY
Injury due to use of too strong or poisonous chemical kept
within the reach of the patient. It occurs due to the caustic
effect of strong chemicals on the skin or taken internally or
from an overdose of a prescribed drug.

23. RADIATION INJURY
Injury that occurs from over exposure to radiation of x-ray,
radium, infra-red and UV light rays.

24. BACTERIOLOGICAL INJURY
Injury related to ineffective elimination of disease causing
organisms and dirt that harbor them.

25. ALLERGEN- INDUCED INJURY
Injury due to allergens may result from insect bites or
material in the environment such as food, cosmetics, soap,
lotion, powders, medicines etc. Manifested by skin reactions
like rashes, and irritation of mucous membrane e.g. Sneezing,
coughing, watery eyes and difficult breathing etc.

26. INJURY INDUCED BY SMALL INSECTS,
PESTS AND VERMIN
Injury caused by small insects, pests and vermin, viz. due to
rats, flies, moth, bed bugs, cockroaches etc.

27. 1. Identify patients at risk for injury:-Those at special risk
include:
a) Elderly or confused patients.
b) Patients with impaired vision or hearing.
c) Patients with impaired mobility(wheelchairs, walkers, partial
paralysis).
d) Patients with a history of falls.
e) Patients with a history of substance abuse.
f) Patients receiving medication that interferes with reasoning or
motor functions.

28. 2. To prevent falls:-
a) Place the bed in the low position.
b) Keep the side rails up when the patient is not receiving
bedside care.
c) Advise the patient to wear flat shoes that fit well when
walking.
d) Ensure that nonskid strips or mats are affixed to the bottom
of bath tubs and shower floors.
e) Ensure that bathtubs have sturdy handrails and shower stools
are in place when needed.
f) Warn Patients and visitors when floors are wet and slippery.
Also see that signs are posted.
g) Maintain dry and uncluttered floors.
h) The total care of environment must be equipped with
adequate night lights.

29. 3. PROTECTIVE RESTRAINTS:-
a) Use restraints when careful assessment indicates that these are needed.
b) Use the least restrictive type of restraint, which will protect the patient.
c) The vest restraint may only be necessary while a patient is sitting in a
wheelchair.
d) Provide for as much movement as possible. The waist restraint protects
the patient from falling out of bed but still allows the patient to change
position independently.
e) Restraint the fewest limbs or body parts possible. However, if leg
restraints are necessary, use wrist restraints also. If this is not done, the
patient may remove the leg restraints or he may accidentally hang by his
heels in the restraints.
f) Tie the restraint with a knot that is not likely to come loose, yet can be
released easily by the nurse in an emergency. A half-bow knot meets these
criteria.
g) Explain to the patient the reason for the patient restraint. Position him
comfortably and change his position every two hours. Feed the patient
who must remain restrained during meals. Help him in using the toilet,
bedpan or urinal at regular intervals.

30. 4. Prevent scalds and burns:-
a) Place coffee, tea and other hot liquids where the patient can
reach easily and safely.
b) Assist the patient if there is any doubt about whether he can
safely regulate the temperature of water in tubs or showers.
c) Carefully follow policy when using hot water bags or heating
pads. Because of the danger of burning patients, many health
care facilities do not allow their use.

31. 5. Prevent the spread of infection:-
A health care facility may adopt its own infection control
policies and practices. However, the procedures generally
follow the recommendations from the CDC. This is a federal
agency that studies pathogens, outbreaks of contagious
diseases and methods used to control these outbreaks.
a) Preventing disease, including infections, is a high priority in
health care. Nurses should use techniques that prevent
microorganisms from living, growing and spreading.
b) Two methods are used to reduce or eliminate the presence of
microorganisms and thus prevent infections. These two
methods are surgical and medical asepsis.

34. d) It is important that the nurse teaches patient facts and
practices about surgical and medical asepsis. When teaching a
patient nurse should:-
 Observe the patient to identify areas where instruction would
be helpful in controlling the spread of infection.
 Act as a model by using sound practices of asepsis when
giving care.
 Provide guidance to the patient who must give himself care at
home in the proper way to handle sterile equipment and
supplies and how to sterilize reusable items.

35. 6. Report infections:-
 Health care workers must report any infection that occurs.
 The Infection Control Committee will investigate any case of
infection to determine the cause.
 If a break in nursing technique is identified, the committee
will propose different procedures to eliminate the problem.

36. 7. Universal body substance precautions:-
a) Blood is the single most important source of transmission of
blood borne pathogens in health care settings. Infection
control efforts must focus on preventing exposures to blood.
Although the risk is unknown, universal precautions also
apply to tissues and to CSF, synovial fluid, pleural fluid,
peritoneal fluid and amniotic fluid.
b) Precautions are used for all patients. (Rationale: It is
impossible to know which patients are infected with such
conditions as HIV, HBV or other infectious agents).
c) Gloves are worn whenever the HCW may come in contact
with blood, body fluids. (Rationale: Disease can be carried in
the body substances).

37. d) Change gloves after each contact with a client.
e) Wash your hand and skin surfaces immediately. (Rationale: Proper
washing will help to stop the spread of infection).
f) Wear a gown or apron when clothing could become soiled.
(Rationale: To prevent spread of infection to yourself or others).
g) Wear a mask and eye protection if splashing is possible. Hospital
protocol will determine what type of eye protection is required for
each specific case. (Rationale: Infection could enter your body
through the mucous membranes of mouth or nose or through eyes).
h) Dispose off sharp objects carefully. Do not recap or break
needles. Needles and sharp objects are placed in a special container
after use. (Rationale: There is possibility of needle stick injury).