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M O H A M M E D A ( R N , B S C N )
Confidentiality and privacy
Cont.…
 The terms 'privacy' and 'confidentiality' are
commonly used interchangeably. Privacy may also
relate to information about oneself, and information
privacy laws regulate the handling of personal
information through enforceable privacy
principles. Confidentiality relates to information
only.
Confidentiality
Confidentiality;- is the protection of personal
information.
 Confidentiality means keeping a client’s information
between you and the client, and not telling others
including co-workers, friends, family, etc.
 Confidentiality is a critical aspect of your duty of
care.
Examples of maintaining confidentiality include:
 individual files are locked and secured
 support workers do not tell other people what is in a
client’s file unless they have permission from the client
 information about clients is not told to people who do not
need to know
 clients’ medical details are not discussed without their
consent
 adult clients have the right to keep any information about
themselves confidential, which includes that information
being kept from family and friends.
The types of information that is considered
confidential can include:
 name, date of birth, age, sex and address
 current contact details of family, guardian etc.
 medical history or records
 personal care issues
 file progress notes
 individual personal plans
 assessments or reports
 income or outgoing personal correspondence.
 Other information relating to
 ethic or racial origin,
 political opinions,
 religious or philosophical beliefs,
 health or sexual lifestyle should also be considered
confidential.
There are several instances where total
confidentiality is either impossible, undesirable or
illegal.
 These include:
 if the health and/or welfare of a child or young
person is at risk. You are required to contact
Department of Community Services and notify them
of your concerns.
 if your client tells you he/she has committed a
serious crime. You are required to notify your
supervisor or the police directly.
 if a worker is subpoenaed to present information in a
court of law
 when the client needs to be protected from harming
themselves (eg if suicidal)
 where others may need to be protected (if the client
has threatened to harm others or will do so
inadvertently).
 when working in conjunction with other
professionals in caring for a client the requirements
of professional supervision, training, workshops or
seminars
When we tell the information of patient
 If welfare of pt. at risk.
 committed a serious crime.
 information in a court of law
 protected from harming themselves (eg if suicidal)
 if the client has threatened to harm others
 conjunction with other professionals in caring for a
client
Importance of confidentiality
 Confidentiality is important for several reasons.
 One of the most important elements of confidentiality
is that it helps to build and develop trust.
 It potentially allows for the free flow of information
between the client and worker and acknowledges that a
client’s personal life and all the issues and problems
that they have belong to them.
 One of the major purposes for obtaining a client’s
consent before speaking to a third party (such as
another agency or a family member/carer) is to protect
the confidentiality and privacy of the client.
Cont.…
 Informed consent (obtaining personal information
with the formal permission of the client or a person
who has the legal authority to provide permission on
behalf of the client) is considered essential in
maintaining the privacy of the client.
privacy
Privacy;-the right of individuals to be left alone and
to be protected against physical or psychological
invasion or the misuse of their property.
What does privacy mean in care?
Medical privacy or health privacy is the practice
of maintaining the security and confidentiality of
patient records.
The terms can also refer to the physical privacy of
patients from other patients and providers while in a
medical facility.
Cont.…
The word privacy has four major usages,
corresponding to four distinct forms, dimensions, or
conceptions of privacy:
 physical privacy,
 Informational privacy,
 proprietary privacy, and
 decisional privacy.
Cont.…
 Physical privacy is a restriction on the ability of
others to experience a person through one or more of
the five senses;
 Informational privacy is a restriction on facts about
the person that are unknown or unknowable;
 Decisional privacy is the exclusion of others from
decisions, such as health care decisions
 proprietary privacy ;-confidentiality of works to
protect patient proprieties.
The principle of confidentiality and privacy
You must respect and protect patient information
Patients must consent before you share any
information about them.
When asking for consent you should tell the patient:
1. what information you want to share
2. who you want to share it with, and
3. how the information will be use
 Anyone you employ must also protect patient
information.
Cont.…
 If an adult patient with capacity tells you not to share
information with other people, you should firstly
discuss this with them, and explain why you need to
share the information.
 If they still refuse, you should not share their
information, even if failure to share would leave the
patient (but no one else) at risk of serious harm or
death.
 If you believe that the patient’s decision to refuse a
service puts them at risk of serious harm, you must
discuss this issue with appropriate colleagues, whilst
respecting the patient’s confidence.
 You can share patient identifiable information if you
are required to do so by law, or disclosure is justified
in the public interest
Cont.…
There are exceptions to the rule of protecting patients’
confidentiality which are:
you may be required to provide information by law,
for example if ordered by a court, or
 you may need to disclose information if it is in the
public interest, for example where failing to disclose
information would expose other members of the
public to risk of death or serious harm.
You may disclose information without patient consent
if you have reason to believe that asking for consent
would put you or other people at risk of serious harm
Privacy and confidentiality are also supported by two
principles of the Belmont Report:
 Respect for persons – Individuals should be treated
as autonomous agents able to exercise their autonomy to
the fullest extent possible, including the right to privacy
and the right to have private information remain
confidential.
 Beneficence – Maintaining privacy and confidentiality
helps to protect participants from potential harms
including psychological harm such as embarrassment or
distress; social harms such as loss of employment or
damage to one‘s financial standing; and criminal or civil
liability
Cont…
Class work
1) Define Confidentiality
2) List types of information that is considered
confidential.
3) What does decisional privacy mean?
4) When we tell the information of patient to the other
person
5) What does physical privacy mean?
Transport client
Definition: Transfer is defined as preparing patient,
completing necessary records and shifting patient to
another department within the hospital or to another
hospital/home.
 Transfer/referral is the preparation of a patient and
the referral records to the shift the patient to another
department within the hospital or to another
hospital
Purpose
To obtain necessary diagnostic tests and
procedure
To provide treatment and Nursing care
To provide specialized care
To place most appropriate utilization or
available personnel and services
To match intensity(quality) of Nursing
care, based on patients level of needs and
problems
Types of transfer of the patient
1. Internal transfer: to transfer the
patient in a unit that provide special
care or care suited to his need, e.g.
