D R . A N J L A T C H I M U T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G S A R F R A Z G A N J ,
L U C K N O W 2 2 6 0 0 3
NURSING CARE OF
PATIENTS

Type of care giving to patients
 Ambulatory Care
 Acute And Critical Care
 Home Health Care
 Long Term Care
 Care of newborn
 Care of infants
 Care of toddler
 Care of preschooler
 Care of adolscent
 Car of women
 Care of old ages
 Care of patients

INTRODUCTION
 The word patient comes from the Latin word patiens,
originally meant “one who suffers”. verb, patior,
meaning “I am suffering” The patient is most often ill
or injured and in need of treatment by a physician,
advanced practice registered nurse or other health
careprovider.patient is one whom needs
care,attention and support from healthcare
professionals and family.

What is nursing ?

CARE IN HOSPITAL
 Care in hospital is the attention or watchful oversight
o supervision and attentive assistance or treatment
for the needed by the nurse or other heath care
professional and health care setting is a place of
organized systems of medical care, including prepaid
group medical practices, collective group insurance-
covered, fee-per-service medical care, and
community clinics organized and run by non-profit
or profit-making organizations.

HOSPITAL
 As an increasing proportion of population and with
the shift in disease patterns from acute illnesses to
chronic illnesses,the traditional disease management
and care focus of the health care professions has
expanded.
 The health care focus must center more on
prevention,health promotion and management of
chronic conditionsthan in previous times.

Hospital and type of services for patients

Type of health care organization

Nursing care consist of
 Registration
 Admission procedure
 Uniform policy
 Identificcation
 Medical /surgical/general ward /icu /hdu etc
 Progressive care
 Laboratory services
 Nutritional services
 Medical services
 Surgical service
 General cleaning of patient/envt/surrounding
/equipment

Continued
 General waste management
 Biomedical waste
 Water facilities
 General facilities daily activities
 Immunization services
 Critical care services
 Rehabilitative services
 Occuapational services
 Physiotherapy services
 Healtheducation
 Counselling servies
 Discharges services
 Follow up
 Records and report

AMBULATION
 It is the ability to walk from place to place with or
without assistance.
 In ambulation Individual is able to walk at least 10 feet
outside the parallel bars with supervision or physical
assistance from only one person
 Ambulatory care is a personal health care consultation,
treatment or intervention using advanced medical
technology or procedures delivered on an outpatient
basis (i.e. where the patient’s stay at the hospital or
clinic, from the time of registration to discharge

AMBULATORY CARE
 Ambulatory health care is provided for the patients
in the community or in hospital settings.


AMBULATION CLASSIFICATION
 Non functional -patient cannot ambulate, ambulates in parallel bars
only,or requires supervision or physical assistance from more than 1
person to ambulate
1. Ambulator –dependent for physical assistance
 patient requires manual contacts of no more than one person during
ambulation.manual contacts are continuos and necessary to support
body weight
2.ambulatory-dependent physical assistance
 patient requires manual contacts of no more than one person during
ambulation.manual condact consists of continuos or intermittent
light touch for assistance
3 Ambulator –dependant for supervision
 patient can physically ambulate on level surfaces without manual
condact with another person but for safety requires stand by
guarding

4.Ambulatory – independent level
 patient can ambulate independently on level surfaces
but requires supervision
5.Ambulator – independent
 patient can ambulate independently on non level and
level surfaces, stairs and inclines

AMBULATORY CARE SETTINGS
 Ambulatory care nursing includes those clinical,
management,educational ,and research activities
provided by registered nurse for and with individuals
who seeks care and assistance with health
maintainence and or health promotion. - AAACN
 SITES

Ambulatory care setting

Nursing information system

Role of nursing officer in ambulatory care
 Providing direct patient care
 Conducting patient intake screenings
 Treating patients with acute or chronic illnesses or emergency conditions
 Reffering patients to other agencies for additional services
 Teaching patients self care activities
 Offering health education programmes that promote health maintainence
 Nurses also work as clinical managers,direct the operation of clinics and supervise other health
team members
 Providing advice and emotional support to patients family members.
 Teach patients and their families how to manage their illness or injury, including post-
treatment home care needs, diet and exercise programs, and self-administration of medication
and physical therapy
 counseling to family members of critically ill patients
 RNs work to promote general health by educating the public on various warning signs and
symptoms of disease and where to go for help
 RNs also might run general health screening or immunization clinics, blood drives, and public
seminars on various conditions.
 Some ambulatory care nurses are involved in telehealth, providing care and advice through
electronic communications media such as videoconferencing or the internet

