basic nursing care part 2

1. Fundamentals of nursing
M.S Yosra Raziani
M.Sc. pediatric nursing
KUST
Spring-2020
session 5
Basic nursing care-I I

2. objectives
◈ After this session you learn:
✓ Genital care
✓ Urinary elimination
✓ Specimens collection
✓ Enema
2

4. Providing genital care
involves thorough cleansing of external genitalia and surrounding skin
to:
➢ Promote patients comfort and cleanliness
➢ Prevent infection in high-risk patient

5. Indications
✓Patient who are unable to do self care
✓Patients with indwelling catheter
✓Patients with incontinence of urine or stool
✓Patients having excessive vaginal discharge
✓Patients recovering from rectal or genital surgery
✓Following childbirth

6. Equipment
1. Wash basin
2. Soap dish with soap
3. Wash cloth
4. Bath towel
5. Bedpan
6. Disposable gloves
7. Cotton swabs
8. Toilet tissue
9. Warm water
10. Kidney tray

7. Procedures
1. introduce self
2. verify the client’s identity using agency protocol.
3. Explain to the client what you are going to do, why it is necessary
4. being particularly sensitive to any embarrassment displayed by the client.
5. Perform hand hygiene and observe other appropriate infection control procedures
6. Provide for client privacy by drawing the curtains around the bed or closing the door to the room
7. Fold the top bed linen to the foot of the bed and fold the gown up to expose the genital area.
8. Place a bath towel under the client’s hips
9. Position and drape the client and clean the upper inner thighs

8. Procedures(female)
1. Position the female in a back-lying position with the knees flexed and spread well apart.
2. Cover her body and legs with the bath blanket
3. Apply gloves. Wash and dry the upper inner thighs
4. Clean the labia majora. Then spread the labia to wash the folds between the labia majora and the labia minora.
5. Wipe from the area of least contamination (the pubis) to that of greatest (the rectum).
6. Rinse the area well.
7. Dry the perineum thoroughly.
8. Clean between the buttocks.
9. Dry the area well.
10. Remove and discard gloves. Perform hand hygiene.
11. Document any unusual findings.

9. Procedures(male)
1. Position the male client in a supine position with knees slightly flexed and hips slightly externally rotated.
2. Apply gloves and wash and dry the upper inner thighs.
3. Wash and dry the penis.
4. If the client is uncircumcised, retract the prepuce
5. Wash and dry the scrotum
6. Clean between the buttocks.
7. Dry the area well.
8. Remove and discard gloves. Perform hand hygiene.
9. Document any unusual

10. Urinal elimination
Elimination refers to the expelling of waste material from the body

14. • Suppression :an anuria due to the kidneys failing to produce urine
• Frequency: need to urinate more frequently than usual
• Glycosuria :sugar in the urine
• Albuminuria: albumin in the urine
• Proteinuria: protein in the urine
• Pyuria :pus in the urine
• Calculi :stones formed from mineral in the urine
• Chyluria :the urine giving it a milky appearance

15. Facilitating urine elimination
• For the patient who has difficulty in voiding :
o Help the patient to assume a natural position of voiding
o Provide water
o Provide privacy and allow time for voiding
o Provide a warm bedpan or urinal
o Pour warm water over the perineum

16. Providing urinal
Purpose :
• To promote comfort
• To assist to void
• To prevent bed wetting
• To minimize the physical strain

17. Providing urinal
Equipment
• Clean urinal
• Disposable gloves

18. Providing urinal
Procedure :
• Perform hand washing
• Allow patient to place urinal
• Prevent soiling of urine on bed or patients body
• Remove urinal after patient has voided
• Measure and empty the urine in sluice room
• Assist the patient to wash perineal area and hands
• Replace the articles used after cleaning
• Wash hands
• Record the procedure and chart intake and output

19. Providing bedpan
• Bedpan is made from steel or plastic device to meet elimination need
of patient confined to bed
• Bedpan used by females for elimination of urine and feces and by
male for elimination of feces

20. Providing bedpan
Purpose :
• To promote comfort
• To collect specimen for diagnostic purpose
• To give perineal wash
For :
• Patient with spinal surgery
• Postoperative patient
• Patient with fracture
• Chronic bedridden patient
• Patients who are strict bedrest

21. Providing bedpan
Equipment :
Bedpan with lid
Clean gloves
Water and mug
Tissue paper
Soap with soap dish
Towel
K-basin

22. Providing bedpan
procedure :
1. Explain to assist
2. Arrange the article at the bedside
3. Provide privacy
4. Position patient
5. Place the mackintosh under the buttocks
6. Place the dry bedpan under patients buttocks
7. Assist patient to lift buttocks
8. Provide adequate time to pass motion/urine
9. Permit to clean self
10. Remove bedpan by lifting patient careful
11. Cover bedpan immediately
12. Provide water and soap to wash hands
13. Replace the article after cleaning
14. Provide hand washing
15. Record the procedure

23. Condom drainage
Applying a thin condom sheath to penis for drainage of urine
To :
Drain urine in case of an incontinent patient
To permit patients normal physical activity without fear of
embarrassment

24. Articles
Rubber condom sheath (proper size)
Urinary collection bag
Basin with warm water
Towel
Disposable gloves

25. Special consideration
Remove the condom once a day
Client may has latex allergy
Do not reattach the condom catheter if it falls off

26. Enema
Introduction of the fluid into the rectum for the purpose of
cleansing or to introduce nourishment

27. Enema
Purpose :
To remove fecal matter
To relieve flatulence
To relieve constipation
To reduce temperature
To administer medication
To administer fluids and nutrient
To…..

