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1. CHAPTER ONE
INTRODUCTION TO NURSING ART
J.K

2.  Nursing is an art and a science by which
people are assisted in learning to care for
themselves whenever possible and cared for
by others when they are unable to meet their
own needs.
J.K

3.  Nursing has evolved from an unstructured method
of caring for the ill to a scientific profession.
 The result has been movement from the mystical
beliefs of primitive times to a “high-tech, high-
touch” era.
 Nursing combines art and science. Using scientific
knowledge in a humane manner, nursing combines
critical thinking skills with caring behaviors.
J.K

4.  Nursing requires a delicate balance of
promoting clients’ independence and
dependence.
 Nursing focuses not on illness but rather on
the client’s response to illness.
 Nursing promotes health and helps clients
move to a higher level of wellness.
J.K

5.  This aspect of nursing also includes assisting
a client with a terminal illness to maintain
comfort and dignity in the final stage of life.
 It is the diagnosis and treatment of human
responses to actual or .potential health
problems” (ANA 1980).
J.K

6.  It is assisting the individual, sick or well in
the performance of those activities
contributing to health or its recovery (to
peaceful death) that he will perform unaided,
if he/she had the necessary strength, will or
knowledge and to do this in such a way as to
help him gain independence as rapidly as
possible (Virginia Henderson 1960).
J.K

7.  Is a practical science with knowledge &
skill
 Bring a positive change to people we
care
 The art of meeting human needs
 Skill full & creative application of nursing
process to the solution of human
problems
 Giving care based on scientific principle
in humanism
J.K

8. To promote health (wellness) to
give Rx.
To prevent illness
To restore health
To facilitate coping
To care of sick
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9. CHAPTER TWO
DIFFERENT TYPES OF BED MAKING
J.K

10. Describe different types of bed
making
Develop understanding about
general instruction of bed making
Develop a skill to make different
types of bed.
Mention purposes of bed making
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11.  Closed bed:-is a smooth, comfortable and
clean bed, which is prepared for a new
patient.
 Purpose:-
 To provide clean and comfortable bed for the
patient
 To reduce the risk of infection by maintaining
a clean environment
 To prevent bed sores by ensuring there are
no wrinkles to cause pressure points
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12.  In closed bed: the top sheet, blanket and
bed spread are drawn up to the top of the
bed and under the pillows.
 Open bed: -is one which is made for an
ambulatory patient are made in the same
way but the top covers of an open bed are
folded back to make it easier of a client to
get in.
 Purpose:
 To prevent bed sores.
 To economize time, material and effort.
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13.  Occupied bed: is a bed prepared for a weak
patient who is unable to get out of bed.
 Purpose
 To provide comfort and to facilitate
movement of the patient
 To conserve patient’s energy and maintain
current health status
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14.  Anesthetic bed: is a bed prepared for a
patient recovering from anaesthesia
 Purpose: to facilitate easy transfer of the
patient from stretcher to bed
 Amputation bed: a regular bed with a bed
cradle and sand bags
 Purpose: to leave the amputated part easy
for observation
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15.  Fracture bed: a bed board under normal
bed and cradle
 Purpose: to provide a flat, unyielding
surface to support a fracture part
 Cardiac bed: is one prepared for a patient
with heart problem
 Purpose: to ease difficulty inbreathing
J.K

16. 1. Put bed coverings in order of use
2. Wash hands thoroughly after handling a patient's
bed Linens and equipment soiled which secretions
and excretions harbor micro-organisms that can
be transmitted directly or by hand’s uniforms
3. Hold soiled linen away from uniform
4. Linen for one client is never (even momentarily)
placed on another client’s bed
5. Soiled linen is placed directly in a portable linen
hamper or a pillow case before it is gathered for
disposal
6. Soiled linen is never shaken in the air because
shaking can disseminate secretions and
excretions and the microorganisms they contain
J.K

17. 7. When stripping and making a bed, conserve
time and energy by stripping and making up
one side as completely as possible before
working on the other side
8. To avoid unnecessary trips to the linen supply
area, gather all needed linen before starting to
strip bed
9. Make a vertical or horizontal toe pleat in the
sheet to provide additional room for the
client’s feet.
Vertical - make a fold in the sheet 5-10 cm 1 to
the foot
Horizontal – make a fold in the sheet 5-10 cm
across the bed near the foot
10. While tucking bedding under the mattress the
palm of the hand should face down to protect
your nails.
J.K

18. 1.Mattress cover
2.Bottom sheet
3.Rubber sheet
4.Cotton (cloth)
draw sheet
5.Top sheet
6. Blanket
7. Pillow case
8. Bedspread
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19. Note
 Pillow should not be used for
babies
 The mattress should be turned as
often as necessary to prevent
sagging, which will cause
discomfort to the patient.
J.K

20.  Closed bed (unoccupied or un assigned bed)
 Equipment required
J.K
 Mattress (1)
 Bed sheets (2): Bottom
sheet (1) Top sheet (1)
 Pillow (1)
 Pillow cover (1)
 Mackintosh (1)
 Draw sheet (1)
 Blanket (1) Savlon
water or Dettol water
in basin
 Sponge cloth (4): to
wipe with solution (1)
to dry (1)
 ✽ when bed
make is done by two
nurses, sponge cloth
is needed two each.
 Kidney tray or paper
bag (1)
 Laundry bag or Bucket
(1)
 Trolley (1)

21. J.K

22.  Wash hands
 Asses the condition of the bed and mattress
 Make sure the unit and the bed is disinfected, clean
and free of contaminants
 Assemble materials
 Place the trolley conveniently
 Maintain proper body mechanics
 Adjust the bed (e.g. height...)
 Grasp the mattress securely, turn and move it up to
the head of bed
 Place the bottom sheet with the center fold at the
center of the bed, spread with hem-side down
wards and tuck at the head of the bed
 Miter the bottom sheet at head of the bed and tuck
on side starting from head to foot of bed
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23.  Place the rubber and cotton draw sheet over
the bottom sheet at the middle third of the
bed and tuck on side.
 Place the top sheet on the bed with the
hem-side upwards, make a vertical or
horizontal toe pleat, tuck and miter corner
at the foot of the bed
 Place the blanket over the top sheet, put the
edge about 15 cm from the head of the
bed, cuff the top sheet and follow the same
procedure as for the top sheet.
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24.  Place the bed spread over the blanket to the
edge of head of the bed tuck at the foot and
miter corner.
 Cover pillow/s completely with pillow case and
put it on the bed tuck side of the bed as a
whole.
 Move to the other side, straighten and secure
the bottom bed linen.
 Complete the top linen as for the other side.
put pillow under the bed spread with open side
away from the door.
 Evaluate the bed and the unit for good
appearance, fresh air and adequate lightening
etc.
J.K

25.  Procedure
 Wash hands
 Identify client, greet and introduce self
 Assess general condition of the client
 Verify specific orders or precautions for
moving and positioning the client
 Determine the ability of the client to move
 Determine the assistance needed
 Assess presence of incontinence or excessive
drainage
 Determine linen to be changed and any need
of comfort device
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26.  Assemble necessary items
 A pair of bed sheet
 Rubber draw sheet
 Cotton draw sheet
 Pillow case
 Others depending on the nurses assessment
 Place trolley in a convenient place
 Explain the procedure to the client
 Take vital signs and make own judgment
 Remove any equipment attached to the bed linen
 E.g. calling bells, drainage tubes etc
 Maintain proper body mechanics
◦ Loosen all the top bed at the foot of the bed and
remove it
◦ Leave the top sheet over the client or replace with
a bath blanket
◦ Adjust the height of bed
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27. ◦ Place the bed in a flat position if the client's
health permits
◦ Grasp the mattress lugs and move the mattress
up to the head of the bed
◦ Assist the client to turn on the side facing away
from the side where the clean linen is
◦ Raise the side rail nearest the client. Have
another nurse support the client at the edge of
the bed
◦ Loosen the foundation linen on the side of the
bed near the trolley
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28. ◦ Fanfold the draw sheet and the bottom sheet at
the center of the bed; as close to the client as
possible and leave the half of the bed free to be
changed.
◦ Assist the client turn towards you on to the clean
side of the bed
◦ Place the new bottom sheet on the bed and
vertically fanfold the half to be used on the far
side of the bed as close as to the client as
possible
◦ Tuck the sheet under the near half of the bed and
miter the corner
◦ Place the clean draw sheet on the bed with the
center fold at the bed .Fanfold the upper most
half vertically at the center of the bed and tuck
the near side edge under the sides of the
mattress
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29. ◦ Move the pillows to the clean side for the client .Raise
the side rail before leaving the side of the bed
◦ Move to the other side of the bed and lower the side rail
◦ Remove the used linen and place it in the portable
hamper
◦ Smooth out the mattress cover to remove any wrinkles.
Unfold the fan folded bottom sheet from the center of
the bed
◦ Facing the side of the bed, use both hands to pull the
bottom sheet so that it is smooth, and tuck the excess
under the side of the mattress
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30. ◦ Unfold rubber and cotton draw sheet, fanfold at
the center of the bed and pull it tightly with both
hands.
 Pull the sheet in three sections face the:
 side of the bed to pull the middle section
 far top corner to pull the bottom section
 far bottom corner to pull the top section
 Tuck the excess rubber and cotton draw sheet
under the sides of the mattress
 Reposition the pillow at the center of the bed
J.K

31.  Assist the client to the center of the bed.
Determine the position the client requires or
prefers and assist the client to that position.
 Spread the top sheet over the client and ask
client to hold the top edge of the sheet or tuck
it under the shoulders. The used sheet is
removed.
 Complete the top of the bed
 Raise the side rails and readjust the height and
position of the bed before leaving the bed side.
 Attach the signal cord to the bed linen and put
items used by the client within reach
 Check client’s comfort and safety, patency of
the drainage tubes if any and client's ability to
call for help when needed.
J.K

32.  Definition: It is a special bed prepared to
receive and take care of a patient returning
from surgery.
Purpose:
 To receive the post-operative client from
surgery and transfer him/her from a
stretcher to a bed
 To arrange client’s convenience and safety
J.K