Research in ambulatory care
 It is needed for many reasons;
 To help to develop new models of nursing care
delivery
 To develop standards of client care
 To create both performance improvement
programmes and nursing intensity systems to
determine the number and types of nursing
personals needed

AcuteCare Hospital services
 An acute care hospital is a healthcare facility that
offers patient care services of a limited duration to
diagnose and/or treat an injury or short-term illness.
Services include medical and surgical inpatient
services and outpatient diagnostic services.

Manpower of department
 PROFESSINAL SERVICES as well as SUPPORT SERVICES
 MEDICAL STAFF
 PRIVATE OR GROUP PRACTICE PHYSICIANS
ADMINISTRATION
 NURSING SERVICE
 BIOMEDICAL ENGINEERING DEPARTMENT
 PHARMACY
 PHARMACISTS AND TECHNICIANS BUSSINESS
DEPARTMENTS
 REHABILITATION SERVICES CENTRAL
SERVICE/MATERIAL MANGMT DPT
 PHYSICAL THERAPISTS, DIETARY DEPARTMENT

Continued
 OCCUPATIONAL THERAPISTS,
 LABORATORY LAUNDRY
 MEDICAL RECORDS DPT
 HUMAN RESOURCE DPT
 VOLUNTEER SERVICES CENTRAL
SERVICE/MATERIAL MANGMT DPT
 DEVOLOPMENT/COMMUNITY RELATIONS
 DIETARY DEPARTMENT ENVORONMENTAL
SERVICES

Role of nurse
 Health care provider
 Researcher
 Educator
 Manager

Critical care
 Critically ill patients are defined as those patients
who are at high risk for actual or potential life-
threatening health problems.
 Critical care is a term used to describe “the care of
patients who are extremely ill and whose clinical
condition is unstable or potentially unstable”.
 Critical care nursing is the field of nursing with a
focus on the utmost care of the critically ill or
unstable patients

Sub Specialities are
 ICU
 ICCU
 CTVS
 MICU
 SICU
 HDU
 Casuality and emergency
 Post-operative area
 Pre-operative area

Child health area
 PICU
 NICU
 SBNC
 HBNC
 IMMUNIZATION AREA
 CTVS-pediatric
 othersarea

Critical care nurse
 critical care nurses:
 Respect and support the right of the patient.
 Help the patient obtain necessary care.
 Respect the values, beliefs and rights of the patient.

Assessment scale in ICU

CAUTI assessment

VAP checklist

CLABSI checklist

SSI chceklist ss

Legal issue in critical care nursing
 Malpractice
 Negligence
 Duty owed to the patient

 Damages
 general(injury),special(all losses and
expenses),emotional,punitive
 Eg:
 INTENTIONAL TORTS -Civil wrong committed
againt a person or persons property
 Assault -Eg:Threatening a pt with an injection.
 Battery -Eg:Forcing a patient to ambulate
 False imprisonment -Eg:Refusing to allow a patient
to leave against medical advice

Invasion of privacy
 Eg:Taking unauthorized pictures of the
patient,releasing confidential information to others
without consent.
 Defamation
 Use of adverse language that affects ones reputation.
Eg:falsely accusing staff members in front of others,
making false chart entries about patients life style

 It includes;
 INFECTIOUS HAZARDS
 HIV exposure
 Viral hepatitis exposure
 MUSCULOSKELETAL INJURIES
 Occupational back injury(back pain)
 CHEMICAL HAZARDS
 Skin irritants,eye irritants,antineoplastic agents et

NOISE
 Sources of noise includes;
 Ventilators
 suction machines
 telephones
 infusion pumps
 doors
 staff conversations
 monitor alarms.