from general ward to ICU
2. External transfer: to transfer the
patient from one hospital to another
hospital for the purpose of special care,
e.g. from general hospital to specialized
hospital- cancer center
Preliminary(preceding) assessment
A. Assess the method for transport, inform
receiving nurse
B. Maintain patient‘s physical wellbeing during
transport to new Nursing unit
C. Provide verbal report about patient‘ s
condition to the receiving unit nurse
D. Be sure all documentation including care
plan is completed
E. Assist‘s patients arrival to the new unit
F. Announce patients arrival to the new unit
G. Transport patient to the new room and assist in
transfer to bed
H. Hand over(pass responsibility to someone else) to
receiving nurse
Equipment
1. Wheelchair/ stretcher
2. Identification labels
3. Patients belongings
4. X-rays
5. Investigation reports
6. Patient records and file
Procedure
1.Check the doctor‘s orders for transfer of
patient
2. Inform the patient and relatives
3. Inform to the ward nurse where the patient
needs to be transferred
4. Check the chart for complete
recording of vital signs, Nursing care and
treatment given
5. Collect patient x-ray, medicine and
other belongings
6. Cancel the hospital diet or transfer
Cont.…
7. Assist the relative to collect other
belongings
8. Make arrangement to settle the due
bills if patient is goining to be transferred
another hospital
9. Record time, mode of transfer and
general condition of the patient
10. Assist transferring sink patient to
wheel chair/stretcher and accompany
patient to new area
11. Handover patient documents ,
belonging and report verbally to the in
charge nurse
Cont.…
12. Collect the ward articles
13. Inform to the concern person /
department regarding transfer of the
patient
14. Clean unit thoroughly and keep ready
for next patient
Caring for a patient on discharge
Definition:
 Patient discharge is sending the
hospitalized patient to home or to
referral after successful discharge
planning process.
 Patient discharge planning is systematic
process for preparing the patient to
leave the hospital & for continuity of
care at home.
Purpose
To continue self care at home
To adjust the patients setting out of
the hospital
To ensure adequate home health care
support
To minimize the patient‘s anxiety at
discharge
Indications for discharge
Progress in the patient's condition
(cured)
No change in the patient's condition
(Referral)
Against medical advice
Death
Procedure
1.Check for the doctor‘s written order that
pt. to be discharged.
2. Inform patient and relative about
discharge
3. Document relevant dis charge
information
4. Make sure all the fees(a payment
made to a professional person) are
included
5. Send admission card to registration
office
Cont.…
6. Plan for continuing care of the patient
Give information for a person
involved in the patient care.
Contact family or significant others, if
needed.
Facilitate transportation with
responsible unit
7. Assist patient to dress up
Cont.…
8. Teaching the patient about ;
What to expect about disease outcome
Medications (Treatments)
Activity
Diet
Need for Follow up and others as needed
9. Do final assessment of physical and emotional
status of the patient and the ability to continue own
care.
Cont.…
10. Check and return all patients‘ personal
property (bath items in patient unit and those
kept in safe area).
11. Help the patient or family to deal with
business office for customary financial matters
and in obtaining supplies.
12. Accompany(occur at the same time as)
patient to the gate, if possible
Cont.…
13. Write Discharge summaries note which usually include:
Time and date of discharge
Description of client‘s condition at discharge
Treatment (e.g. Wound care, Current medication)
Diet
Activity level
Restrictions
N.B: If a patient insists upon going home against medical
advice he should be requested to sign a statement indicating
that he is responsible for his action.
Discharging a patient against medical
advice (AMA)
1. When the patient want to leave an agency
without the permission of the physician –
unauthorized discharge the following
activities are indicated:
2. Ascertain why the person wants to leave the
agency
3. Notify the physician of the client‘s decision
4. Offer the patient the appropriate form
to complete
5. If the client refuses to sign the form,
document the fact on the form and have
another health professional witness this
Cont.…
6. Provide the patient with the original of
the signed form and place a copy in the
record
7. When the patient leaves the agency,
notify the physician, nurse in charge, and
agency administration as appropriate
8. Assist the patient to leave as if this
were a usual discharge from the agency
(the agency is still responsible while the
patient is on premises)
Lifting the patient
Dangling ; is sitting on the side of the bed with the feet
hanging down .
Purpose ;
 To prepare patient before walking ,moving to chair
or wheelchair or performing others
 To relive pressure in case of pulmonary edema (fluid
accumulation in the tissue and air spaces of the lungs.
It leads to impaired gas exchange and may cause
respiratory failure)
Indication
 Moving patient out of bed
Cont.…
Contraindication ;-
Unconscious patient
Spinal injury
Precaution
Do not leave the patient alone when dangling.
If the patient becomes dizzy lie him down.
Have the patient cough, deep breathe, and exercise
their leg muscles when dangling
Check the person‘s pulse and respirations
Cont.…
Equipment
 Turn sheet or draw sheet
 Screen
Procedure
1. Greet the patient and explain the procedure
2. Perform hand hygiene
3. Collect the necessary material
4. Provide privacy
5. Assess the patient condition
Cont.…
6. Position yourself and client appropriately before
performing the move
a. Assist the client to a lateral position facing you
b. Raise the head of the bed slowly to its highest
position
c. Position the clients feet and lower legs at the edge of
the bed
d. Stand beside the client‘s hips and face the far corner
of the bottom of the bed
Cont.…
7. Move client to sitting position
a. Place one arm around the client shoulder and the other
arm beneath both of the client thighs near the knee
b. Tighten your gluteal , abdominal, leg and arm muscle
c. Lift the client thighs slowly
d. Private on your feet in the desired direction facing the
foot of the bed while pulling the client feet and legs off the
bed
e. Keep supporting the client until client is well balanced
and comforted
f. Assess vital signs as indicated
8. Document all relevant information
Log rolling
Definition: Logrolling is a technique used to turn a
patient whose body must at all times be kept in a
straight alignment.
Purpose
To turn a patient to the side of bed
Indication
Spinal injury
Confidentiality and privacy.pptx
Cont.….
Cont.…
Equipment
1. Hospital bed with side rails
2. Turn sheet or draw sheet
3. Pillows
Cont.…
Procedure
1. Wash your hands
2. Greet and explain the procedure
3. Provide privacy
4. Position the bed in the flat position at a comfortable
working height
5. Lower the side rail on the side of the body at which
you are working
6.Position yourself with your feet apart and your knees
flexed close to the side of the bed
Cont.…
7. Fold the patient's arms across his chest
8. Place your arms or turn sheet under the patient so
that a major portion of the patient's weight is centered
between your arms.
9. The arm of the other nurse should support the
patient's head and neck.
10. On the count of three, move the patient to the side
of the bed, rocking backward on your heels and keeping
the patient's body in correct alignment.
Cont.…
11. Move to the other side of the bed.
12. Place a pillow under the patient's head and another
between his legs.
13. Position the patient's near arm toward you.
14. Grasp the far side of the patient's body with your hands
evenly distributed from the shoulder to the thigh.
15. On the count of three, roll the patient to a lateral
position, rocking backward onto your heels.
16. Place pillows in front of and behind the patient's trunk
to support his alignment in the lateral position. Provide for
the patient's comfort and safety.
Cont.…
15. On the count of three, roll the patient to a lateral
position, rocking backward onto your heels.
16. Place pillows in front of and behind the patient's
trunk to support his alignment in the lateral position.
Provide for the patient's comfort and safety.
17. Report and record as appropriate
Moving patient up in bed with two nurses
using draw sheet
Definition ;- Moving patients up in bed refers to
returning the patient to previous correct position in bed
if he/she slides to the foot side of the bed.