33. 1. Bed sheets: Bottom
sheet(1)Top sheet (1)
2. Draw sheet(1-2)
3. Mackintosh or rubber sheet(1-
2) NB;-According to the type
of operation, the number
required of mackintosh and
draw sheet is different.
4. Blanket(1) Adhesive tape(1)
5.Hot water bag with hot
water(104-140℉)If needed (1)
6. Tray1(1)
7. Thermometer, stethoscope,
sphygmomanometer: 1each
8. Spirit swab
9. Artery forceps(1)
10.Adhesive tape(1)
11 Gauze pieces
12 Kidney tray(1)
13. Trolley(1)
14. IV stand
15. Client’s chart
16. Client’s kardex
17. According to doctor’s orders:
Oxygen cylinder with flow meter
O2 cannula or simple mask
Suction machine with suction
tube
Airway
Tongue depressor
SpO2 monitor
ECG
Infusion pump, syringe pump
J.K

34. Learning Objectives
 At the end of this unit, the learner able to:
 Describe several aspects of general care to
the patient, including bath oral, hair,
Perineal area care, and feeding helpless
patient.
 Demonstrate the ability to perform each of
these specific care procedures of general
patient care.
J.K

35.  It is a bath given to a patient in the bed
who is unable to care for himself/herself.
Purpose:
 To prevent bacteria spreading on skin
 To clean the client’s body
 To stimulate the circulation
 To improve general muscular tone and joint
 To make client comfort and help to induce
sleep
 To observe skin condition and objective
symptoms
J.K

36. 1. Cleansing
2. Therapeutic
 Before bathing a patient, determine
a. The type of bath the client needs
b. What assistance the client need
c. Other care the client is receiving – to prevent
undue fatigue
d. The bed linen required
Note: when bathing a client with infection, the
caregiver should wear gloves in the presence of
body fluids or open lesion.
J.K

37. Principles
 Close doors and windows: air current
increases loss of heat from the body by
convection
 Provide privacy – hygiene is a personal
matter & the patient will be more
comfortable
 The client will be more comfortable
after voiding and voiding before
cleansing the perineum is advisable
 Place the bed in the high position:
avoids undue strain on the nurses back
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38.  Assist the client to move near you –
facilitates access which avoids undue
reaching and straining
 Make a bath mitt with the washcloth. It
retains water and heat better than a cloth
loosely held
 Clean the eye from the inner canthus to the
outer using separate corners of the wash
cloth – prevents transmitting micro
organisms, prevents secretions from
entering the nasolacrmal duct
 Firm strokes from distal to proximal parts
of the extremities increases venous blood
return
J.K

39. BED BATH
Equipment’s required:
a. Basin(2):for with out soap(1)for with soap
(1)
b. Bucket(2):for clean hot water(1)for waste
(1)
c. Jug(1)
d. Soap with soap dish(1)
e. Sponge cloth(2):for wash with soap(1)
 For rinse (1) Face towel (1)Bath towel
(2):for covering over mackintosh (1)for
covering over client’s body (1) Gauze piece
(2-3)
J.K

40. Mackintosh(1)
g. Trolley(1)
h. Thermometer(1)
i. Old news paper - Paper bag (2): A. for
clean gauze (1) B. For waste (1)
 Bath Solutions
1. Saline: 4 ml (1Tsp) NaCl to 500 ml (1 pt)
water
 Has a cooling effect
 Cleans
 Decrease skin irritation
J.K

41. 2. Sodium: 4 ml (1Tsp) NCHCO3 to 500 ml (1
pt) water, bicarbonate or 120-360 ml 120
liters
 Has a cooling effect
 Relieves skin irritation
3. Potassium permanganate (Kmno4):
available in tablets, which are crushed,
dissolved in a little water, and added to the
bath
 Cleans and disinfects
 Treats infected skin areas
 Oatmeal (Aveeino) and cornstarch can also
be used
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42.  Definition: Back care means cleaning and
massaging back, paying special attention to
pressure points.
 Especially back massage provides comfort and
relaxes the client; thereby it facilitates the
physical stimulation to the skin and the
emotional relaxation.
 Purpose
 To improve circulation to the back (To prevent
pressure sores (decubitus))
 To refresh the mood and feeling
 To relieve from fatigue, pain and stress
 To induce sleep (To relieve insomnia )
J.K

43.  Definition: Mouth care is defined as the
scientific care of the teeth and mouth.
 Purpose
 To keep the mucosa clean, soft, moist and
intact
 To keep the lips clean, soft, moist and intact
 To prevent oral infections
 To remove food debris as well as dental plaque
without damaging the gum
 To alleviate pain, discomfort and enhance or
alintake with appetite
 To prevent halitosis or relieve it and freshen
the mouth
J.K

44.  Perineal Area: Is located between the thighs
and extends from the top of the pelvic bone
(anterior) to the anus (posterior)
 Contains sensitive anatomic structures
related to sexuality, elimination and
reproduction
 Perineal Care (Hygiene)
 Is cleaning of the external genitalia and
surrounding area
 Always done in conjunction with general
bathing
J.K

45.  Post-partum and surgical patients
(surgery of the perinealarea)
 Non-surgical patients who unable
to care for them selves
 Patients with catheter (particularly
indwelling catheter)
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46.  Genito- urinary inflammation
 Incontinence of urine and feces
 Excessive secretions or concentrated urine,
causing skin irritation or excoriation
 Presence of indwelling urinary (Foley)catheter
 Post partum care
 Care before and after some types of perinea
surgery
 Purpose
 To remove normal perineal secretions and
odour’s
 To prevent infection (e.g. when an indwelling
catheter is in place)
 To promote the patient's comfort
J.K

47.  procedure
 if the individual is weak or helpless, two
peoples are needed to place and remove bed
pans
 If a person needs the bed pan for a longer
time periodically remove and replace the pan
to ease pressure and prevent tissue damage
 Metal bed pans should be warmed before use
by:
 Running warm water inside the rim of the pan
or over the pan
 Covering with cloth
J.K

48.  Semi-Fowler’s position relieves strain on the
client’s back and permits a more normal
position for elimination
 Improper placement of the bedpan can cause
skin abrasion to the sacral area and spillage
 Place a regular bed pan under the buttocks
with the narrow end towards the foot of the
bed and the buttocks resting on the smooth,
rounded rim
 Place a slipper (fracture) pan with the flat, low
end under the client’s buttocks
 Covering the bed pan after use reduces
offensive odors and the clients
embarrassment
J.K

49.  Definition:
 Mouth care is defined as the scientific care of the
teeth and mouth.
 Purpose:
 To keep the mucosa clean, soft, moist and intact
 To keep the lips clean, soft, moist and intact
 To prevent oral infections
 To remove food debris as well as dental plaque
without damaging the gum
 To alleviate pain, discomfort and enhance oral
intake with appetite
 To prevent halitosis or relieve it and freshen the
mouth
J.K

50.  Definition
 Assisting a helpless patient to take food
and fluid
 During illness, trauma or wound healing,
the body needs more nutrients than usual.
 However, many peoples, because of
weakness, immobility and/or one or both
upper extremities are unable to feed
themselves all or parts of the meal.
J.K

51.  Therefore, the nurse must be knowledgeable, sensitive
and skillful in carrying out feeding procedures.
 Purpose
 To be sure the pt. receives adequate nutrition
 To promote the pt. well-beings
 Preliminary assessment
 Check physicians order
 Plan diet according to the need of the client
 Ensure that the ordered diet is prepared properly and
safely
 Find out food habits of client • Find out any treatment
or procedures to be carried out immediately • Check
the general condition of the client
 Check the clients ability to follow directions
 Check the articles available in the clients unit
J.K

52. Learning Objectives
At the end of the unit the learner will be able
to:-
• Take vital signs and interpret the finding
• Assist the patient in laboratory diagnosis.
• Collect specimen with accuracy as indicated.
• Record, maintain and communicate the
finding.
• Give appropriate care based on the finding.
J.K

53.  Because only medical history can’t lead to the
accurate diagnosis of the patient’s problem.
 Laboratory examinations of specimens such as;
urine, blood, sputum, stool, throat swab, vaginal
swab, wound drainage etc. provide important
adjunct information for diagnosing health care
problems and also provide a measure of the
response to therapy.
 Laboratory test contribute vital information about
the clients health.
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54.  Correct diagnosis and therapeutic decision
rely, in part, on the accuracy of the test
result.
 Adequate patient preparation, specimen
collection, and specimen handling are
essential prerequisites for accurate test
results.
 Specimen collection refers to collecting
various specimens (samples), such as, stool,
urine, blood and other body fluids or
tissues, from the patient for diagnostic or
therapeutic purposes.
J.K

55.  Failure to label specimen correctly and to
provide all pertinent information required on
the test request form.
 Insufficient quantity of specimen to run the test
 Failure to use the correct container /tube for
appropriate specimen preservation
 Inaccurate and incomplete patient instruction
prior to collection
 Failure to tighten specimen container, resulting
in leakage and/or contamination of the
specimen.
 failure to maintain the specimen at appropriate
temperature
J.K

56. ◦ Patient’s name, address, age, sex,
ward and bed number, ID (if any)
◦ clearly marked test request
◦ Name and address of ordering
person
◦ Type (or source of the specimen)
◦ Clinical information
◦ Date and time of collection
J.K

57.  Patient’s full name
 Medical record no
 Date and time of specimen
collection
 Specimen source (it indicated)
 Sign of the person who conducted
the procedure
Unless it is labeled with this
information the specimen will be
rejected.
J.K

58.  When collecting specimen, wear gloves to
protect self from contact with body fluids.
1. Get request for specimen collection and
identify the types of specimen being
collected and the patient from which the
specimen collected.
2. Give adequate explanation to the patient
about the purpose, type of specimen being
collected and the method used.
J.K

59. 3. Assemble and organize all the necessary
materials for the specimen collection.
4. Get the appropriate specimen container
and it should be clearly labeled have tight
cover to seal the content and placed in the
plastic bag or racks, so that it protects the
laboratory technician from contamination
while handling it.
J.K

60.  The patient's identification such as, name,
age, card number, the ward and bed
number (if in-patient).
 The types of specimen and method used (if
needed).
 The time and date of the specimen
collected.
5. Put the collected specimen into its
container without contaminating outer parts
of the container and its cover.
6. All the specimens should be sent promptly
to the laboratory, so that the temperature
and time changes do not alter the content.
J.K