 Effects;
 Prolonged exposure can cause hearing loss and
mental irritability
CHEMICAL DEPENDANCY
 Without healthy coping skills; a nurse may secretly
turn to drugs or alcohol for emotional and spiritual
support. Drugs that are abused commonly include
cocaine, alcohol, narcotics and tranquilizers

 INFORMED CONSENT
 DURABLE POWER OF ATTORNEY FOR HEALTH
CARE
 DO NOT RESUSCITATE ISSUES
 LIVING WILLS
 WITHDRAWAL OF ORDINARY CARE MEASURES
 DOCUMENTATION

critical care nurses
 Respect and support the right of the patient.
 Help the patient obtain necessary care.
 Respect the values, beliefs and rights of the patient.

 Support the decisions of the patient or designated
surrogate, or transfer care to an equally qualified
critical care nurse. Intercede for patients who
cannot speak for themselves in situations that
require immediate action. Monitor and safeguard
the quality of care the patient receives. Act as a
liaison between the patient, the patient's family and
other healthcare professionals

 Critical care nurses work in a wide variety of settings, filling
many roles including bedside clinicians, nurse educators,
nurse researchers, nurse managers, clinical nurse specialists
and nurse practitioners a particular specialty.
 The CNS is responsible for the identification, intervention and
management of clinical problems to improve care for patients
and families.
 They provide direct patient care, including assessing,
diagnosing, planning and prescribing pharmacological and
nonpharmacological treatment of health problems.
 CNS in the critical care setting focus on making clinical
decisions related to complex patient care. Their activities
include risk appraisal, interpretation of diagnostic tests and
providing treatment, which may include prescribing
medication.

Principles of critical care nursing

Legal issue and neligence in nursing

Home care
 Home Care (also referred to as domiciliary care or
social care)is health care or supportive care provided
in the patient's home by health care professionals
(often referred to as home health care or formal care)
 Home Health Nursing is about patients receiving
nursing care in their home. Home health nurses have
a new environment every day and face many
challenges. Patients are going home from the
hospital with more acute problems and the home
health nurse must rise to the occasion.

 A Home Health Care Nurse works with patients in
their homes. These nurses mainly work with the
elderly, but sometimes work with younger children
who have developmental or mobility issues.
 A Home Health Care Nurse is great for people that
would rather work outside of a hospital.

HHNA
 The Home Healthcare Nurses Association (HHNA) is
a national professional nursing organization of
members involved in home health care and hospice
nursing practice, education, administration and
research. HHNA provides leadership and a unified
voice so that home care and hospice nurses may
improve their specialty and influence public policy as
it relates to home care and hospice

 The HHNA’s predecessor organization was founded
in 1993 by the JB Lippincott Company with the
vision of providing a forum for members to discuss
and refine professional, educational and conceptual
aspects of the home healthcare nursing practice as a
specialty.

 33. The HHNA is committed to improving the
specialty of home care and hospice nursing and
influencing public policy as it relates to home care
and hospice. HHNA is a forum that recruits and
brings together energized home care and hospice
nurses who want to become leaders in their field and
enable them to speak out in a unified voice.

 Develop the specialty of home care and hospice
nursing
 Foster excellence in the practice of home care and
hospice nursing
 Promote high standards of patient care in home care
and hospice Provide an organized and unified voice
among the home care and hospice nursing
profession
 Disseminate and exchange information with those
involved in the home care and hospice nursing
specialties

 Honor and select the top home care and hospices nurses
across the country.
 Learn about changes in laws or regulations which impact
your work.
 Establish home health and hospice care best practices.
 A subscription to Caring Magazine, the only publication
received by the entire home care and hospice community
as well as all U.S. hospitals and physicians who serve the
home care community.
 Receive the Home Healthcare Nurse Journal and keep up
to date on new protocols, best practices, and clinical and
therapeutic advances.

 36. The National Association for Home Care &
Hospice is the nation's largest trade association
representing the interests and concerns of home care
agencies, hospices, and home care aide
organizations.

 Professionals providing home care include:
licenced practical nurses ,
 Registered nurses , Home Care Aids, and
Social workers . Rehabilitation services are
provided by: Physical therapists , Occupational
therapists , Speech therapist pathologists and
Dietitians. Home care aides are trained to provide
non-custodial care, such as helping with dressing,
bathing, getting in and out of bed, and using the
toilet. They may also prepare meals.