Purpose
To make patients in comfortable position in bed
To maintain good body alignment
Indication
Patient slides to the foot of the bed
Equipment
 Documentation format
 Draw sheet
 Pillow
Cont.…
Procedure
1. Explain the procedure
2. Perform hand washing
3. Collect necessary equipment
4. Lower head of the bed to flat position and raise level of bed to
comfortable height
5. Remove all pillows from under the client. Leave one at head of bed
6. One nurse stands on each side of the bed with leg positioned for wide
base of support and one foot slightly in front of bed frame
7. Each nurse rolls up and grasps edges of turn sheet close to client‘s
shoulder buttocks
8. Flex knees and hips tighten abdominal and gluteal muscle.
9. Raise the patient up in bed
10. Observe the condition of the patient
11. Record the procedure
Positioning the patient
Definition ;-Positioning is turning or putting the
patients in a proper body alignment for the purpose of
preventive, promotive ,curative and rehabilitative
aspects of health.
Purpose of positioning
To relief pressure on various parts or lessen possible
stress on pressure points
To prevent formation of deformity
To Improve circulation
Preserve muscle function as different muscle group‘s
contract and relax.
To provide comfort, support, and good body
alignment
To make the patient ready for different procedures
Type of positioning
Common positioning methods of patient in a bed include
but not limited to
1. Front lying (prone):
2. semi-prone position(or Sims‘ position)
3. Dorsal Supine (back lying):
4. Dorsal recumbent position
5. Lateral recumbent (on either side)
6. Fowler‘s position position
7. Knee chest position
8. Trendelenburg position
9. Lithotomy position
Front lying (prone)
Definition ;- Prone position is putting the patient in a
flat on the abdomen, legs extended, feet over the edge of
the mattress, and toes pointing to the floor.
Purpose
To Promotes drainage from mouth
To prevent contractures of hips and knee
To examine the spine and the back
Cont.…
Indication
Patient with excessive secretion from mouth
Patient with potential risk of knee and hip
contracture
Contraindication
Cervical –spine fracture
Respiratory impairment/breathing difficulties
Foot drop (DAMAGE OF FRONT FOOT)
Pregnant women
Clients with abdominal incisions
Cont.….
Equipment
1. Small pillow (3)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Documentation format
5. Receiver for drainage( if any)
Procedure
1. Great the patient ( if conscious ) and explain the procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Place turn or draw sheet under client‘s back and head
7. Assist the client to lie on abdomen.
8. Place a small pillow under client‘s head; turn head to side.
9. Extend the client‘s arms near side or flexed toward head.
10. Place a small pillow under chest for female clients and for clients
with barrel chest.
11. Place a small pillow under ankles or allow toes to rest in space
between foot of bed and the mattress.
Cont.…
12. Assess client for comfort.
13. Lower the bed and elevate the side rails
14. Wash your hand
15. Note the patient reaction
16. Document the procedure
Cont.…
Semi-prone position
Definition ;Semi-prone position putting or assisting
patients with upper arm flexed at shoulder and elbow;
lower arm positioned behind client and both legs
flexed in front of client with more flexion in upper leg
either of body side.
Purpose
To promotes drainage from mouth
To prevents aspiration
Comfortable for sleeping
 sacrum and greater trochanter of hip
 Promotes comfort especially in pregnant clients
Cont.…
Indication
For rectal examination
Pressure sore on the buttocks/sacrum and hips
Contraindication
 lumbar lordosis (EXCESSIVE INWARD
CURVATURE OF THE SPINE)
 Foot drop
 client with leg injuries or arthritis
Cont.…
Equipment
1. Small pillow (3)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Sand bag
5. Documentation format
6. Receiver for drainage( if any)
Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Place turn or draw sheet under client‘s back and head
7. Flexed at shoulder and elbow
8. Position lower arm behind and away from the back
9. Put pillow between chest and upper arm;
Cont.…
10. Flex both legs in front with more flexion in upper
leg.
11. Put pillow between legs
12. Support ankle with sand bag (if necessary )
13. Lower the bed and elevate the side rails
14. Wash your hand
15. Note the patient reaction
16. Document the procedure
Cont.…
Supine (back lying)
Definition: Supine position is putting patient in back lying
often with a small pillow to support the head and shoulder.
Purpose
 Promote comfort
 To help healing after certain abdominal operations
Indication
 After abdominal, chest and neck surgery
 For physical examination of anterior part of the body
 Usual position for the patient
Cont.…
Contraindication
Spinal injury
Cardiac patient (CHF)
Breathing impairments
Pressure sore (buttock, scrum, heal and shoulder )
Equipment's
1. Pillow of different size (3)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Wrist splint
5. Air rings
6. Cotton rings
7. Footboard or high-top tennis shoes
8. Documentation format
Procedure
1. Great the patient ( if conscious ) and explain the procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Place turn or draw sheet under client‘s back and head
7. Place bed in a flat position.
8. Place the patient‘s head in a straight line with his or her
back, shoulders, hips and knees
9. Place small pillows under head, back and ankles.
Cont.…
10. Place air ring under the hips/buttock
11. Flex the arm and rest on the stomach or
straighten and support with wrist splint
12. Support the feet with padded footboard or high-
top tennis shoes
13. Place the cotton ring under the heal
14. Lower the bed and elevate the side rails
15. Wash your hand
16. Note the patient reaction
17. Document the procedure
Cont.…
Dorsal recumbent position
Definition: Dorsal recumbent position is putting
patient in back lying position with knees are flexed and
the soles of the feet flat on the bed.
Purpose
 Promote comfort
 For visualize the perineum
To insert urinary catheter
To relief pressure from ileum, knee and ankle
Cont.…
Indication
Rectal , vulval and vaginal examination
Pelvic surgical procedures
Vaginal douche (VAGINAL WASH)
Perineal care
Catheterization
Supra-pubic puncture
Contraindication
Spinal injury
Cardiac patient (CHF)
Breathing impairments
Pressure sore (buttock, scrum, heal and shoulder )
Equipment's
1. Pillow of different size (3)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Bath Blanket or sheet
5. Air rings
6. Cotton ring
7. Bed block ( if necessary)
8. Documentation format
Procedure
1. Great the patient ( if conscious ) and explain the procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Place turn or draw sheet under client‘s back and head
7. Place bed in a flat position
Cont.…
8. Cover the client with a sheet or a bath blanket folded
once across the chest.
9. Place the patient‘s head in a straight line with his or
her back, shoulders, hips and knees
10. Place small pillows under head and shoulder or
elevate the top of the bed with block.
11. Place air ring under the hips/buttock
12. Flex the leg and wide apart
13. Place cotton ring under the heels
Cont.…
14. Lower the bed and elevate the side rails
15. Wash your hand
16. Note the patient reaction
17. Document the procedure
Confidentiality and privacy.pptx
Lateral recumbent (on either side)
Definition: Lateral recumbent position is putting
patient on either of the side with the legs flexed at knee
(The upper leg is more flexed than the lower leg).