61. Purpose
 To identity components of urine
 To determine the presence of legal or illegal
drugs
 To determine pregnancy
 To diagnose physiological disorder
 Routine laboratory analysis and culture and
sensitivity tests
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62. A. Clean voided urine specimen
 Clean catch or midstream specimen: - is used
when specimen relatively free of MOs is
required.
 The specimen is taken immediately to the lab.
B. Sterile urine specimen
 Specimen from catheter: - may be necessary
when the client is unable to void or already has
a catheter in place.
 Urine should not be collected from the
collection bag; it should be directly obtained
from the catheter.
J.K

63. C. Timed urine specimen
 It is two types
 Short period  1-2 hours
 Long period  24 hours
 24hrs urine specimen: - is used to measure
accurately renal (kidney) function for certain
substances such as creatinine, urine urea
nitrogen, glucose, sodium, potassium etc.
 often started early in the morning after the
client’s first void, the first void is discarded
and the time is noted as the beginning of
the 24hrs period during which all urine is
saved /collected
J.K

64. D. Random urine specimen: -
 As the name implies the specimen is
collected at any time.
 This is the specimen most commonly sent
to the laboratory for analysis, because it is
easier to obtain and readily available.
 This specimen is usually submitted for
urinalysis and microscopic analysis,
although it is not a specimen of choice for
either of these tests.
J.K

65.  Sterile urine specimen collected using a
catheter in aseptic techniques
 Collecting a Timed Urine Specimen
Purpose
 For some tests of renal functions and urine
compositions, such as: - measuring the
level of or hormones, such as adrenocortico
steroid hormone creatinine clearance or
protein quantization tests.
J.K

66.  Sputum is the mucus secretion from the
lungs, bronchi and trachea, but it is
different from saliva.
 The best time for sputum specimen
collection is in the mornings up on the
patient’s awaking (that have been
accumulated during the night).
 If the patient fails to cough out, the health
professionals can obtain sputum specimen
by aspirating pharyngeal secretion using
suction.
J.K

67. Purpose
 Sputum specimen usually collected for:
 Culture and sensitivity test (i.e. to identify
the microorganisms and sensitive drugs for
it)
 Cytological examination
 Acid fast bacillus (AFB) tests
 Assess the effectiveness of the therapy
J.K

68. Collecting Stool Specimen
 Purpose
 For laboratory diagnosis, such as
microscopic examination, culture and
sensitivity tests.
◦ COLLECTING BLOOD SPECIMEN
Arterial blood
◦ Difficult to identify
◦ Blood flows with pumping pressure
◦ Control of blood collection is difficult
◦ Difficult to stop the blood
J.K

69.  Venous blood
 Easy to identify
 Better control on flow of blood
 Blood can be stopped
 The hospital laboratory technicians obtain
most routine blood specimens.
 Venous blood is drown for most tests, but
arterial blood is drawn for blood gas
measurements.
J.K

70.  Purpose
 To assess the bloods normal cells & other
components
 To determine the presence of abnormalities or
disease causing organisms
 Specimen of venous blood are taken for
complete blood count, which includes
o Complete blood count including Hgb and Hct,
WBC with differential count etc.
o To measure serum electrolyte and acid-base
balance
o To evaluate renal function test by measuring
blood urea and creatinine
o To evaluate serum osmolarity (fluid balance)
J.K

71. o For monitoring serum drug levels. e.g. digoxin,
o For blood chemistry e.g. to evaluate serum enzyme
level
o To evaluate blood glucose level
o To measure arterial blood gases
o To know blood group etc
Equipment
• Sterile gloves
• Tourniquet
• Antiseptic swabs
• Dry cotton (gauze)
• Needle and syringe
• Specimen container with the required diluting or
preservative agents
• Identification/ labeling
• Laboratory requisition forms
J.K

72.  Procedure
1. Patient preparation
• Instruct the pt what to expect and for fasting
(if required)
• Position the pt comfortably
2. Select and prepare the vein sites to be
punctured
• Put on gloves
• Select the vein to be punctured. Usually the
large superficial veins used such as, brachial
and median cubital veins.
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73. • Place the veins in dependent positions
• Apply tourniquet firmly 15-20 cm about the
selected sites. It must be tight enough to
obstruct vein blood flow, but not to occlude
arterial blood flow.
• If the vein is not sufficiently to dilate
massage (stroke) the vein from the distal
towards the site or encourage the pt to clench
and unclench repeatedly.
.Clean the punctured site using antiseptic
swabs
J.K

74. 3. Obtain specimen of the venous to blood
• Adjust the syringe and needles
• Puncture the vein sites
• Release the tourniquet when you are sure
in the vein
• Withdraw the required amount of venous
blood specimen
• Withdraw the needle and hold the sites
with dry cotton (to apply pressure)
• Put the blood into the specimen container
• Made sure not to contaminate outer part
of the container and not to distract the
blood cells while putting it into the
container
J.K

75. 4. Recomfort the patient
5. Care of the specimen and the equipment
• Label the container
• Shake gently (if indicated to mix)
• Send immediately to laboratory,
accompanying the request
• Give care of used equipments
6. Documentation and reporting
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76. Vital Signs (Cardinal Signs)
 Vital signs reflect the body’s physiologic
status and provide information critical to
evaluating homeostatic balance.
 Includes: temperature, Pulse Rate,
Respiratory Rate and Blood Pressure
 Purposes:
 To obtain base line data about the patient
condition
 for diagnostic purpose
 For therapeutic purpose
J.K

77. Times to Assess Vital Signs
 On admission – to obtain baseline data
 When a client has a change in health status or
reports symptoms such as chest pain or fainting
 According to a nursing or medical order
 Before and after the administration of certain
medications that could affect RR or BP
(Respiratory and CVS (Cardio Vascular System)
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78.  Before and after surgery or an invasive
diagnostic procedures
 Before and after any nursing intervention
that could affect the vital signs. E.g.
Ambulation
 According to hospital /other health
institution policy.
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79.  It is the hotness or coldness of the body.
 It is the balance b/n heat production & heat
loss of the body.
 Normal body temperature using oral 370
Celsius or 98.6 0 F.
J.K

80. Kinds of Body Temperature
1. Core Temperature
 Is the temperature of internal organs
and it remains constant most of the
time (37oc); with range of 36.5-37.5oc.
 Is the Temperature of the deep tissues
of the body
 Remains relatively constant
 measure with thermometer
J.K

81.  Surface body temperature: - is the
temperature of the skin, subcutaneous
tissue & fat cells and it rises & falls in
response to the environment
◦ (Ranges b/n 20-40oc).
◦ It doesn’t indicate internal physiology.
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82.  Normal body temperature is 370 C or
98.6 0F
 The range is 36-38 0c (96.8 – 100 0F)
 Body temperature may be abnormal due
to fever (high temperature) or
hypothermia (low temperature).
J.K

83.  Pyrexia, fever: a body temperature above
the normal ranges 38 0c – 410 c (100.4 –
105.8 F)
 Hyper pyrexia: a very high fever, such as
410 C > 42 0c leads to death.
 Hypothermia: –body temperature between
34 0c – 35 0c, < 34 0c is death
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84.  Intermittent fever: the body temperature alternates
at regular intervals between periods of fever and
periods of normal or subnormal temperature.
 Remittent fever: a wide range of temperature
fluctuation (more than 2 0c) occurs over the 24 hr.
period, all of which are above normal
J.K

85.  Relapsing fever: short febrile periods of a
few days are interspersed with periods of 1
or 2 days of normal temperature.
 Constant fever: the body temperature
fluctuates minimally but always remains
above normal
J.K

86. 1. Age
2. Environment
Ordinarily, changes in environmental temperatures don’t
affect core temperature because of our internal
regulatory mechanism, but exposure to extremely hot
or cold temp can alter body temp
3. Time of day (circadian rhythm)
Body temp normally fluctuates throughout the day temp is
usually lowest in the morning & highest in the evening
4. Exercise
J.K

87. 5.Stress
Emotional or physical stress can elevate body T0
stress stress sympathetic Ns 
circulating levels of epinephrine & nor-
epinephrine  metabolic rate  heat
production
6. Hormones
Women usually have greater variations in their T0
than do men eg progesterone  res body T0 by
0.3 to 0.68 during ovulation.
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88. 1. Oral
2. Rectal
3. Auxiliary
4. Tympanic
 Thermometer: is an instrument used to
measure body temperature
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89. ◦ Obtained by inserting the thermometer into
the rectum or anus.
◦ It gives reliable measurement & reflects the
core body temperature.
◦ More accurate, most reliable, is > 0.650 c (1
0F) higher than the oral temperature.
◦ because few factors can influence the
reading
J.K

90. -Its disadvantages are: it may injure the rectum,
it needs privacy, it is inappropriate for patients
with diarrhea & anal fissure.
Contraindications
 Rectal or perennial surgery;
 Fecal impaction
 Rectal infection
 newborn infants
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91.  Obtained by putting the thermometer under the
tongue.
 Its measurement is 0.65 less than rectal To. and
0.65 greater than auxiliary temp.
 This site is inconvenient for unconscious patients,
infants and children, & patients with ulcer or sore
of the mouth, pts with persistent cough.
 Is the most common site for temp measurement
J.K

92. Advantage – easy access &pt comfort
Disadvantage – T0 measurement can be affected
if the person has had hot or cold liquids
contraindication
 It can lead to a false reading if a person has
taken hot or cold food/ drink by mouth, & has
smoked so we have to wait for at least 10-
15min, after meal or smoking.
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93.  Pts who cannot follow instruction to keep their mouth closed
 Child below 7 yrs
 Epileptic, delirious or mentally ill patients
 Unconscious
 Clients receiving O2 &etc
 Clients with persistent cough
 Uncooperative or in severe pain
 Surgery of the mouth
 Nasal obstruction
 If patient has nasal or gastric tubs in place

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94.  It is safe and non-invasive
 Its disadvantage is the thermometer must be left in place for a
long time (5-10min.) to obtain an accurate measurement & it is
less accurate as it is not close to major vessels.
 Is considered the least accurate & least reliable of all the sites
because the temp obtained using this route can be influenced by
a number of factors e.g. bathing & friction during cleaning
 Is recommended for infants and children
 Is the route of choice in pt.’s that cannot have their temp
measured by other routes.
J.K