 Home care aims to make it possible for people to remain at home rather
than use residential, long-term, or institutional-based nursing care. Home
care providers render services in the client's own home.
 These services may include some combination of professional health care
services and life assistance services. Professional home health services
could include medical or psychologicalassessment, management, wound
care, medication teaching, pain management,disease education and
physical therapy, speech therapy, or occupational therapy.
 Life assistance services include help with daily tasks such as meal
preparation, medication reminders, laundry, light housekeeping, errands,
shopping, transportation, and companionship.
 Home care is often an integral component of the post-hospitalization
recovery process, especially during the initial weeks after discharge when
the patient still requires some level of regular physical assistance.
 To prepare for early hospital discharge and possible need for follow up care
in home,discharge planning begins with patients admission

COMMUNITY RESOURCES AND REFERRALS
 Home health nurses and public health nurses act as
case managers. after assessing patients needs they
may refer to the other team members.
 Home health care nurse is responsible for providing
information about various resources. resource
booklet should be provided for the patient which
includes the resources available in the community.

 Nurse should review the patients referral form to
contact the reffering agency if the purpose for the
referral is unclear
 Call the patient and obtain permission and schedule
the time for visit.
 Ask permission before entering the house and
explain the purpose of referral.

CONDUCTING A HOME VISIT
 Whenever the nurse makes a visit,the agency should
know the nurses schedule and locations of the visits.
 Initiate the visit in which the patient is evaluated and
a plan of carevis established
 Determine the needs for future visits such as current
health status,home environment,level of self care
abilities ,mental status etc

 Learn a cellular phone with the telephone numbers
of the agency ,police and emergency services
 Let the agency know your daily schedule and
telephone numbers of your patients
 Know where the patient lives
 Schedule visit only in day hours
 When making visits in crime areas visit with another
person

AMBULATORY SETTINGS
 Ambulatory health care is provided for the patients
both in community and hospital settings.
 types of agencies includes medical clinics,ambulatory
care units,mental health centres,student health
centres etc

OCCUPATIONAL HEALTH PROGRAMMES
 Occupational nurses work in industrial setting or they
may serve as consultants on a limited or part time basis
 The occupational health nurses works in several ways
and provide direct care to the employers who becomes ill
or injured and conduct health education programmes .
 Some school nurse programmes provide community
care.
 physical examinations are performed by advanced
practice nurses who then diagnose and treat students
and families for acute and chronic illnesses.
 nurse act as care provider.consultant.educator and
counselor.

CARE FOR HOMELESS
 Homeless have difficulty in affording or gaining acess to health care.
 they will experience high rates of trauma,tuberculosis and other
communicable diseases.community health nurses who works with
homeless shoulb be patient,non judgemental and understanding.nursing
interventions are aimed at obtaining health care services for homeless.
 A home health care nurse helps to care for the elderly, disabled, chronically
ill or mentally impaired.
 Daily tasks for a home health care nurse can include administering
medication,
 checking on patients' status,
 performing routine procedures and
 helping administer treatments that patients need. Some home health care
nurses will also provide for the basic needs of patients, helping them to
bathe or providing nutritious meals.
 At times, they must also provide support to patient's family members and
other caretakers, instructing them on how best to care for the patient and
providing emotional support.

 The roles of the home care rehabilitation nurse include, but
are not limited to, those outlined below.
 Practitioner
 Serves as a clinical resource for those involved in
rehabilitation nursing practice and in the care of clients with a
complex chronic illness, a disabling condition, or both
 Acts as a resource during a crisis that is aggravated by a
chronic illness or a disabling condition
 Assesses the appropriateness of a client's admission to, and
the delivery of rehabilitation services in, the home
environment
 Provides assistance with discharge planning to ensure a
smooth transition into the community or, when appropriate,

 Collaborates with the interdisciplinary team in the
management of the team function in the home
environment Helps the client and the client's
family adapt to changes in lifestyle necessitated by
the disabling condition Implements rehabilitation
nursing care based on scientific knowledge, home
care standards, and rehabilitation principles that are
appropriate environment to the home care