Purpose
To perform back care
To relieves pressure on sacrum and heels
To perform enema
To take rectal body temperature
To insert suppositories
Cont.…
Indication
Enema and colonic irrigation
Pressure sore on heel and sacrum
Rectal examination
To measure rectal temperature
Contraindication
Arm and rib fracture
Spinal injury
Flank injury
Cont.…
Equipment's
1. Pillow of different size (4)
2. Bed with side rails
3. Draw sheet or turn sheet
4. Documentation format
Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Place turn or draw sheet under client‘s back and head
6. Elevate bed to highest position
7. Logroll client to side
Cont.…
7. Logroll client to side
a. For left lateral position, place the patient on left side
with buttocks to the edge of the bed both thighs flexed
and left arm underneath
b. For right lateral position, Place the patient on right
side with buttocks to the edge of the bed both thighs
flexed and right arm underneath
Cont.…
8. Place a small pillow under client‘s head.
9. Place pillow or foam wedges behind client‘s back.
10. Put a pillow tucked by the client‘s abdomen.
11. Place a pillow between client‘s legs.
12. Run your hand under the client‘s dependent
shoulder and move the shoulder slightly forward
13. .Lower the bed and elevate the side rails
14. Wash your hand
Cont.….
15. Note the patient reaction
16. Document the procedure
Knee chest
Definition: Knee chest position is putting a patient on
the Knee and the chest with the head turned one side,
arms above the head and one cheek on a pillow.
Purpose
1. Used for vaginal and rectal examination
2. Used in first aid treatment in cord Prolapse or
retroverted uterus
3. Assumed for postpartum and gynecologic exercises
Indication
1. Sigmoidoscopic examination
2. Vaginal and rectal examination
3. Cord Prolapse
4. Retoverted uterus
Contraindication
Cardio-pulmonary problem
Upper arm, spine and ribs fracture
Increased intra-cranial pressure (IICP)
Equipment's
1. Pillow (1)
2. Drape/ Bath Blanket or sheet
3. Screen
4. Documentation format
Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Make the patient on the knees and chest
7. Turn the head to one side with the cheek on pillow
8. Extend the arms on the beds and flex it at the elbows
to support the patient partially
9. The weight should rest on the chest and knees which
are flexed so that the thighs are at right angles to the legs
10. Cover the client with a sheet or a bath blanket.
11. Lower the bed and elevate the side rails
12. Wash your hand
13. Note the patient reaction
Confidentiality and privacy.pptx
Fowler's position (semi-upright with back
and knee rests elevated)
Definition: Fowler's position is sitting position in which the
head is elevated at different angle (15-90) o angle and may
have knees either bent or straight.
Type
1. High Fowler's position is when the patient's head is raised
80-90 degrees,
2. Semi-Fowler's position is when the patient's head is
elevated 30-45 degrees.
3. Low Fowler's position is when the head of bed is elevated
15-30 degrees
4. Fowler's which is 45-60 degrees
Cont.…
Purpose
1. To relive dyspnea
2. To improve circulation
3. To prevent thrombosis
4. To prevent aspiration during the introduction of feeding
tubes
5. To facilitate drainage from abdomen and pelvic cavity
post operatively
6. To relax the muscle of the abdomen, back and thighs
7. To relive tension on abdominal suture
8. To promote comfort
9. Increase comfort during eating
10. To relieve edema of the chest and abdomen
Indication
Cardio-pulmonary problem (Respiratory distress,
CHF, pulmonary edema..)
Increased intra abdominal pressure
Thrombosis
Abdominal, back and thigh muscle strain
Nasal or oral passageway procedures (e.g. NGT…)
Contraindication
1. Comatose/unconscious patients
2. Spinal injury
3. Foot drop
4. Head injury
5. Shoulder dislocation
Equipment
1. Small pillow (3)
2. Foot rest/foot board
3. Back support
4. Hand wrist support
5. Screen if necessary
Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Place the patient in sitting position with arms at sides
knees raised with pillow
6. Place bed in a 15° to 30° angle for low-Fowler‘s position,
45° to 60° angle for Fowler‘s position, or 70° to 90° angle
for high-Fowler‘s position.
7. Turn patients head to one side and align the patient in
good position
8. Place a small pillow under client‘s head.
9. Support the backs and arms with pillows.
10. Place a pillow between client‘s legs.
11. Lower the bed and elevate the side rails
12. Wash your hand
13. Note the patient reaction
14. Document the procedure
Confidentiality and privacy.pptx
Trendelenburg position
Definition: Trendelenburg is putting the patient in a
flat on the back with the feet higher than the head by
15-30 degree.
Purpose
To increase cerebral perfusion pressure
To allow better access to pelvic organ during pelvic
surgery
To help in surgical reduction of hernia
To enhance access to central venous line
Cont.…
Indication
Hypotension/shock
Abdominal and gynecologic surgery
Placing central venous line
Surgical reduction of hernia .
Cont.…
Contraindication
Cervical –spine fracture
Respiratory impairment/breathing difficulties
Brain injury with increased intracranial pressure
Spinal injury
Cardiac patient (CHF)
Breathing impairments
Pressure sore (buttock, scrum, heal and shoulder )
Cont.…
Equipment's
1. Bed block(if necessary
2. Drape
3. Screen
4. Documentation format
Procedure
1. Great the patient ( if conscious ) and explain the
procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Place the patient‘s head lower than the feet with arms
at the side
Cont.…
6. Place bed blocks at the foot end of the bed.
7. Lower the bed and elevate the side rails
8. Wash your hand
9. Note the patient reaction
10. Document the procedure
Lithotomy position
Definition: Lithotomy position is positioning the
client feet above or the same level as hips with
perineum positioned at the edge of examination table.
Purpose
To provide good visual and physical access to
perineum
To perform simple pelvic procedures to major
surgeries
To conduct delivery
Cont.…
Indication
Pelvic medical examination and surgeries
Delivery
Contraindication
Spinal injury
Breathing impairments
Cont.…
Equipment's
1. Pillow (1)
2. Bed with side rails/examination table/delivery couch
3. Draw sheet /drape
4. Screen
5. Documentation format
Procedure
1. Great the patient and explain the procedure
2. Perform hand washing
3. Collect all necessary equipment's
4. Provide privacy
5. Elevate bed to highest position.
6. Place bed in a flat position.
7. Cover the client with a sheet or a bath blanket
Cont.…
8. Lie the patient flat with pillow under the head
9. Flex the feet above or the same level as hips and
support with knee rest over a couch ( if available)
10. Wash your hand
11. Note the patient reaction
12. Document the procedure
Confidentiality and privacy.pptx
patient Ambulation
Definition: Client ambulation is assisted or unassisted
walking which encouraged soon after the onset of illness
or surgery to prevent the complications of immobility.