95.  Placed in to the client’s outer ear canal.
 It reflects the core body temperature
 Is readily accessible and permits rapid temp readings in
pediatric , or unconscious pts
 It is very fast method 1 to2 seconds.
Disadvantages: –
 it may be uncomfortable involves risk of injuring the
membrane
 Presence of cerumen (wax) can affect the reading.
 Right & left measurements may differ.
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96.  To obtain baseline data with which future
measurements can be compared
 To screen for alterations in temperature
 To evaluate temp response to therapies
Assessment
◦ Identity pt.’s baseline temp
◦ Assess for clinical signs & symptoms of temp
alteration
◦ Assess for factors that influence body T0
J.K

97.  Ingestion of hot or cold foods or liquids in last
15 minutes
 Smoking I in last 15 minutes
 Recent exercise
 Age, hormones, drugs that cause variation in
body T0
 Determine site most appropriate for temp
measurement
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98. Equipment
 Appropriate thermometer
 Water – soluble lubricant (for rectal temp )
 Disposable glove
 Pen and v/s sheet
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99.  Always check thermometer before inserting (should
read 35 oc 96 o F) or below
 Handle thermometer with care- never wash with
boiling water
 Never hold thermometer by the bulb. Always hold
by the stem
 Keep oral thermometer separate from rectal
 Temperatures are commonly taken by mouth
unless contraindicated.
 Temperature are usually taken two o three times a
day four hourly temperature
J.K

100.  Axilay temperature are least accurate and therefore
should not be taken unless oral and rectal
temperatures are contraindicated
 Temperature should be taken for all patients newly
admitted
 Changes in vital signs should be reported
 Temperatures should be properly Labelle with the
full name of the patients, room or bed number and
date.
 Temperature should be charted neatly and
accurately
 Thermometer should be well immersed in
disinfectant solution at the end of the procedure
J.K

101.  Pulse is a wave of blood created by the contraction
of left ventricle.
 pulse reflects the heart beat
 Stroke volume and the compliance of arterial wall
are the two important factors influencing pulse
rate.
 Pulse rate is regulated by autonomic nervous
system.
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102.  Peripheral Pulse: is a pulse located in the
periphery of the body e.g. in the foot, and or
neck
 Apical Pulse (central pulse): it is located at the
apex of the heart
 The PR is expressed in beats/ minute (BPM)
 The difference between peripheral and apical
pulse is called pulse deficit, and it is usually
zero.
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103.  Pulse is assessed for
◦ rate (60-100bpm),
◦ rhythm (regularity or irregularity),
◦ Volume,
◦ elasticity of arterial wall.
 The pulse is commonly assessed by
palpation (feeling) and auscultation (hearing
using a stethoscope).
J.K

104.  Age
 Sex
 Autonomic Nervous system activity
 Exercise
 Fever
 Heat
 Stress
 Position changes
 Medication
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105. J.K

106.  Pulse: is commonly assessed by palpation (feeling) or
auscultation (hearing)
 The middle 3 fingertips are used with moderate
pressure for palpation of all pulses except apical
 Assess the pulse for Rate Rhythm Volume Elasticity of
the arterial wall
1. Pulse Rate
 Normal 60-100 b/min (80/min)
 Adult PR > 100 BPM is called tachycardia
 Adult PR < 60 BPM is called bradycardia
J.K

107. 2. Pulse Rhythm
 The pattern and interval between the beats,
random, irregular beats – dysrythymia
3. Pulse Volume: the force of blood with each beat
 A normal pulse can be felt with moderate pressure
of the fingers
 Full or bounding pulse forceful or full blood
volume destroy with difficulty
 Weak, feeble readily destroy with pressure from the
finger tips
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108. 4. Elasticity of arterial wall
 A healthy, normal artery feels, straight, smooth,
soft, easily bent
 Reflects the status of the clients vascular system
 If the pulse is regular, measure (count) for 30
seconds and multiply by 2
 If it is irregular count for 1 full minute.
J.K

109.  Each heart beat consists of two sounds
 s1 - is caused by closure of the mitral and
tricuspid valves separating the atria from
the ventricles
 S2 – is caused by the closure of the plutonic
and aortic values
 The sounds are often described as a
muffled “lub – bub”
J.K

110.  Respiration rate (RR):-Respiration is the act of
breathing and includes the intake of oxygen and
removal of carbon-dioxide.
 Ventilation is also another word, which refers to
movement of air in and out of the lung.
 Hyperventilation: - is a very deep, rapid
respiration.
 Hypoventilation: - is a very shallow respiration.
J.K

111. Types of Breathing
1. Costal (thoracic)
 Observed by the movement of the chest up ward
and down ward.
 Commonly used for adults
2. Diaphragmatic (abdominal)
 Involves the contraction and relaxation of the
diaphragm, observed by the movement of
abdomen.
 Commonly used for children.
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112.  Age
 Medications
 Stress or strong emotions
 Exercise
 Altitude
 Gender
 Body position
 Fever
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113. Assessment
◦ The client should be at rest
◦ Assessed by watching the movement of
the chest or abdomen.
◦ Rate, rhythm, depth and special
characteristics of respiration are
assessed
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114. A. Rate:
 Is described in rate per minute (RPM)
 Healthy adult RR = 15- 20/ min. is
measured for full minute, if regular for 30
seconds.
 As the age decreases the respiratory rate
increases.
J.K

115.  Eupnea- normal breathing rate and
depth
 Bradypnea- slow respiration
 Tachypnea - fast breathing
 Apnea - temporary cessation of
breathing
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116. B. Rhythm: is the regularity of expiration and
inspiration
 Normal breathing is automatic & effortless.
C. Depth: described as normal, deep or shallow.
 Deep: a large volume of air inhaled & exhaled,
inflates most of the lungs.
 Shallow: exchange of a small volume of air
minimal use of lung tissue.
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117. Age average Range/min
 New born 30-80
 Early childhood 20-40
 Late childhood 15-25
 Adulthood-male 14-18
 Female 16-20
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118.  It is the force exerted by the blood against the walls of
the arteries in which it is flowing.
 It is expressed in terms of millimeters of mercury (mm
of Hg).
 Systolic pressure is the maximum of the pressure
against the wall of the vessel following ventricular
contraction.
 Diastolic pressure is the minimum pressure of the blood
against the walls of the vessels following closure of
aortic valve (ventricular relaxation).
J.K

119.  BP is measured by using an instrument
called Bp cuff (sphygmomanometer) &
stethoscope and the average normal value
is 120/80mmHg for adults.
 A rise or fall of 20-30mmhg in a person’s
Bp is significant.
J.K

120.  Although different sites are used to assess
Bp, brachial artery and popliteal artery are
most commonly used.
 It is measured by securing the Bp cuff to the
upper arm & thigh placing the stethoscope
on brachial artery in the antecubital space &
popliteal artery at the back of the knee.
J.K

121.  Pulse pressure: is the difference between the systolic and
diastolic pressure
 Factors Affecting Blood Pressure
 Fever
 Stress
 Arteriosclerosis
 Exposure to cold
 Obesity
 Hemorrhage
 Low hematocrit
 External heat
J.K

122.  Upper arm (using brachial artery
(commonest)
 Thigh around popliteal artery
 Fore -arm using radial artery
 Leg using posterior tibia or dorsal pedis
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123.  A persistently high Bp, measured for greater
than three times is called hypertension & that
persistently less than normal range is called
hypotension.
 Because of many factors influencing Bp a single
measurement is not necessarily significant to
confirm hypertension.
 When the cause of hypertension is known it is
called secondary hypertension and when the
cause is unknown is called primary/essential
hypertension
J.K

124. Purpose
 To obtain base line measure of arterial blood
pressure for subsequent evaluation
 To determine the clients homodynamic status
 To identify and monitor changes in blood pressure.
Equipment
 Stethoscope
 Blood pressure cuff of the appropriate size
 Sphygmomanometer
J.K

125. Suctioning the Air way
 Definition: is a mechanical removal of
mucus or secretion from the air ways in
clients who can not cough effectively to
expectorate the secretion.
 Indication
◦ Air way Obstruction
◦ Respiratory problem with lot of
secretion
J.K

126.  Purpose
◦ To clear the air way
◦ To take specimen
◦ To relieve airway obstruction
 Hazards or Risks of
suctioning
 Trauma to the mucus membrane
 Hypoxia
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127. J.K

128.  Oxygen therapy is the administration of
oxygen at a concentration of pressure
greater than that founding in the
environmental atmosphere.
J.K

129.  Oxygen transport to the tissues depends on
the following factors, and these factors
must be considered when oxygen therapy
is considered
 Cardiac out put
 Arterial oxygen content
 Adequate concentration of Hgb
 Metabolic requirements
J.K

130. Hypoxemia, while decreasing the work of
breathing and the stress on the myocardium
Pneumonia
Sever asthma
Carob monoxide poisoning
Heart failure or MI
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131.  Oxygen is dispensed from a cylinder or
from a piped – in system
 Reduction gauge is necessary to reduce the
pressure to a working level
 Flow meter regulates the control of oxygen
in L/min
J.K

132.  Oxygen is monitored and moistens by
passing it through a humidification system
(To prevent mucous membrane of the
respiratory tree from becoming dry)
 When a patient/child is unable to take
enough oxygen, he/she must get oxygen by
the following ways/methods:
J.K

133.  Traditionally, the oxygen tent was a clear
plastic canopy placed over the upper half of a
bed.
 A motor unit that circulate oxygen in the tent is
attached to it
 The face tent is an adaptation of the oxygen
tent, which is a clear plastic molded to fit under
the chin and in front of the mouth and nose
J.K

134.  Face-tent can supply high humidty with the
02
 It also supply 30% - 55% oxygen
concentration with a flow rate of 4 to 8
litters/min
 Nurses should pay special attention to care
of the child’s facial skin when caring for a
child using face tent.
J.K

135. J.K

136.  Is a transparent mask with a simple nipple adaptor
 It fits over the client’s nose, mouth and chin
 Used for low to moderate concentration of oxygen
(40-60% range), with a flow rate of 6 to 10 lit/min
 Simple mask requires a minimum oxygen flow rate
of 6 LPM to prevent C02 build up
J.K