28. Enema
Contraindications :
Acute renal failure
Appendicitis
Acute cardiac problems

30. Methods of giving enema
To give large amounts of fluidsCan and tube
To give small quantity of fluidsFunnel and catheter
To give small quantity of fluidsSyringe and catheter
Rectal drip To administration the fluid very slowly

31. General instruction of enema
▪ The rectal tube need to be
smooth and flexible
▪ The temperature of the
solution need to be adjust
▪ The proper position is left
lateral position

32. Equipment
• Enema cans
• Rubber tubing
• Mackintosh and towel
• Rectal tube
• Lubricant gel
• Iv stand
• K.basin
• Rag pieces
• Screw clamp

33. Procedure
1. Introduce yourself
2. Explain the procedure to patient
3. Provide privacy
4. Position patient in left lateral
5. Place the mackintosh and towel under the buttocks
6. Adjust the iv pole to hold the enema can at the required height
7. Perform hand washing and don gloves
8. Attach tubing to enema can and clamp tube
9. Prepare solution at required temperature
10. Attach rectal tube to tubing ,expel air and clamp tube
11. Lubricate tip of rectal tube

34. Procedure
13. Insert rectal tube gently to a distance of 2 to 4 inch
15. Note level of fluid and make sure there is free flow
16. Clamp or pinch the rectal tube if the fluid is about to get over
17. Use rag pieces to remove the rectal tube
18. Instruct patient to hold the solution for 10-15 minutes
19. Discard rag pieces in k-basin
20. Position the patient in supine and assist to toilet
21. Keep the patient dry and comfortable
22. Perform hand washing
23. Record the procedure

35. Collection of specimen
Urine
Stool
Blood
Sputum

36. sputum specimen collection
• A sputum specimen is a sample of material expelled from the respiratory passages taken for
laboratory analysis to determine the presence of pathogens. A specimen of mucus from the lungs
expectorated through the mouth
• Specimens are often taken for three consecutive days ,why?

37. Purposes
• A sputum specimen is obtained for culture to identify the microorganism
responsible for lung infections
• Identify cancer cells shed by lung tumors
• Aid in the diagnosis and management of occupational lung diseases

38. Equipment
• Sterile container with tight-fitting lid
• Emesis basin
• Box of tissues
• Gloves
• Goggles
• Laboratory request form

39. Preparation
• have the patient drink enough fluids on the night before the test
Why?
• For best results, obtain the sample first thing in the morning
• Ten to 15 ml of sputum is typically needed for laboratory analysis.
Note: A specimen will be rejected by the laboratory if it contains
excessive numbers of epithelial cells from the mouth or throat

41. Procedure
1. Observe proper hand hygiene and gather equipment.
2. Provide privacy for the patient and explain the entire procedure.
3. Position your patient in a chair or on the side of bed / high-fowlers position.
4. Place the tissues nearby and have the patient rinse his mouth with clean water to remove any food particles.
5. Don gloves and goggles. Uncap the container but avoid touching the inside.
6. instruct the patient to take three deep breaths, then force a deep cough and expectorate into a sterile screw-top container.
7. Once you’ve collected the specimen, securely cap the container. Remove and discard your gloves and wash your hands
8. Allow the patient to rinse out his mouth and provide a tissue.
9. Record the amount, consistency, and color of the sputum collected, as well as the time and date in the nursing notes.
10. Send the sample to the lab immediately.

42. STOOL SPECIMEN AND CULTURE
A stool culture is the process of growing or
culturing organisms existing in feces to see if any of
them cause disease.
The most common is the ova and parasites test, a
microscopic examination of feces for detecting
parasites or worms.

43. Purpose
• Stool cultures play an important role in understanding and treating intestinal illness.
.It can confirm the presence of harmful bacteria.
• It may also show what treatments may work to kill an invasive organism.
• A parasitic infection
• Other diagnosis can be explored

44. Equipment
• Gloves
• Clean bedpan and cover
• Specimen container and lid
• Wooden tongue blades
• Paper bag
• Labels
• Plastic bag

45. Procedure
1. Discuss the test and the procedure with the patient.
2. Ask the patient to tell you when he feels the urge to have a bowel movement.
3. Wear gloves
4. provide the bedpan when the patient is ready
5. Avoid mixing urine or regular toilet paper into the sample.
6. With the use of a tongue blade, transfer a portion of the feces to the specimen container
7. Immediately cover the container and label it with the patient’s name
8. Fill out the appropriate laboratory request form
9. Take the specimen to the lab immediately

46. URINE SPECIMEN AND CULTURE
• A urinalysis (UA), also known as routine and microscopy (R&M), is the physical,
chemical, and microscopic examination of urine.
• It has been a useful tool of diagnosis.