Purpose
To Keeps client more active
To prevent the complications of immobility
To improves muscle tone and strength in his legs
To slow down loss of bone mass and density related to
osteoporosis
Cont.…
To improves appetite , peristalsis and circulation
To give a sense of accomplishment and maintains
greater independence for clients( psychological
wellbeing)
Indication
Immobile patients unless contraindicated
Postoperative patient
Contraindication
Unstable vital sign
Spinal fracture
Patient with traction
Equipment
Assistive devices
(Gait belt,
Cane,
Walker and
Crutch )

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Confidentiality and privacy.pptx

  • 1. M O H A M M E D A ( R N , B S C N ) Confidentiality and privacy
  • 2. Cont.…  The terms 'privacy' and 'confidentiality' are commonly used interchangeably. Privacy may also relate to information about oneself, and information privacy laws regulate the handling of personal information through enforceable privacy principles. Confidentiality relates to information only.
  • 3. Confidentiality Confidentiality;- is the protection of personal information.  Confidentiality means keeping a client’s information between you and the client, and not telling others including co-workers, friends, family, etc.  Confidentiality is a critical aspect of your duty of care.
  • 4. Examples of maintaining confidentiality include:  individual files are locked and secured  support workers do not tell other people what is in a client’s file unless they have permission from the client  information about clients is not told to people who do not need to know  clients’ medical details are not discussed without their consent  adult clients have the right to keep any information about themselves confidential, which includes that information being kept from family and friends.
  • 5. The types of information that is considered confidential can include:  name, date of birth, age, sex and address  current contact details of family, guardian etc.  medical history or records  personal care issues  file progress notes  individual personal plans  assessments or reports  income or outgoing personal correspondence.
  • 6.  Other information relating to  ethic or racial origin,  political opinions,  religious or philosophical beliefs,  health or sexual lifestyle should also be considered confidential.
  • 7. There are several instances where total confidentiality is either impossible, undesirable or illegal.  These include:  if the health and/or welfare of a child or young person is at risk. You are required to contact Department of Community Services and notify them of your concerns.  if your client tells you he/she has committed a serious crime. You are required to notify your supervisor or the police directly.
  • 8.  if a worker is subpoenaed to present information in a court of law  when the client needs to be protected from harming themselves (eg if suicidal)  where others may need to be protected (if the client has threatened to harm others or will do so inadvertently).  when working in conjunction with other professionals in caring for a client the requirements of professional supervision, training, workshops or seminars
  • 9. When we tell the information of patient  If welfare of pt. at risk.  committed a serious crime.  information in a court of law  protected from harming themselves (eg if suicidal)  if the client has threatened to harm others  conjunction with other professionals in caring for a client
  • 10. Importance of confidentiality  Confidentiality is important for several reasons.  One of the most important elements of confidentiality is that it helps to build and develop trust.  It potentially allows for the free flow of information between the client and worker and acknowledges that a client’s personal life and all the issues and problems that they have belong to them.  One of the major purposes for obtaining a client’s consent before speaking to a third party (such as another agency or a family member/carer) is to protect the confidentiality and privacy of the client.
  • 11. Cont.…  Informed consent (obtaining personal information with the formal permission of the client or a person who has the legal authority to provide permission on behalf of the client) is considered essential in maintaining the privacy of the client.
  • 12. privacy Privacy;-the right of individuals to be left alone and to be protected against physical or psychological invasion or the misuse of their property. What does privacy mean in care? Medical privacy or health privacy is the practice of maintaining the security and confidentiality of patient records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility.
  • 13. Cont.… The word privacy has four major usages, corresponding to four distinct forms, dimensions, or conceptions of privacy:  physical privacy,  Informational privacy,  proprietary privacy, and  decisional privacy.
  • 14. Cont.…  Physical privacy is a restriction on the ability of others to experience a person through one or more of the five senses;  Informational privacy is a restriction on facts about the person that are unknown or unknowable;  Decisional privacy is the exclusion of others from decisions, such as health care decisions  proprietary privacy ;-confidentiality of works to protect patient proprieties.
  • 15. The principle of confidentiality and privacy You must respect and protect patient information Patients must consent before you share any information about them. When asking for consent you should tell the patient: 1. what information you want to share 2. who you want to share it with, and 3. how the information will be use  Anyone you employ must also protect patient information.
  • 16. Cont.…  If an adult patient with capacity tells you not to share information with other people, you should firstly discuss this with them, and explain why you need to share the information.  If they still refuse, you should not share their information, even if failure to share would leave the patient (but no one else) at risk of serious harm or death.
  • 17.  If you believe that the patient’s decision to refuse a service puts them at risk of serious harm, you must discuss this issue with appropriate colleagues, whilst respecting the patient’s confidence.  You can share patient identifiable information if you are required to do so by law, or disclosure is justified in the public interest
  • 18. Cont.… There are exceptions to the rule of protecting patients’ confidentiality which are: you may be required to provide information by law, for example if ordered by a court, or  you may need to disclose information if it is in the public interest, for example where failing to disclose information would expose other members of the public to risk of death or serious harm. You may disclose information without patient consent if you have reason to believe that asking for consent would put you or other people at risk of serious harm
  • 19. Privacy and confidentiality are also supported by two principles of the Belmont Report:  Respect for persons – Individuals should be treated as autonomous agents able to exercise their autonomy to the fullest extent possible, including the right to privacy and the right to have private information remain confidential.  Beneficence – Maintaining privacy and confidentiality helps to protect participants from potential harms including psychological harm such as embarrassment or distress; social harms such as loss of employment or damage to one‘s financial standing; and criminal or civil liability
  • 21. Class work 1) Define Confidentiality 2) List types of information that is considered confidential. 3) What does decisional privacy mean? 4) When we tell the information of patient to the other person 5) What does physical privacy mean?