137. J.K

138.  A device used to deliver small to
moderate increases in 02 concentration
 The Cannula has two short tubes that fit
into the nostrils
 It can deliver 24% to 44% of oxygen at a
flow rates of 1 to 6 LPM
J.K

139.  Is relatively simple and allows people
(patient) to move about in bed, talk, cough
and eat without interruption of 02 flow.
 Use Cannula with caution for client’s who
have irregular breathing patterns
(Rationale- The percentage of 02 that
reaches the lung depends on the rate and
depth of respiration)
J.K

140. J.K

141. Reverse Hypoxemia
Decreases the work of respiratory
system
Decreases the heart’s work in pumping
blood
J.K

142.  Are available in several styles and size
 They are made from a light weight plastic material
fit over the nose and mouth and are secured in
position by an elastic band around the head
 As the mask covers both the nose and the mouth it
is confining and impedes activities such as eating
drinking and speaking
J.K

143.  Depending on the style a face mask can deliver oxygen
as follows
 Simple mask - oxygen flow rate 5 to 8 LpM (40%-
60%)
 Partial rebreathing mask - oxygen flow rate 8 to 11
LPM (50% - 90%)
 Non rebreather mask - oxygen flow rate 12 to 15
LPM (90%-100%)
 Venture mask - delivers precise percentage of
oxygen
J.K

144. J.K

145.  Oxygen cylinder with valve and pressure tubing
 Safety pin
 Glass connector
 Wolff’s bottle
 Fine catheter, mask, Cannula or tent
 “No smoking sign”
 Hanger for the tent
 Atray with gallipot of saline or water
J.K

146.  Whenever a client is receiving 02, the Client
respiratory status must be continually monitored to
ensure that Rx has the desired effect
 For monitoring 02 administration, consider the
following points
 Observe the client’s respiration. (rate, depth,
character)
J.K

147.  Document difficulty in breathing
• Abnormal movements
• Retraction
• Irregular breathing pattern
• Abnormal breathing sounds
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148.  Assess lung sounds-Document abnormal
lung sounds
 Assess the client’s/child’s level of comfort
 Measure the client’s pulse rate often
 Assess for evidence of cyanosis
 Monitor the 02 delivery device for proper fit
and usage
 Closely observe the child whose 02 has
been discontinued
J.K

149.  02 is a drug and can cause serious side effects such as:
 02 – induced hypoventilation (which can be prevent by giving
low flow 02 at a rate of 1-2 LPM)
 Atelectasis
 The most serious and insidious hazard is 02 toxicity
 Caused by too high concentration of 02 for an extended
period of time
J.K

150.  02 toxicity is believed to cause the following two conditions
 destruction and decrease of surfactant
 Development of pulmonary edema
Signs and symptoms of 02 toxicity include
 Substantial distress
 Paresthesias in the extremities
 Dyspnea and anorexia
 Flaring of nares
 Restlessness, fatigue and malaise
 Progressive respiratory difficulty
J.K

151.  Oxygen will not by itself burn or explode,
but it does facilitate combustion
 The greater the concentration of 02, the
more rapidly fires start and burn
 There fore, the staff, the patient and visitors
must take safety precautions.
J.K

152.  The nurse ensures safety by
 Placing cautionary “No smoking: 02 in use” sign
on the child’s/patient’s door, at the foot or
head of the bed and on the 02 equipment
 Removing matches and cigarette lighters from
the bedside
 Requesting other people in the room and
visitors to smoke in areas provided elsewhere
in the hospital
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153.  Removing and storing electrical equipment
(in case short-circuit sparks occur)
 Avoiding materials that generate static
electricity (E.g.-woollen blanket, synthetic
fabrics)
 Avoiding the use of volatile, flammable
materials near pt’s receiving 02
e.g. Oils, greases, alcohol or ether
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154.  Grounding electrical monitoring equipment,
suction machines and portable diagnostic
machines
 02 therapy should be discontinued temporarily if
portable diagnostic radiographic) equipment is
required
 Monitoring and suction equipment needs to be
placed on the bed side opposite to the 02 source
 Making known the location of fire extinguishers
and making sure personnel are trained in their use.
J.K

155. J.K

156.  Prevention of 02 toxicity is achieved by using
oxygen only as prescribed
 If high concentration of 02 are necessary, the
duration of administration is kept to a minimum
and reduced as soon as possible.
 Positive End Expiratory pressure (PEEP) or
continuous positive Airway pressure (CPAP) is used
in conjunction with 02 therapy to reverse or
prevent micro atelectasis
J.K

157.  Responsibilities during O2 Administration
 Explain the procedure to the Client and allow
him/her to feel the equipment, the 02 flowing
through the tube, mask, etc …
 Maintain clear airway by suctioning if necessary
 Provide humidification to moisten the dry 02
 Measure 02 concentration every 1 to 2 hours
 Observe the child’s response to 02 therapy
 Decrease restlessness
J.K

158.  Improved colour
 Decreased respiratory distress
 Improved V/S
 Keep combustible materials and potential
source of fire a way from the 02 equipment
 Ensure and maintain the safety precaution
of 02 administration
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159.  Learning Objectives
At the end of this unit the students will be able to:
 Describe various rout of drug administration.
 Mention the general rules & care of administering medications.
 List the necessary equipment's required for drug administration.
 Mention the six rights and the three cheeks before drug
administration.
 Locate the different sites of parenteral drug administration.
 Demonstrate essential steps of medication administration.
 List precautions for medication administration.
J.K

160. Introduction:
 Health care provider administering medication is
expected to have a knowledge base concerning
drugs, including: drug names, preparations,
classifications, adverse effects, mechanisms of
drug actions, and physiologic functions that affect
drug action.
J.K

161.  Assessment entails a comprehensive
medication history as well as on going
assessment of the client’s response during
and after drug therapy.
 The preparation and administration of
medication are perhaps the most dangerous
function performed by the health care
provider.
J.K

162.  In addition to administering the correct dosage by
specified route, the health care provider must
observe and interpret the patient’s response to the
medication as well as recognize medication
incompatibility and reaction.
 Health care provider must also be able to recognize
unclear or unsafe medication orders and
administration practice.
J.K

163.  Only administer medication that you have prepared or
received from the pharmacy as unit dose.
 Be familiar with all potential medication effects, both
therapeutic and non-therapeutic.
This information can be found in the
 a. Manufacture’s medication insert that accompanies
prepackaged medications.
 b. If available, Physicians’ Desk Reference (PDR) or RN’s
Drug Book.
J.K

164.  CAUTION: if there is any doubt about
administering a medication, check with
supervisor, nurse, physician or pharmacist.
 Administration route and time will be
followed in accordance with provider’s
orders.
J.K

165. WARNINIG: NEVER alter medication dosage ordered
by physician!
 If in doubt about medication dose, time,
administration route, or if a medication is missing,
check with supervisor, nurse, physician or
pharmacist.
a. MD/HO order and medications label DO NOT
match exactly.
b. Illegible medication label: return to pharmacy.
J.K

166.  Check all medications label 3 times to
ensure that the correct medication is being
prepared for administration.
a. When removing the medication or
container from the storage area.
b. When preparing the medication dose.
c. When returning the medication to storage
area
J.K

167.  Check the expiration date of the medication
 Handle only one medication at a time
 While administering medication, do not perform
other duties (i.e., obtain vital signs, dressing
changes)
 Prepare the prescribed dose of medication
a. Tablet or capsules – transfer the prescribed dose
of tablets or capsules to the medicine cup or if unit
dose – open the package and give directly to the
patient.
J.K

168. b. Liquids – pour the prescribed dose of
liquid medication in to the medicine cup.
Small amounts of liquid medication should
be drawn up in a syringe.
c. Powders – pour the correct dose of
powdered or granulated medication in to the
medicine cup.
J.K

169.  Pour the required amount of water or juice into a paper
cup
 Reconstitute the medication at the patient’s bedside.
WARNING: Never directly touch oral medications. Some
medications can be absorbed through the skin; also the
medication will become contaminated.
 The medic may assist the patient in taking the
medication if the patient is physically unable.
WARNING: DO NOT: administer oral medications to
patients with a decreased level of consciousness. Check
with supervisor for instruction.
J.K

170. The medication order consists of seven parts. These
are:
1. Client’s name
2. Date & time the order is written
3. Name of the drug to be administered
4. Dosage of the drug
5. Route by which the drug is to be administered
6. Frequency of administration
7. Signature of a person writing the order
J.K

171. Abbreviations meanings abbreviations meanings
Po by mouth bid twice a day
ac before meal tid three times a day
Pc after meal hs at bed time
Qd. every day prn as needed
Qod every other day OD right eye
Qid four times a day os left eye
Q2h every 2 hours ou both eyes
Qhr every hour am in the morning
Pm after noon IV Intravenous
IM Intramuscular ID Intradermal
SC Subcutaneous KVO keep vein open
J.K

172. Drugs can be classified from d/t perspectives. For example:
◦ By body system affected by the drug(drugs that affect the
respiratory system, the cardiovascular system),
◦ By the symptom relieved by the drug (anti pain, analgesics),
◦ By the clinical indications for the drug (antibiotics,
antifungal …)
J.K

173. 1. Metric system
a. Decimal system, each basic unit of measure is organized into
units of 10
b. Basic units of measure are the meter (length), the liter (volume),
and the gram (weight).
c. Small or large letters are used to designate the basic units
1. Gram = g or GM
2. Liter = l or L
d. Small letters are abbreviations for subdivisions of major units
1. Milligram = mg
2. Milliliter = ml
J.K

174. 2. Household measurements
a. Familiar to most people
b. Used when more accurate systems measure are
unnecessary
c. Basic units of measure include drops, teaspoons,
tablespoons, cups, and glass for volume: and ounces
and pounds for weight.
J.K

175.  The health care provider observes the three checks and
the six rights when administering medication.
The three checks:-
 When the nurse reaches for container or unit dose
package.
 Immediately before pouring or opening the medication
and
 When replacing the container to the drawer or shelf or
prior to giving the unit dose to the client.
J.K

176. Remember the five R’s
Right medication
Right dose
Right client
Right route
Right time
the right information
The right to refusal
The right documentation
Appropriate documentation is a critical
element of drug administration
J.K