47. physical appearance
• Color
Normal urine color ranges from pale yellow to deep amber in color, depending on the concentration
of the urine.
• Odor
Urine normally doesn’t have a very strong smell

48. Urine
collection
Random
sample
24-hour
Clean-
catch

49. RANDOM URINE SAMPLE
• A sample of urine collected at any time of the day. This type of
specimen is most convenient to obtain.
This type of sample may be used to detect the presence of various
substances in the urine at one particular point in the day.

50. Equipment
• Clean, dry container with lid
• Cotton ball
• Laboratory request form

51. Procedure
1. Instruct the patient to use the cotton ball to clean urethral area
2. Let the patient void into the container.
3. Label the specimen container with patient identifying information
4. send to the lab immediately
5. Wash your hands and instruct the patient to do it as well.
6. Note that the sample was collected.

52. MIDSTREAM “CLEAN-CATCH” URINE SPECIMEN
• Midstream “clean-catch” urine collection is the most common method
of obtaining urine specimens from adults, particularly men.
• This method allows a specimen, which is not contaminated from
extern
• The most common reason to get a clean catch urine sample is to test
for a urinary tract inflectional sources

53. Equipment
• Sterile specimen cup
• a soap solution / three antiseptic towelettes
• cotton balls
• Laboratory request form

54. Preparation
• Explain to the patient that this kind of urine collection involves first
voiding approximately one half of the urine into the toilet, urinal, or
bedpan, then collecting a portion of midstream urine in a sterile
container, and allowing the rest to be pass into the toilet.
• Discuss that this is done to detect the presence or absence of
infecting organisms and, therefore, must be free from contaminating
matter that may be present on the external genital areas

55. Procedure
1. Wash hands with soap and water.
2. For female Instruct the patient to clean perinea area with cotton balls. Tell the patient
to separate folds of urinary opening and clean inside with towelettes, using downward
strokes only; keep labia separated during urination.
3. For male Instruct the patient to completely retract foreskin and cleanse penis with
towelettes
4. Instruct the patient to void the midstream urine into the specimen cup
5. Fill out the laboratory request form completely
6. label the specimen container with patient identifying information
7. send to the lab immediately
8. Wash your hands and instruct the patient to do it as well.
9. Note that the specimen was collected.

56. TIMED URINE SPECIMENS (24-HOUR)
• A 24-hour urine collection is performed by collecting a person’s urine
in a special container over a 24-hour period.
• It always begins with an empty bladder
• This specimen shows the total amounts of wastes the kidneys are
eliminating and the amount of each.

57. Equipment
• Large, clean bottle with cap or stopper
• Bedpan or urinal
• Refrigerated storage area
• Gloves

58. Procedure
• Label the bottle with patient identifying information, the date, and time the
collection begins and ends.
• Instruct the patient to urinate, flush down the urine down the toilet when he gets up
in the morning.
• tell the patient to collect the rest of his urine in the special bottle for the next 24
hours, storing it in a cool environment.
• Instruct the patient to drink adequate fluids during the collection period.
• Emphasize proper hand hygiene before and after each collection.
• Record each amount on the intake and output (I&O) sheet.
• Exactly 24-hours after beginning the collection, ask the patient to void.
• continue to keep the collection container refrigerated until transfer to laboratory.
• Send the bottle and laboratory request form to the lab.

59. BLOOD SPECIMEN COLLECTION/ CULTURES
• A blood culture is a fairly routine test that identifies a disease-causing
organism in the blood, especially in patients who have temperatures
that is higher than normal, for an unknown reason.

60. Equipment
• Sterile syringe (20 cc) and three needles
• Two blood culture bottles (one for anaerobic and one for aerobic
specimens)
• Betadin solution or alcohol swab
• Sterile cotton balls or gauze pads
• Gloves
• Tourniquet
• Laboratory request form

61. Procedure
• Discuss the procedure and the reason for doing it to the patient.
• Bring together all supplies and equipment needed to patient’s bedside.
• Assist the patient to comfortable position
• Observe proper hand hygiene.
• Clean the top of both culture bottles with betadin solution or alcohol swab.
• Place the needle on the syringe.
• Apply the tourniquet to allow the veins to fill with blood
• Put on gloves and clean the drawing site with betadine solution or alcohol
• Draw at least 10 cc of blood from the patient
• Unbind the tourniquet.
• Remove the syringe and needle while applying pressure to the venipuncture site with the
cotton ball or gauze pad.

62. Procedure
• Replace the needle on the syringe with another sterile needle.
• Inject 5 cc of blood into the anaerobic bottle
• Replace the needle on the syringe with another sterile needle.
• Inject the remaining 5 cc of blood into the aerobic bottle
• Gently mix the blood with the solution in both bottles.
• Label both bottles with the patient’s identifying information
• Fill out the laboratory request form completely
• send the specimens to the laboratory immediately.

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THANKS!
You can find me at
Yosra.anvar@komar.edu.iq