  • 22. Transport client Definition: Transfer is defined as preparing patient, completing necessary records and shifting patient to another department within the hospital or to another hospital/home.  Transfer/referral is the preparation of a patient and the referral records to the shift the patient to another department within the hospital or to another hospital
  • 23. Purpose To obtain necessary diagnostic tests and procedure To provide treatment and Nursing care To provide specialized care To place most appropriate utilization or available personnel and services To match intensity(quality) of Nursing care, based on patients level of needs and problems
  • 24. Types of transfer of the patient 1. Internal transfer: to transfer the patient in a unit that provide special care or care suited to his need, e.g. from general ward to ICU 2. External transfer: to transfer the patient from one hospital to another hospital for the purpose of special care, e.g. from general hospital to specialized hospital- cancer center
  • 25. Preliminary(preceding) assessment A. Assess the method for transport, inform receiving nurse B. Maintain patient‘s physical wellbeing during transport to new Nursing unit C. Provide verbal report about patient‘ s condition to the receiving unit nurse D. Be sure all documentation including care plan is completed
  • 26. E. Assist‘s patients arrival to the new unit F. Announce patients arrival to the new unit G. Transport patient to the new room and assist in transfer to bed H. Hand over(pass responsibility to someone else) to receiving nurse
  • 27. Equipment 1. Wheelchair/ stretcher 2. Identification labels 3. Patients belongings 4. X-rays 5. Investigation reports 6. Patient records and file
  • 28. Procedure 1.Check the doctor‘s orders for transfer of patient 2. Inform the patient and relatives 3. Inform to the ward nurse where the patient needs to be transferred
  • 29. 4. Check the chart for complete recording of vital signs, Nursing care and treatment given 5. Collect patient x-ray, medicine and other belongings 6. Cancel the hospital diet or transfer
  • 30. Cont.… 7. Assist the relative to collect other belongings 8. Make arrangement to settle the due bills if patient is goining to be transferred another hospital 9. Record time, mode of transfer and general condition of the patient
  • 31. 10. Assist transferring sink patient to wheel chair/stretcher and accompany patient to new area 11. Handover patient documents , belonging and report verbally to the in charge nurse
  • 32. Cont.… 12. Collect the ward articles 13. Inform to the concern person / department regarding transfer of the patient 14. Clean unit thoroughly and keep ready for next patient
  • 33. Caring for a patient on discharge Definition:  Patient discharge is sending the hospitalized patient to home or to referral after successful discharge planning process.  Patient discharge planning is systematic process for preparing the patient to leave the hospital & for continuity of care at home.
  • 34. Purpose To continue self care at home To adjust the patients setting out of the hospital To ensure adequate home health care support To minimize the patient‘s anxiety at discharge
  • 35. Indications for discharge Progress in the patient's condition (cured) No change in the patient's condition (Referral) Against medical advice Death
  • 36. Procedure 1.Check for the doctor‘s written order that pt. to be discharged. 2. Inform patient and relative about discharge 3. Document relevant dis charge information
  • 37. 4. Make sure all the fees(a payment made to a professional person) are included 5. Send admission card to registration office
  • 38. Cont.… 6. Plan for continuing care of the patient Give information for a person involved in the patient care. Contact family or significant others, if needed. Facilitate transportation with responsible unit 7. Assist patient to dress up
  • 39. Cont.… 8. Teaching the patient about ; What to expect about disease outcome Medications (Treatments) Activity Diet Need for Follow up and others as needed 9. Do final assessment of physical and emotional status of the patient and the ability to continue own care.
  • 40. Cont.… 10. Check and return all patients‘ personal property (bath items in patient unit and those kept in safe area). 11. Help the patient or family to deal with business office for customary financial matters and in obtaining supplies. 12. Accompany(occur at the same time as) patient to the gate, if possible
  • 41. Cont.… 13. Write Discharge summaries note which usually include: Time and date of discharge Description of client‘s condition at discharge Treatment (e.g. Wound care, Current medication) Diet Activity level Restrictions N.B: If a patient insists upon going home against medical advice he should be requested to sign a statement indicating that he is responsible for his action.
  • 42. Discharging a patient against medical advice (AMA) 1. When the patient want to leave an agency without the permission of the physician – unauthorized discharge the following activities are indicated: 2. Ascertain why the person wants to leave the agency 3. Notify the physician of the client‘s decision
  • 43. 4. Offer the patient the appropriate form to complete 5. If the client refuses to sign the form, document the fact on the form and have another health professional witness this
  • 44. Cont.… 6. Provide the patient with the original of the signed form and place a copy in the record 7. When the patient leaves the agency, notify the physician, nurse in charge, and agency administration as appropriate
  • 45. 8. Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises)
  • 46. Lifting the patient Dangling ; is sitting on the side of the bed with the feet hanging down . Purpose ;  To prepare patient before walking ,moving to chair or wheelchair or performing others  To relive pressure in case of pulmonary edema (fluid accumulation in the tissue and air spaces of the lungs. It leads to impaired gas exchange and may cause respiratory failure) Indication  Moving patient out of bed
  • 47. Cont.… Contraindication ;- Unconscious patient Spinal injury Precaution Do not leave the patient alone when dangling. If the patient becomes dizzy lie him down. Have the patient cough, deep breathe, and exercise their leg muscles when dangling Check the person‘s pulse and respirations
  • 48. Cont.… Equipment  Turn sheet or draw sheet  Screen Procedure 1. Greet the patient and explain the procedure 2. Perform hand hygiene 3. Collect the necessary material 4. Provide privacy 5. Assess the patient condition
  • 49. Cont.… 6. Position yourself and client appropriately before performing the move a. Assist the client to a lateral position facing you b. Raise the head of the bed slowly to its highest position c. Position the clients feet and lower legs at the edge of the bed d. Stand beside the client‘s hips and face the far corner of the bottom of the bed
  • 50. Cont.… 7. Move client to sitting position a. Place one arm around the client shoulder and the other arm beneath both of the client thighs near the knee b. Tighten your gluteal , abdominal, leg and arm muscle c. Lift the client thighs slowly d. Private on your feet in the desired direction facing the foot of the bed while pulling the client feet and legs off the bed e. Keep supporting the client until client is well balanced and comforted f. Assess vital signs as indicated
  • 51. 8. Document all relevant information
  • 52. Log rolling Definition: Logrolling is a technique used to turn a patient whose body must at all times be kept in a straight alignment. Purpose To turn a patient to the side of bed Indication Spinal injury
  • 55. Cont.… Equipment 1. Hospital bed with side rails 2. Turn sheet or draw sheet 3. Pillows
  • 56. Cont.… Procedure 1. Wash your hands 2. Greet and explain the procedure 3. Provide privacy 4. Position the bed in the flat position at a comfortable working height 5. Lower the side rail on the side of the body at which you are working 6.Position yourself with your feet apart and your knees flexed close to the side of the bed
  • 57. Cont.… 7. Fold the patient's arms across his chest 8. Place your arms or turn sheet under the patient so that a major portion of the patient's weight is centered between your arms. 9. The arm of the other nurse should support the patient's head and neck. 10. On the count of three, move the patient to the side of the bed, rocking backward on your heels and keeping the patient's body in correct alignment.
  • 58. Cont.… 11. Move to the other side of the bed. 12. Place a pillow under the patient's head and another between his legs. 13. Position the patient's near arm toward you. 14. Grasp the far side of the patient's body with your hands evenly distributed from the shoulder to the thigh. 15. On the count of three, roll the patient to a lateral position, rocking backward onto your heels. 16. Place pillows in front of and behind the patient's trunk to support his alignment in the lateral position. Provide for the patient's comfort and safety.