177.  Age:-infants or children are more responsive to
medication because of the immaturity of their organs,
so they accommodate only small dose. Older people are
also very responsive because of aging.
 Sex: - this is due to the difference in body fat and fluid
content between male and female that will affect
absorption and distribution of drugs and also may be
due to hormonal fluctuation/variation.
J.K

178.  Weight:-wt. and body surface area can affect drug
action.
 Genetic:-differences in ethnic or racial group may
give different response to the same medication.
 Other:-factors include illness and disease, time of
administration, environment, psychology, diet, etc.
J.K

179.  ADVERSE DRUG EFFECT
 Although therapeutic effect is the desired in
medication administration, sometimes adverse
effect may occur.
 Drug reaction may be unpredictable and harmful.
 Adverse effects of drugs should be reported to the
nurse or physician in charge.
J.K

180. TYPES OF PREPARATION
 Oral preparation
 Topical preparation
 Parenteral
 Rectal
 Vaginal
 Inhalation
J.K

181. i. Capsule
ii. Emulsion-oil based preparation
iii. Enteric coated- prepared to be dissolved and absorbed in
the intestine.
iv. Lozenges-dissolved & absorbed in the mouth like candy.
v. Powder-finely ground drugs
vi. Syrup-sugar sweetened (acquos solution of sugar)
vii. Suspension-is liquid form, shacked before administration.
viii. Elixir-liquid form of drug
J.K

182. i. Cream=non greasy/oily, semi solute preparation
ii. Ointment=semi solute than cream, for external use on skin,
conjunctiva, etc.
iii. Paste=thicker & stiffer than ointment
iv. Lotion=clear, suspension, emollient liquid
v. Gel or jelly=clear, translucent form.
vi. Suppository=prepared to be inserted through the rectum/
anus, & vagina
J.K

183.  Prepared to be injected using needle.
1. Glass capsule:-contain liquid drugs
2. Vials (glass bottle):-may contain powder dissolved before
administration
3. Ampoule:-glass flask/container containing a single dose
medication for parentral administration.
J.K

184. Definition: Oral medication is drug administered by mouth
Purpose
 When local effects on GI tract are desired
 When prolonged systemic action is desired
Medications that are given by mouth are designed to
 To be swallowed (oral route)
 To be held under the tongue until they dissolve (sublingual route)
 To be administered through tubes
 To be held in the side of the month until they dissolve (buccal route)
J.K

185.  Advantage
 Usually the simplest & easiest way to take
 Minimizes pt discomfort
 Associated with the fewest side effects of any route
 Less expensive & more widely available than any other route
 Disadvantages
 Drugs may have un pleasant taste
 Drugs may irritate the gastric mucosa
 Drugs may be absorbed slowly
 Drugs may be absorbed irregularly from GIT
 In some case drugs harm the patient teeth
J.K

186.  Contraindication of oral medications
◦ For patient with nausea and vomiting
◦ For unconscious patient
◦ when the effect of the drugs is/ are inactivated by the
digestive juice
◦ NPO patient
 Complication/ side effect of oral medication:
o Side effects are the sign and symptom that may arise as result of
using a specific drug. These complication are usually due to the
o pharmacological action of drug,
o depend on the dose,
o frequency and duration,
o use, as well as individual sensitivity and tolerance of the user.
J.K

187. 1. Lozenges (troches) - sweet medicinal tablet containing
sugar that dissolve in the mouth so that the medication is
applied to the mouth and throat
2. Tablets
3. Capsules
4. Syrups - sugar containing medicine dissolved in water
5. Tincture - medicinal substances dissolved in water
6. Suspensions - liquid medication with undissolved solid
particles in it.
J.K

188. 7. Pills and gargle
8. Effervescence- drugs given of small bubbles of gas.
9. Gargle - mildly antiseptic solution used to clean the
mouth or throat.
10. Powder - a medicinal preparation consisting of a
mixture of two or more drugs in the form of fine
particles
J.K

189.  certain medications are administered sublingually,
that is, the tablet is placed under the client’s
tongue.
 This area is reach in superficial blood vessels that
allows the drug to be absorbed relatively rapidly
into bloodstream for quick systemic effect.
E.g. Nitroglycerine-a drug for treatment of angina
pectoris (severe chest pain)
J.K

190.  Are medications that are given by injection or infusion via
parenteral route
 Advantages
1. Absorbed completely and began acting faster than medication given by
other route
2. And the method of choice in emergencies, the answer is rapid, predictable
absorption.
3. Most efficient method of drug administration
4. fairly quick absorption
5. When drug would be altered by the digestive juice (insulin)
J.K

191.  Disadvantages
1. May cause damage if placed incorrectly
2. Injection abscess can occurs
3. accidental penetration of blood vessels may cause
hematoma or necrosis of vessels depending on the
medicine
4. Medication intended for a certain injection route if
used for the wrong route may cause tissue damage
5. Allergic reaction occurs fast e.g. anaphylactic shock
J.K

192. Syringe can be made of glass, metal or
plastic. Three type of syringe
 Hypodermic 2-3ml
 Insulin 100 units level
 Tuberculin 1/10-1/100ml.
 Syringes are also made in other size level
like 5ml, 10ml, 20ml and 50ml
 Needle is made of stainless steel.
.
J.K

193.  Parts of needles:-
 Hub which is fit in to the
syringe
 Cannula/ shaft- connect with
hub
 Bevel- the slanted part of the
tip of the needle
 Parts of syringe:-
 The tip of the syringe
 Barrel- outside part where
the scale is printed
 Plunger- the part that fit
inside the barrel.
J.K

194. Route Site needle Degree of needle
insertion
Intra
dermal(ID)
 Inner fore arm
 Upper chest
 Upper arm
 Across the scapula
¾ inch 10-15 degree
Subcutaneous(
SC)
 Upper arm
 Upper back
 The abdomen
 The upper buttocks
 The thigh
0.30mm= = =>
0.54mm= = =>
45 degree
Intramuscular
(IM)
 Deltoid muscle/ upper
arm
 Ventro- gluteal/ hip
 Vastus-lateral is/ thighs
 Rectus femoris
 Dorso-gluteal /but tock
3-5ml 90 degree
Intra
venous/IV/
 Large vein at cubital
fossa
 Visible superficial
 Vein dorsum of hand
iv-cannula 15-45 degree
J.K

195. J.K

196.  it is injection given into the outer layer of the skin into the epidermis
 Purpose:-
o For diagnostic purpose as the tuberculin test and allergic reaction test
o For therapeutic purpose such as BCG
 Site of injection
 For diagnostic purpose the inner part of fore arm mid way between the
wrist and elbow.
 For some allergic test the upper back is used
 For therapeutic purpose the whole body may be used
J.K

197.  Precaution
 This is a painful procedure and is used only with small amount of
solution.
 The nurse should insure that the needle is inserted into the epidermis
not subcutaneous as absorption would be reduced.
 Prior to administration of any medication, check the right patient,
right medicine, right route, right dose, the right time and right site.
 Contraindication
 Hair follicle
 Area that have scarring or postular eruption
 Site that could be irritated by clothing
J.K

198. Equipment required:-
Medication tray
Medication card or order
Syringe with needle(sterile)
Receiver
Drug to be injected
File to cut ampoules
Marking pen
J.K
Equipment required:-
Medication tray
Medication card or order
Syringe with needle(sterile)
Receiver
Drug to be injected
File to cut ampoules
Marking pen
Procedure
 Wash your hand
 Prepare tray and materials
 Explain the procedure to the
patient
 Get hold of the arm and locate
the site of injection
 Clean the skin with the alcohol
swabs/water swabs from
center out wards, allow the
antiseptic to dry before
injection
 Hold the syringe with the bevel
up, almost parallel to the skin.
The needle is inserted until the
entire bevel lies under the skin.
 Inject the drug, the order
amount (usually 0.1-0.2ml)
into the epidermis. Do not
massage the area.
 Mark the area when it is for
diagnostic purpose & inform
the patient not to wash the
mark.-NB- Check for the
immediate reaction of the skin


199.  =>10-15 minute later for tetanus
 =>20-30 minute later for penicillin and
 =>72 hours for tuberculin/ tine test
 Document the dose and reaction seen
 Take care of the equipment and return to their places and wash your hands.
J.K

200.  Definition:
 injection of drug under the skin, in the subcutaneous
tissue
 Purpose:
o To obtain quick absorption than oral administration
o To administer medication that are inactivated by GIT
enzymes (e.g., Insulin, heparin)
J.K

201.  Indication:
 Circumstance that compromises oral administration
 =dysphagia
 =decrease level of consciousness
 =intestinal obstruction
 =nausea and vomiting
 Requiring rapid and reliable medication administration and
absorption
 Poor or variable compliance
J.K

202.  =dementia
 =agitated, delirium
 =personal issue
 Contraindication:
 Wasting of subcutaneous injection at least every 6 to
7 weeks
J.K

203.  Medication tray
 Sterile syringe with needle (1 to 2ml syringe)
 Antiseptics swabs
 Vial or ampoule of ordered medication
 Sterile gauze or cover for opening an ampoule
 Glove
 File
 Medication card order
 Receiver
 Water in bowel
 Disposing box
J.K

204.  Site of injection
Outer upper arm
The upper back
The abdomen
The upper buttocks
Anterior aspect of the thighs
Subcutaneous Injection Sites:
J.K

205.  Procedure:
 wash your hands
 take equipment to the patient
 explain the procedure to the
patient
 assemble needle and syringe
 remove needle guard and
with draw medication from
container
 select appropriate site
 expel the air from the syringe
 identify the client by name
and bed number
 clean the site
 Grasp the area between the
thumb and fore finger to
tense it
 hold the syringe between
thumb and fore finger of
dominant hand
 Insert the needle quickly at an
angle of 450 to 900 depending
on the amount of adipose
tissue.
 release the grasp
 aspirate to determine whether
the needle is in a blood vessels,
inject the solution slowly
 Massage the area gently with the
swabs to help absorption. Don’t
massage after heparin and
insulin
NB
 If repeated injections are given, the
nurse should rotate the site of
injection so the succeeding injection
is about 5cm away from the
previous one.
 Teach the diabetic patients to inject
themselves their insulin
 Avoid damaged skin ,delicate skin,
hematoma, oedema
J.K