 Consultant Identifies clients and families who could benefit
from rehabilitation home care services Serves as a liaison
with third-party payers and justifies the use of funds for
rehabilitation home care Serves as a resource for
rehabilitation nurses and as a process consultant to staff in
the home care setting Promotes rehabilitation nursing
services to community health professionals and to the
community at large areas
 Researcher Participates in research involving home care
clients and their families Participates in the analysis and
dissemination of evaluative data that may have an impact on
clients and their families Incorporates evaluative data into
nursing practice

 Long-term care is a variety of services that includes
medical and non-medical care to people who have a
chronic illness or disability. Long-term care helps
meet health or personal needs.
 Most long-term care is to assist people with support
services such as activities of daily living like dressing,
bathing, and using the bathroom. Long-term care
can be provided at home, in the community, in
assisted living or in nursing homes.

 Long-Term Care Nurse A Long-Term Care Nurse cares for
patients who have a disability or illness in need of extended care.
Many of their patients live in long-term care facilities, rehabilitation
centers, or nursing homes What Is Long Term Care? When a
person requires someone else to help him with his physical or
emotional needs over an extended period of time, this is long-term
care EG:WALKING,BATHING,DRESSING etc
 54. Temporary long term care (need for care for only weeks or
months) Rehabilitation from a hospital stay Recovery from
illness Recovery from injury Recovery from surgery Terminal
medical condition
 55. Ongoing long term care (need for care for many months or
years) Chronic medical conditions Chronic severe pain
Permanent disabilities Dementia Ongoing need for help with
activities of daily living Need for supervision

 SUBACUTE OR TRANSITIONAL CARE For
people who require ongoing care or recovery for an
acute conditionbut donot need to receive the services
on an acute hospital unit. ASSISTED LIVING
FACILITY A form of housing that provide 24 hr
staffing,meals,supervision of medications,personal
assistance care.

ADULT DAY CARE
 A day time programme for people who typically have
the same level of impairments as nursing home
residants but who receive care in the community
usually family members.the client is transported to
the center and receives structured
activities,meals,personal health care supervision.
care assistance, and

HOME CARE
 For community based people who are home bound
and who need caregiving assistance or
specialtreatments.
 For people who r terminally ill and in need of
care.this care can b provided in the home or in a day
hospital setting care of dying is common experience
in long term care
 caring behaviours of staff at the time of
death,allowing family to be involved with the
resident and providing spiritual support are
important and valued nursing functions.

Long-term care services may be provided in any
of the following settings:
 In the home of the recipient
 In the home of a family member or friend of the
recipient
 At an adult day services location
 In an assisted living facility or board-and- care home
 In a hospice facility
 In a nursing home

 Residants of LTCFs can be of any age,although most of them are older adults.The
risk of being in an LTCFs increases with each decade of life:average age of resiants is
82yrs.Women outnumber men ratio is 3:1.
 Most residents have conditions that impair their selfcae capacity or require
interventions that they cannot perform independently.About one half have
progressive cognitive impairment,such as alzheimers
disease,arthritis,cardiovascular disease,impaired vision,impaired hearing or
combination of illnesses.Most residents need assistance with atleast several ADL.
 Although most residents spend remainder of their lives in the facility,an increasing
number do recover ,have return to the community. restored function and
 According to federal regulations a reggisterd nurse must be on dutyatleast 8
consecutive hours per day,7 days a week and a full time director of nursing must be
on staff if the facility has more than60 beds.
 The propotion ofnursing staff is not stated,although it is required that “the facility to
provide 24 hour nursing services which are sufficient to meet otal nursing care
needs”.

 Health care plans such as health insurance plans,
Medicare, Medicaid and the Veterans Administration.
They are used primarily to differentiate care provided by
medical specialists as opposed to care provided
volunteers, family or friends. by aides,
 A patient receiving skilled care in a nursing home from
Medicare not only receives care from skilled providers
such as nurses, therapists or doctors but also receives
care from custodial providers consists such as help aides.
with This care usually dressing,of ambulating , toileting,
bathing,

 ASSESMENT
 Nurse hav to assess residents within the first 14 days of admission and atleast
annually there after;residants are to be reassed whenever thereis change in their
status.
 CARE PLANNNG
 Regulations require that a careplan be written for each resident within 7 days after
completion of assessment.care plan is a interdisciplinary one and is the blue blue
print for nursing actions.
 CAREGIVING
 Nurses performs selected roles,such as administering medications and treatments
and they may be involved in total care activities.
 NURSE have to make the residants to face many adjustments;
 ROUTINES AND SCHEDULES
 ENVIRONMENT
 PEOPLE
 INDEPENDENCE
 COMMUNICATION