  • 59. Cont.… 15. On the count of three, roll the patient to a lateral position, rocking backward onto your heels. 16. Place pillows in front of and behind the patient's trunk to support his alignment in the lateral position. Provide for the patient's comfort and safety. 17. Report and record as appropriate
  • 60. Moving patient up in bed with two nurses using draw sheet Definition ;- Moving patients up in bed refers to returning the patient to previous correct position in bed if he/she slides to the foot side of the bed. Purpose To make patients in comfortable position in bed To maintain good body alignment Indication Patient slides to the foot of the bed
  • 61. Equipment  Documentation format  Draw sheet  Pillow
  • 62. Cont.… Procedure 1. Explain the procedure 2. Perform hand washing 3. Collect necessary equipment 4. Lower head of the bed to flat position and raise level of bed to comfortable height 5. Remove all pillows from under the client. Leave one at head of bed 6. One nurse stands on each side of the bed with leg positioned for wide base of support and one foot slightly in front of bed frame 7. Each nurse rolls up and grasps edges of turn sheet close to client‘s shoulder buttocks 8. Flex knees and hips tighten abdominal and gluteal muscle. 9. Raise the patient up in bed 10. Observe the condition of the patient 11. Record the procedure
  • 63. Positioning the patient Definition ;-Positioning is turning or putting the patients in a proper body alignment for the purpose of preventive, promotive ,curative and rehabilitative aspects of health.
  • 64. Purpose of positioning To relief pressure on various parts or lessen possible stress on pressure points To prevent formation of deformity To Improve circulation Preserve muscle function as different muscle group‘s contract and relax. To provide comfort, support, and good body alignment To make the patient ready for different procedures
  • 65. Type of positioning Common positioning methods of patient in a bed include but not limited to 1. Front lying (prone): 2. semi-prone position(or Sims‘ position) 3. Dorsal Supine (back lying): 4. Dorsal recumbent position 5. Lateral recumbent (on either side) 6. Fowler‘s position position 7. Knee chest position 8. Trendelenburg position 9. Lithotomy position
  • 66. Front lying (prone) Definition ;- Prone position is putting the patient in a flat on the abdomen, legs extended, feet over the edge of the mattress, and toes pointing to the floor. Purpose To Promotes drainage from mouth To prevent contractures of hips and knee To examine the spine and the back
  • 67. Cont.… Indication Patient with excessive secretion from mouth Patient with potential risk of knee and hip contracture Contraindication Cervical –spine fracture Respiratory impairment/breathing difficulties Foot drop (DAMAGE OF FRONT FOOT) Pregnant women Clients with abdominal incisions
  • 68. Cont.…. Equipment 1. Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Documentation format 5. Receiver for drainage( if any)
  • 69. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Assist the client to lie on abdomen. 8. Place a small pillow under client‘s head; turn head to side. 9. Extend the client‘s arms near side or flexed toward head. 10. Place a small pillow under chest for female clients and for clients with barrel chest. 11. Place a small pillow under ankles or allow toes to rest in space between foot of bed and the mattress.
  • 70. Cont.… 12. Assess client for comfort. 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 16. Document the procedure
  • 72. Semi-prone position Definition ;Semi-prone position putting or assisting patients with upper arm flexed at shoulder and elbow; lower arm positioned behind client and both legs flexed in front of client with more flexion in upper leg either of body side. Purpose To promotes drainage from mouth To prevents aspiration Comfortable for sleeping  sacrum and greater trochanter of hip  Promotes comfort especially in pregnant clients
  • 73. Cont.… Indication For rectal examination Pressure sore on the buttocks/sacrum and hips Contraindication  lumbar lordosis (EXCESSIVE INWARD CURVATURE OF THE SPINE)  Foot drop  client with leg injuries or arthritis
  • 74. Cont.… Equipment 1. Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Sand bag 5. Documentation format 6. Receiver for drainage( if any)
  • 75. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Flexed at shoulder and elbow 8. Position lower arm behind and away from the back 9. Put pillow between chest and upper arm;
  • 76. Cont.… 10. Flex both legs in front with more flexion in upper leg. 11. Put pillow between legs 12. Support ankle with sand bag (if necessary ) 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 16. Document the procedure
  • 78. Supine (back lying) Definition: Supine position is putting patient in back lying often with a small pillow to support the head and shoulder. Purpose  Promote comfort  To help healing after certain abdominal operations Indication  After abdominal, chest and neck surgery  For physical examination of anterior part of the body  Usual position for the patient
  • 79. Cont.… Contraindication Spinal injury Cardiac patient (CHF) Breathing impairments Pressure sore (buttock, scrum, heal and shoulder ) Equipment's 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Wrist splint 5. Air rings 6. Cotton rings 7. Footboard or high-top tennis shoes 8. Documentation format
  • 80. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Place bed in a flat position. 8. Place the patient‘s head in a straight line with his or her back, shoulders, hips and knees 9. Place small pillows under head, back and ankles.