206.  Definition:
 it is the administration of medication in to the muscle.
 Indication:
 For medication that irritate subcutaneous tissue and unsafe to give
intravenously eg. Penicillin
 When fast absorption is required
 When there is a need to administer large dose
 Complication:
 Injection fibrosis is a complication that may occur, if the injections are
delivered with a great frequency or without proper technique.
J.K

207.  Contraindication:
 Thrombocytopenia(low platelet counts)
 Coagulopathy(bleeding tendency)because they lead to
hematoma
 Sites
 Dorsogluteal
 Ventrogluteal
 Vastus lateralis
 Deltoid and triceps
J.K

208. J.K

209. J.K

210. ◦ It is gluteus medius lies over gluteus minimus
◦ No large blood vessel and nerves
 To establish the exact sites
 Place the palm of the hand on greater trochanter with the
fingers towards the patient head
 Then place the index finger on the anterior superior iliac
spine and extend the middle finger dorsally.
 Palpate the crest of the ileum and press below it
 The injection site is in the center of the triangle formed. That
is the index finger, 3rd finger and crest of the ileum.
J.K

211.  It is a thick muscle of the buttocks
 The injection site must be chosen carefully to avoid strike of
sciatic nerve, bone and large blood vessels.
 The exact site is the upper outer quadrant of the buttocks 5
cm to 8cm /2-3inch/
 There are two methods
 First method
 Divide the buttock by two imaginary lines in to 4 quadrants
 Draw a vertical line from crest of ileum to gluteal fold
 Move a horizontal line from medial fold to the lateral aspects
of the buttock
 Choose the upper outer aspect of the upper outer quadrant
J.K

212.  The second method
 Palpate the posterior iliac spine then draw an imaginary line
to the greater trochanter of the femur. This line is parallel to
the sciatic nerve.
 The injection site is lateral and superior of this line.
 Indication:
 used in adult and older children with well developed muscle.
 Contraindication:
 infant under 3 years
 Position during administering drug
 Prone position
 Side lying position with upper leg flexed at the thigh and
knee and placed in front of the lower leg.
J.K

213. J.K

214. Vastus lateralis site
 It is well developed and thick muscle in both children
and adults. It is strongly recommended site since there
is no nerve and blood vessels near by the muscle.
 Location: it is established by dividing the area between
the greater trochanter of the femur and the lateral
femoral condyle in to three and selects the middle third.
 For young children the muscle is bunched before
injection.
 Reducing discomfort technique
 Select the needle of the smallest gauge
 Be sure the needle is free from medication
J.K

215.  Use the Z-track technique for intramuscular
injection to prevent leakage of medication
into the needle track, thus minimize the
client’s discomfort
 Inject the medication in relaxed muscle
 Insert the needle with slow motion and
remove quickly with slow angle insertion.
 Inject the solution slowly
J.K

216.  Hold an alcohol pad against the skin while
removing the needle
 Rotate the site when the client is to receive
repeated injection
 Do not administer more solution on one
injection than is recommended for site.
 Do not inject areas that feel hard on
palpation or tender to the client
J.K

217.  Medication
 Medication card/cardex
 Sterile syringe and needles
 Alcohol swabs
 Dry sponge/gauze/
 Disposable gloves
 Patient chart
 Adrenalin
 Safety boxes
J.K

218. Procedure:
 Prepare tray, check the physician
order and take it to the patients
room
 Explain the procedure to the
patient
 Wash your hands
 Prepare medication
 Draw medicine from ampoule or
vials
 Provide privacy, have the client
assume a position appropriate for
the site selected.
 Ventrogluteal: client may lie
on the back or side with knee
flexed
 Dorsogluteal: prone position
 vastus laterais: lie on back or
sitting position
 Deltoid: sit or lie with arm
flexed
 Expel air from syringe
 Choose the site for injection
 Using the iliac crest as upper
boundary divide the buttock in to
four
 Clean the upper outer quadrant with
alcohol
 Stretch the skin Z truck manner and
inject the medicine
 Draw back the piston / plunger to
check whether or not you are in the
blood vessel (if blood returns with
draw and get a new needle and inject
in different spot.)
 Push the drug slowly into the muscle
 When completed withdraw the
needle, massage the area with swab
gently to hasten absorption.
 Place the patient in comfortable
position.
 Take care of equipment you have
used and return to their place
 Chart the date, time, route and type
of medication
 Check the patient reaction
J.K

219.  The doctor prescribe penicillin fortified/ ppf/ 800,000
IU im BID for 07 days. If you are assigned in injection
room how many ml/cc you should give for the patient?
Vial of PPF 4,000,000 IU
 Distilled water 10ml
 On hand vials 800,000 IU
 So calculate the correct dose:
4,000,000=10ml
800,000=?
800,000*10ml/4,000,000=2ml
J.K

220.  Definition:
 It is the introduction of drug in solution form into a
vein often the amount is not more than 10ml at a
time.
 Purpose:
 When quick action is desired/emergency/
 When the given drug is irritating the body tissue if
given through other routes
 To eliminate the variability of the absorption
 To draw blood /exsanguinations/
J.K

221.  Site of injection:
 Large vein at cubital fossa/inner aspect of elbow/
 Visible superficial vein at dorsum of hand/palm
 Scalp veins and jugular vein in infant
 Vein at inner side of ankle
 Complication:
 Phlebitis
 Hematoma, accidentally intra- arterial injection/
make strong pain
J.K

222.  Medication tray
 Towel and rubber sheet
 Antiseptic swab
 Medication vial or ampoule
 Syringe with needle(sterile)
 File
 Sterile foreceps in sterile container
 Tourniquet
 Medication chart /cardex/
 Glove
J.K

223. Procedure:
 Position patient comfortably on
his back, semi sitting with
support
 Select possible vein
 Place rubber sheet and draw
sheet to protect linen
 Expose arm and apply
tourniquet wide above the
injection site
 Ask the patient to open and
close fist
 Clean the vein with alcohol swab
from the center outwards
 Puncture the vein in an angle of
15-45 degree
 Draw the plunger back to check
whether you are in the vein or
not
 When in vein release tourniquet
gently
 Lower needle until nearly parallel to
the vein. instill medication give
slowly unless there is no other order
to give it fast.
 Check the patient; color of the skin
and any complaints from the patient
should not be ignored
 Remove needle, apply dry swab and
pressure to prevent bleeding. Ask
the patient to flex his elbow.
NB-
 if swelling occurred stop injection
immediately
 You use strict sterile technique.
 Never inject in an inflamed vein,
hematoma or edema and hard vein.
J.K

224.  Definition:
 It is the administration of a large amount of fluid in
to the system through a vein.
 Purpose:
 To maintain fluid and electrolyte balance
 To introduce medication particularly antibiotics
 To maintain acid-base balance
 For general anesthesia purpose
J.K

225. IV
solution
Tonicity Content indication Precaution
0.9%
normal
saline
Isotoni
c
-Nacl-9gm
-Water for injection
1000ml
-For plasma volume
expansion
-Sodium depletion
Etc.
-Should be
administered
with caution: HTN, HF,
pulmonary edema renal
failure
5%
D/W
Isotoni
c
-Dextrose 50gm
-Water for injection
1000ml
-Used as nutrition
source
-Extra cellular fluid
depletion
-Should be
administered with
caution:HTN, HF,
pulmonary edema renal
failure
J.K

226. Dextrose
5%, 10 %
Hypertonic 1 lit of DW 5%
-Dextrose 50gm
-H2O for injection
1000m
1 lit DW 10%
-Dextrose 50gm
-H2O for injection
1000ml
-In CHO and
fluid depletion
-hypoglycemia
Side effect
 local pain
 thrombophlebiti
s fluid and
electrolyte
disturbance
 contraindication
 anuria
 intracranial
hemorrhage
 needs special
care to DM
patient
J.K

227. Ringer
lactate
isotonic -Na lactate
3.1gm
-Nacl-6gm
-Kcl-0.3gm
-Cacl-0.2gm
-H2O-
1000cc
-Substitution for
fluid lose
-Electrolyte
relishes--
Side effect
-Hypernatermia
-Renal
insufficiency
-Do not
administer with
blood and
solution
containing
phosphate
Contraindication
Not
recommended in
the treatment of
acidosis
J.K

228.  Site of IV therapy
 Preferable the arm vein, left arm
 Scalp vein in infant
 Vein in the dorsal part of the fist
J.K

229.  Same as for IV injection
 IV fluid/ medication as ordered
 Sterile IV infusion set
 Sterile plastic cannula
 Arm board or splint long enough to splint
elbow and wrist
 Bandage to fix board
 Adhesive tape
 IV-pole/stand
J.K

230.  Preparation as for IV-
injection and preparation of
the infusion ordered
medication has to be
inserted in to the bag
aseptic technique.
 Hang infusion bag over the
IV stand , run solution
through the tubing to expel
air.
 Position the patient on his
back comfortably, place
rubber and towel under the
arm
 Apply tourniquet 3 finger
above the intended site and
identify suitable vein.
 Clean the injection site or
port with antiseptic solution
and dry it.
 Hold the needle bevel up at
15-40 degree angle and
pierce skin to reach but not
penetrate vein.
 After needle in the vein
connect tubing from IV set
 Start flow of the solution
opening the clamp, rate of
flow depending on the time
of therapy and medication.
 Fix gauze and needle with
plaster and the IV- tubing to
prevent pulling on the
needle.
 Place arm board under the
arm and put bandage
around adjust the rate.
 Regulation formula
J.K

231.  Number of ml solution *number of drops in ml/number
of hours * 60 minute
Example:
1. If 1000ml of DNS is to run over 10hours.
 How many drops per minute should it run?
1000ml*15/10*60= 25drops
2. How many drops per minute should it run?
If 100ml of 5% D/W is to run for 20 hours
…………1 drops…………
NB-
 The infusion bottle should be labeled with date, time,
and drops per minute and adding medication.
 if more than one bottle is given in 24hours numerate
the bottle like 1, 2, and 3
J.K

232.  General risk of intravenous therapy
◦ Infection
◦ Phlebitis
◦ Fluid over load
◦ Electrolyte imbalance
◦ Embolism
◦ Extravasations
J.K