 COMMUNICATION
 Proper communication helps the nurse for identifying
and obtaining timely treatment of complications and new
health problems and also nurse must make sure that
physicians learn of condition in a timely manner.
changes in residants
 Provide the physician with complete information that
can aid in medical decision making. Eg: current and
manifestations etc usual vital signs,clinical
 Avoid making diagniosis.report th clinical manifestations
and allow physicaian to make medical judgement.
 Take order directly from the physician If there is
anything wrong in the order question the physician

 MANAGEMENT
 Nurse performs some management functions such as:
 Delegating assignments
 Supervising other staffs
 Evaluating performance
 Implementing disciplinary actions
 Completing reports
 Reviewing and auditing records
 Communicating needs to other departments
 Handling complaints
 Ordering supplies
 Communicating with regulatory agencies.

Nursing management system

Essential care for patient

Nursing care plan assessment

Care of newborn baby

Care of infants
 Maintain body temperature
 Immunization
 Breast feeding
 Position of the baby
 Growth an development
 Umblical cord care
 Eye care ,ear care , spongy bath,
 Bowel andd bladder movement
 Sleeping pattern
 Prevention of infection

Care of toddler
 Growth and development
 Immunization
 Weaning /balancing diet
 Dental care
 Prevention of warm infestation
 Vitamin A prophylaxis
 Play needs
 Prevention of accidents
 Prevention respiratory infection

Care of preschooler
 Growth and development
 Immunization
 Balancing diet
 Prevention of dental caries
 Prevention of warm infestation
 Prevention of malnutrition
 Prevention of accidents
 Play and basic needs
 Vitamin A prophylais
 Prevention of respiratory infection

Care of school going childrens
 Growth and development
 Immunization
 Balancing diet
 Personal hygiene
 Prevention of skin diseases
 prevention of communicable disease s
 Prevention of non communicable disease
 Prevention of respiratory infection
 Prevention of accident
 Prevention of dental caries
 Vision screening
 Prevention of warm infestation

Care of adolescent
 Growth and development
 Secondary sexual characteristic
 Immunization
 Personal hygiene
 Menstrual hygiene
 Sexual hygiene
 Health education
 Prevention of anemia
 Maintain the balance nutrition
 Prevention of warm infestation
 Prevention of infection

Care of adults
 General check up of height, weight, ABG, BMI etc
 General condition like vital sign, rbs, saturation etc.
 Immunization
 Maintain dental hygiene
 Maintain balancing diet
 Prevention of anemia
 Yoga
 Meditation
 Exercises
 Psychological support
 Physical balancing of daily activities
 Sleeping pattern
 Bowel and bladder movement

Care of antenatal mother

Care of post natal mother

Care of unconscious patient

Care of the patient with tracheostomy

Care of vulnerable patients

Continued

Monitoring and evaluation of care

Care of geriatric patients

Care of dying patients

End of life care and health insurance

References
 TEXT BOOK OF MEDICAL SURGICAL NURSING-JOYCE M BLACK-7
EDITION-ELSEVIER PUBLICATION-2005-PAGE NO:121 – 189 TH
 CRITICAL CARE NURSING-2 ND EDITION-JOHN M CLOCHESY-W.B
SAUNDERS COMPANY PUBLISHERS,PAGE NO: 28 – 35,1996
 CRITICAL CARE NSG-PATRICIA GONCE
MORTON,DORRIE.K.FONTAINE
 SUZANNE .C .SMELTER,MSN-LIPPINCOTT WILLIAMS AND WILKINS
PUBLISHERS PAGE:6-25- 10 TH EDITION-2004
 WWW.MEDICARE.GOV.IN
 WWW.DISCOVERNSG.IN
 WWW.LONGTERMCARE.LINKNET
 CANADIAN JOURNAL OF RESEARCH NURSING TIMES –MARCH 30-
2012
 WWW.PUBMED.COM
 JOURNAL OF NURSE OLDER PEOPLE 2012

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