  • 81. Cont.… 10. Place air ring under the hips/buttock 11. Flex the arm and rest on the stomach or straighten and support with wrist splint 12. Support the feet with padded footboard or high- top tennis shoes 13. Place the cotton ring under the heal 14. Lower the bed and elevate the side rails 15. Wash your hand 16. Note the patient reaction 17. Document the procedure
  • 83. Dorsal recumbent position Definition: Dorsal recumbent position is putting patient in back lying position with knees are flexed and the soles of the feet flat on the bed. Purpose  Promote comfort  For visualize the perineum To insert urinary catheter To relief pressure from ileum, knee and ankle
  • 84. Cont.… Indication Rectal , vulval and vaginal examination Pelvic surgical procedures Vaginal douche (VAGINAL WASH) Perineal care Catheterization Supra-pubic puncture
  • 85. Contraindication Spinal injury Cardiac patient (CHF) Breathing impairments Pressure sore (buttock, scrum, heal and shoulder )
  • 86. Equipment's 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Bath Blanket or sheet 5. Air rings 6. Cotton ring 7. Bed block ( if necessary) 8. Documentation format
  • 87. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Place bed in a flat position
  • 88. Cont.… 8. Cover the client with a sheet or a bath blanket folded once across the chest. 9. Place the patient‘s head in a straight line with his or her back, shoulders, hips and knees 10. Place small pillows under head and shoulder or elevate the top of the bed with block. 11. Place air ring under the hips/buttock 12. Flex the leg and wide apart 13. Place cotton ring under the heels
  • 89. Cont.… 14. Lower the bed and elevate the side rails 15. Wash your hand 16. Note the patient reaction 17. Document the procedure
  • 91. Lateral recumbent (on either side) Definition: Lateral recumbent position is putting patient on either of the side with the legs flexed at knee (The upper leg is more flexed than the lower leg). Purpose To perform back care To relieves pressure on sacrum and heels To perform enema To take rectal body temperature To insert suppositories
  • 92. Cont.… Indication Enema and colonic irrigation Pressure sore on heel and sacrum Rectal examination To measure rectal temperature Contraindication Arm and rib fracture Spinal injury Flank injury
  • 93. Cont.… Equipment's 1. Pillow of different size (4) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Documentation format
  • 94. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place turn or draw sheet under client‘s back and head 6. Elevate bed to highest position 7. Logroll client to side
  • 95. Cont.… 7. Logroll client to side a. For left lateral position, place the patient on left side with buttocks to the edge of the bed both thighs flexed and left arm underneath b. For right lateral position, Place the patient on right side with buttocks to the edge of the bed both thighs flexed and right arm underneath
  • 96. Cont.… 8. Place a small pillow under client‘s head. 9. Place pillow or foam wedges behind client‘s back. 10. Put a pillow tucked by the client‘s abdomen. 11. Place a pillow between client‘s legs. 12. Run your hand under the client‘s dependent shoulder and move the shoulder slightly forward 13. .Lower the bed and elevate the side rails 14. Wash your hand
  • 97. Cont.…. 15. Note the patient reaction 16. Document the procedure
  • 98. Knee chest Definition: Knee chest position is putting a patient on the Knee and the chest with the head turned one side, arms above the head and one cheek on a pillow. Purpose 1. Used for vaginal and rectal examination 2. Used in first aid treatment in cord Prolapse or retroverted uterus 3. Assumed for postpartum and gynecologic exercises
  • 99. Indication 1. Sigmoidoscopic examination 2. Vaginal and rectal examination 3. Cord Prolapse 4. Retoverted uterus
  • 100. Contraindication Cardio-pulmonary problem Upper arm, spine and ribs fracture Increased intra-cranial pressure (IICP) Equipment's 1. Pillow (1) 2. Drape/ Bath Blanket or sheet 3. Screen 4. Documentation format
  • 101. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Make the patient on the knees and chest 7. Turn the head to one side with the cheek on pillow
  • 102. 8. Extend the arms on the beds and flex it at the elbows to support the patient partially 9. The weight should rest on the chest and knees which are flexed so that the thighs are at right angles to the legs 10. Cover the client with a sheet or a bath blanket. 11. Lower the bed and elevate the side rails 12. Wash your hand 13. Note the patient reaction
  • 104. Fowler's position (semi-upright with back and knee rests elevated) Definition: Fowler's position is sitting position in which the head is elevated at different angle (15-90) o angle and may have knees either bent or straight. Type 1. High Fowler's position is when the patient's head is raised 80-90 degrees, 2. Semi-Fowler's position is when the patient's head is elevated 30-45 degrees. 3. Low Fowler's position is when the head of bed is elevated 15-30 degrees 4. Fowler's which is 45-60 degrees
  • 105. Cont.… Purpose 1. To relive dyspnea 2. To improve circulation 3. To prevent thrombosis 4. To prevent aspiration during the introduction of feeding tubes 5. To facilitate drainage from abdomen and pelvic cavity post operatively 6. To relax the muscle of the abdomen, back and thighs 7. To relive tension on abdominal suture 8. To promote comfort 9. Increase comfort during eating 10. To relieve edema of the chest and abdomen
  • 106. Indication Cardio-pulmonary problem (Respiratory distress, CHF, pulmonary edema..) Increased intra abdominal pressure Thrombosis Abdominal, back and thigh muscle strain Nasal or oral passageway procedures (e.g. NGT…)
  • 107. Contraindication 1. Comatose/unconscious patients 2. Spinal injury 3. Foot drop 4. Head injury 5. Shoulder dislocation
  • 108. Equipment 1. Small pillow (3) 2. Foot rest/foot board 3. Back support 4. Hand wrist support 5. Screen if necessary
  • 109. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place the patient in sitting position with arms at sides knees raised with pillow 6. Place bed in a 15° to 30° angle for low-Fowler‘s position, 45° to 60° angle for Fowler‘s position, or 70° to 90° angle for high-Fowler‘s position. 7. Turn patients head to one side and align the patient in good position
  • 110. 8. Place a small pillow under client‘s head. 9. Support the backs and arms with pillows. 10. Place a pillow between client‘s legs. 11. Lower the bed and elevate the side rails 12. Wash your hand 13. Note the patient reaction 14. Document the procedure
  • 112. Trendelenburg position Definition: Trendelenburg is putting the patient in a flat on the back with the feet higher than the head by 15-30 degree. Purpose To increase cerebral perfusion pressure To allow better access to pelvic organ during pelvic surgery To help in surgical reduction of hernia To enhance access to central venous line
  • 113. Cont.… Indication Hypotension/shock Abdominal and gynecologic surgery Placing central venous line Surgical reduction of hernia .
  • 114. Cont.… Contraindication Cervical –spine fracture Respiratory impairment/breathing difficulties Brain injury with increased intracranial pressure Spinal injury Cardiac patient (CHF) Breathing impairments Pressure sore (buttock, scrum, heal and shoulder )
  • 115. Cont.… Equipment's 1. Bed block(if necessary 2. Drape 3. Screen 4. Documentation format
  • 116. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place the patient‘s head lower than the feet with arms at the side
  • 117. Cont.… 6. Place bed blocks at the foot end of the bed. 7. Lower the bed and elevate the side rails 8. Wash your hand 9. Note the patient reaction 10. Document the procedure
  • 118. Lithotomy position Definition: Lithotomy position is positioning the client feet above or the same level as hips with perineum positioned at the edge of examination table. Purpose To provide good visual and physical access to perineum To perform simple pelvic procedures to major surgeries To conduct delivery
  • 119. Cont.… Indication Pelvic medical examination and surgeries Delivery Contraindication Spinal injury Breathing impairments
  • 120. Cont.… Equipment's 1. Pillow (1) 2. Bed with side rails/examination table/delivery couch 3. Draw sheet /drape 4. Screen 5. Documentation format
  • 121. Procedure 1. Great the patient and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place bed in a flat position. 7. Cover the client with a sheet or a bath blanket
  • 122. Cont.… 8. Lie the patient flat with pillow under the head 9. Flex the feet above or the same level as hips and support with knee rest over a couch ( if available) 10. Wash your hand 11. Note the patient reaction 12. Document the procedure
  • 124. patient Ambulation Definition: Client ambulation is assisted or unassisted walking which encouraged soon after the onset of illness or surgery to prevent the complications of immobility. Purpose To Keeps client more active To prevent the complications of immobility To improves muscle tone and strength in his legs To slow down loss of bone mass and density related to osteoporosis
  • 125. Cont.… To improves appetite , peristalsis and circulation To give a sense of accomplishment and maintains greater independence for clients( psychological wellbeing)
  • 126. Indication Immobile patients unless contraindicated Postoperative patient Contraindication Unstable vital sign Spinal fracture Patient with traction