233. Common abbreviation
Route of drug administration
IM= intramuscular
IV=intravenous
OD=occulo dextra/ right eye
OS= occulo sinisitra/left eye
OU=both eye
Po= per os by mouth, oral
SC= subcutaneous
ID=intra dermal
Drug dosage
CC= cubic centimeter
G=gram
Gr=grain
Gt=drop/gt
Mg=milligram/mg/
Mi=milliliter/ml/
Oz=ounce
Tbsp=table spoonful
Tsp=tea spoon ful
Time of drug
administration
AC= before meal
Ad lib=as desired
BID= twice a day
PC= post cibeum/ after
meal/
PRN= when needed or
necessary
QD=every day/ daily/
Q.4= every four hourly
QI= every six hourly
TID= every eight hourly
J.K

234. Definition: - it is the giving of blood to a patient through a vein
as part of the management of the circulatory system disorder,
especially a disorder of blood.
A transfusion may be prescribed.
 A transfusion may consist of whole blood or it may consist of
one of the components of blood. Whole blood is generally
transfused when decreased volumes results from
hemorrhage.
J.K

235. Purpose
 To counteract severe hemorrhage and replace the blood
loss
 To prevent circulatory failure in operation where blood
loss is considerable such as in rectal resection,
hysterectomy and arterial surgery
 In severe burns to make up for blood loss by burning but
only after plasma and electrolytes have been replaced.
 For treatment of anemia due to cancer and marrow aplasia
 To provide clotting factors normally present in blood
which may be absent as a result of disease.
J.K

236. Blood group and types
 Human blood is commonly classified in to four
main groups (A, B, AB, and O) the surface of an
individual’s red blood cells contains a number of
antigens that are unique for each person.
 Many blood antigens have been identified but the
antigens A, B and Rh are the most important in
determining blood group or type.
 Because antigen promotes agglutination or
clumping of blood cell they are also known
agglutinogens.
J.K

237.  Rhesus (Rh) factors- the Rh factors antigen is
present on the RBC.
 Blood that contains the Rh factor is known as Rh
positive (Rh+) and when it is not present the blood
is said to be Rh-negative (Rh-).
 To avoid transfusing incompatible RBC, both blood
donor and recipient are typed and their blood cross
matched. Blood typing is done to determine the
ABO blood group and Rh factor status.
J.K

238. Most clients do not require transfusion of whole blood
component. The blood product for transfusion:-
 Whole blood
 Red blood cell
 Autologous red blood cell
 Platelets
 Fresh frozen plasma
 Albumin and plasma protein
 Clotting factors
J.K

239.  All donated blood is carefully screened for the
◦ hepatitis B antigen
◦ syphilis and HIV
◦ Malaria
 The blood should be administered with in 30 minute
after it has been received from the bank, to maintain
RBC integrity and to decrease the chance of infection.
 The whole blood should not go UN refrigerated for
more than 4 hours.
 The room temperature will cause RBC lysis, releasing
potassium and causing hyperkalemia.
J.K

240. Body site
 Preferable the arm vein
 Scalp vein in infant
 Vein in the dorsal part of the fist
Indication: - the major indication for whole blood transfusion
would be in some cases of:-
 cardiac surgery or
 situations of massive hemorrhage when more than ten units
of RBC are required in any 24 hours period.
Life threatening condition
 Acute blood loss >40% blood volume loss
 Hemoglobin concentration Hgb<7mg/dl, clinical signs
J.K

241. Contraindication
The contraindication to a blood donor includes
 Previous malaria or hepatitis
 History of drug abuse
 Donor who have received human pituitary hormone
 Donor with high risk sexual behavior
Precautions
 Special precautions are necessary when administrating blood
 The client should be observed for the initial 15minute for
transfusion reaction The V/S are usually taken every
15minutes for the first hours then every hours while the
blood transfusing
J.K

242. Transfusion reaction
 Transfusion reaction is classified in to two
Immediate reaction
 head ache
 back ache
 chills
 pyrexia- fever
 rash of the skin
late reaction
 dyspnea
 renal shut down in severe cases
 hematuria
 chest pain
J.K

243. Calculating and regulating infusion flow rates
The quantity of blood (Q) is determined by the
desired hgb level-current hgb level *6 wt in kg
Therefore Q= Dhgb level – chgblevel * 6x kg
e.g Dhgb= 12 gm/dl
Chgb= 7gm/dl
Wt= 50kg
Required amount of blood (Q)
Q= (12-7)*6*58= 1740 ml
Q= around 3 of unit blood
J.K

244. To calculate the infusion rate
Flow rate= volume/T*3
FR= V/T*3
Where F= flow T= time (hours)
R= Rate 3 = Give
Or FR= the amount of blood in ml*20/60 minute *
given hours
e.g V= 450
T= 3 hrs
FR= V/T*3 = 450/3*3 = 50 drops/m
FR= 450*20/60*3
= 50drop/m
J.K

245. Hemolytic reaction- occurs when the donors’ blood is
incompatible with recipient blood.
Sign: discomfort as headache, sensation of lighting,
nausea, vomiting, difficulty in breathing Shock, renal
shut down, hematuria.
Action to be taken
 Stop transfusion
 inform doctor
 take vital sign
 prepare isotonic solution
J.K

246. Allergic reaction- occur b/c the client has a sensitivity to the
plasma from the donor’s blood
Sign: feeling itchy especially on back and buttocks, urticaria.
Action to be taken:
 stop transfusion
 inform the doctor
 take vital sign
 prepare antihistamine injection
Febrile reaction: - occur because of the recipient
hypersensitivity to the donor’s blood cells.
Sign: pyrexia, rigor, flushing of skin
Action to be taken
 stop transfusion
 inform doctor
 take vital sign
 give antipyretic if ordered
J.K

247. Circulatory over load: - occur when blood product are infused too
quickly
Septic reaction: occurs if the blood product has been contaminated
with bacteria.
Health care provider responsibility
 The health care provider is responsible for insuring that the right
unit of blood is to be administered to the right patient after typing
and cross matching by the lab. This is done by checking the serial
number, blood type and expiration date with another nurse or
qualified Lab personnel.
 The health care provider has to get consent forms signed by the
patient except in the cases of trauma or life saving situation.
 The health care provider has to take V/S for base line.
J.K

248.  Equipment required:-
 Bag or bottle containing
blood with the patient name,
blood group and Rh factor
and expiry date
 Blood giving set include
cannula 16 gauge
 Sterile syringe with needle
 Alcohol swabs
 Sterile gauze
 Rubber sheet and towel
 Tourniquet
 Arm splint
 Bandages and scissor
 Adhesive tape
 Receiver for dirty swabs
 IV pole (stand)
 Patients chart
 Pre medication like
frusomide
J.K

249. Procedure
Pre-procedure
 Verify that patient has
signed a written consent
 Check that patients blood
has been typed and cross
matched and test for HIV
 Confirm that the transfusion
has been prescribed
 The procedure is more or less
similar to that of any IV
infusion.
 Cross-match of the donor and
the recipient blood is done if it
is compatible.
 The blood should not be
hemolytic
 Prepare tray
 Before taking to the patients’
room check the patients name,
bed number, blood group Rh
factor and expiration date
together with a second nurse or
doctor and check for hemolysis.
 Blood should be used within 21
days of its withdrawal date.
 Check vital sign before
administrating blood
 Select appropriate vein
 Apply tourniquet
 Clean the site and dry it
 Puncture the vein with the
needle holding bevel at 25o to
45o angle
 The flow rate at the beginning
should be very slow , watch pt
for any reaction for about 10-
15 minutes
 If there is no sign of reaction ,
regulate the rate of flow
according to the order or pt’s
condition(40-60 drop/min)
 Check pt. frequently for any
reaction, be familiar with the
most usual symptom of blood
reaction

J.K

250.  Definition
 Venous cut down is an emergency procedure in which the
vein is exposed surgically and then a cannula is inserted into
the vein under direct vision.
 It is used to get vascular access in trauma and hypovolemic
shock patients when peripheral cannulation is difficult or
impossible.
 The saphenous vein is most commonly used.
J.K

251.  The skin is cleaned, draped, and anesthetized if time allows.
The greater saphenous vein is identified on the surface above
the medial malleolus,
 a full-thickness transverse skin incision is made, and 2 cm of
the vein is freed from the surrounding structures.
 The vessel is tied closed distally, the proximal portion is
transected (venotomy) and gently dilated, and
 a cannula is introduced through the venotomy and secured in
place with a more proximal ligature around the vein and
cannula.
 An intravenous line is connected to the cannula to complete
the procedure.
J.K

252.  cellulitis,
 hematoma,
 phlebitis,
 perforation of the posterior wall of the vein,
 venous thrombosis and nerve and arterial
transection.
 This procedure can result in damage to
the saphenous nerve due to its intimate path with
the great saphenous vein, resulting in loss of
cutaneous sensation in the medial leg.
 Over the years, the venous cutdown procedure
has become outdated by the introduction and
recent prehospital developments of intraosseous
infusion in trauma/hypovolemic shock patients.
J.K

253.  is the process of injecting medications, fluids, or blood
products directly into the marrow of a bone; this provides a
non-collapsible entry point into the systemic venous system
 Site of injection:-
 The most common sites are the lateral proximal humerus or
the medial proximal tibia. Both sites offer a solid cortex, and
a flat surface on which to start the catheter. They are also
easy to palpate. These sites can also be used with the manual
technique in larger patients, a bone marrow needle is
recommended.
J.K

254.  Complication of IO:-
 The most commonly reported complications of IO
access are infection at the injection site, which may
result in severe osteomyelitis, damage to the
growth plate, and fat embolism. How the procedure
of intraosseous cannula is done?
 Procedure
 Identify the appropriate site. ...
 Prepare the skin.
 Insert the needle through the skin, and then with a
screwing motion perpendicularly / slightly away
from the physeal plate into the bone. ...
 Remove the trocar and confirm position by
aspirating bone marrow through a 5 mL syringe.
J.K

255. Contraindications for intraosseous access include the
following:
 Infection at the entry site.
 Burn at the entry site.
 Ipsilateral fracture of the extremity.
 Osteogenes is imperfecta.
J.K

256.  Osteopenia.
 Osteopetrosis.
 Previous attempt at the same site.
 Previous attempt in a different location on
the same bone
J.K