Date &                                        Action                                         Teachers  Time               ...
Duties of Nurse Assistants   - Monitors patient’s condition by taking and recording temperature,      pulse, respiration, ...
DATE & TIME                                 ACTION                                       TEACHER’S                        ...
Types of Fever   1. Continued Fever: (Pneumonia, Typhoid Fever).          The temperature remains above normal throughout ...
Rhythm of the Pulse:- The beats follow with equal intervals and are equalthat is regular pulse.Pulse Tension:- The pressur...
DATE & TIME                                                                               TEACHERS                        ...
Type of cellIncreaseDecreaseRed Blood Cell (RBC)EythrocytosisErythroblastopeniaWhite Blood Cell(WBC)LeukocytosisLeucopenia...
DATE & TIME                                                                                 TEACHERS                      ...
-    The colonoscope is slowly with drawn while the lining of the bowel        is carefully examined.    - The procedure l...
- The tube is inserted in the rectum about 10-12cm   - The solution is then slowly released with the help of funnel.  Afte...
Zimnistskiy MethodThis method helps to determine functional renal capabilities to osmoticconcentration and dilution in diu...
DATE & TIME                                ACTION                                       TEACHER’S                         ...
Injection of atropine Solution and take B portion after that take C        portion from hepatic duct. Colour → White or Ye...
ECG (ELECTROCARDIOGRAPHY)Is a diagnostic tool that measures and records the electric activity of heartin exquisite detail....
QRS-Complex:- Represents ventricular depolarization. The QRS Complexconsists of 3 waves. The Q-wave, R-wave and the S-wave...
TEACHER’SDATE & TIME                                   ACTION                                                             ...
Soak the Mustard Plaster in moderate warm water and put to the     affected area except the trunk, cover worth towel and b...
1. Checking the medication package in the medication administration    area (Infusion unit)                               ...
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  1. 1. Date & Action Teachers Time Signature24TH March, Moral – ethical and legal principles of Nursing. Organization of work and 2010 responsibilities of basic structural units of therapeutic hospital. Duties of Nurses in therapeutic department. Documentation in the reception words Moral – ethical and legal principle of Nursing Nurses are subject to a plethora of ethical, legal and professional duties. These are main duties which are generally considered to be respecting a patient’s confidentiality and autonomy and to recognize the duty of care that is owned to all patients. Nurses’ ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. It shares much principle with medical ethics such as beneficence, non-maleficience and respect for autonomy. Confidentiality Is where information about the person is only shared with others after permission of the person unless it is felt that the information must be shared to comply with a higher duty such as preserving life. Autonomy refers to the capacity of a rational individual to make informed un-coerced decision. Organization of work and Responsibilities of basic Structural units of Therapeutic hospital Organization: - health core in hospital/clinics is very hierarchical. At the top is the attending physician, a staff doctor who has ultimate responsibility, a physician in the advanced stages of their training. They supervise the Interns, doctors in their first year out of medical school. Some teams have additional layers of residents depending on the complexity and volume of work to be done. Hospital structure usually includes of a reception ward, some different medical department, pharmacy, laboratory department, Radiology department, Administrative department. Many hospitals also have designated intensive care areas (Intensive Care Unit ICC of cortical care unit-CCU) for certain specialties of medicine. Every department have wards, rooms for medical procedures, dining hall, a physicians’ office, a n office of department Chiefs, head nurse, shower room , a toilet, room for clean & dirty linen. Duties of Nurse’s in Therapeutic Department Typical duties of head Nurses - Carries out therapeutic treatment as ordered by the physician. - Giving of medication - Carries out diagnostic procedures as ordered by physician - Provision of Information on a patient’s status, new symptoms responses to medication to the physician.
  2. 2. Duties of Nurse Assistants - Monitors patient’s condition by taking and recording temperature, pulse, respiration, weight, blood pressure, observing patient’s behavior and reporting all information to the nurse. - Assist nurses inpatient care by performing routine duties such as toileting, feeding, passing water and nourishments, bathing etc. - Assist patient in maintaining mobility by assisting in ambulation, transfer, range of motion exercises.Reception:- It is the first unit for patient. Their function includes;Administration and Registration of patient Examination of the patient and preliminary diagnostics of the patient’s disease Sanitary Inspection and cleaning of the admitting patient Emergency medical care, qualified medical treatment Transportation of patient’s to the hospital equipments Usually when arriving at the hospital, it is required to register at the reception ward. There is a register for registration of patients’ planned hospitalization, a register of hospitalized patients and of consulted patient. These register have passport date, data of laboratory test, medical decision, description of medical procedures which are provided foe s patient and the doctor’s advises about the following examination and treatment in case of refusing the hospitalization.
  3. 3. DATE & TIME ACTION TEACHER’S SIGNATURE Thermometry, the measurement of blood pressure pulse, its st31 March, registration. 2010 Organization of work and responsibilities of nurses manipulation office. Sanitary – epidemic regimen in manipulation office. Thermometry is an instrument used in measuring temperature. It plays an important role in the patient examination and decision making. Infection and products of tissue decomposition usually cause fever (elevation of the body temperature). The temperature is measured by a thermometer graded in 0.10 (C or F) A clinical thermometer is a small, self-registering thermometer consisting of simple glass tube with etched scale, used for taking temperature of body. Types of thermometer Mercury in glass thermometer Alcohol thermometer Digital thermometer Ear thermometer Liquid crystal thermometer Resistance thermometer Bi-metal mechanical Pill thermometer Reversing thermometer Patch thermometer contact thermometer Medical thermometer: - examples; oral, rectal, basal thermometer. A thermometer is placed in the patient’s mouth to obtain an oral temperature, In the anal canal to obtain rectal temperature, and in the axilla to obtain an axillary temperature. An a.m. temperature of greater than 370C would define a fever. Fever is an elevation of body temperature above the normal circadian range as the result of a change in the thermoregulatory center. It is characterized not only by elevated temperature but also by the upset function of the entire body. Causes of Fever Infection diseases example Malaria, Influenza, Common cold etc. Skin infection example Boils, Pimples, Abscess, Immunological diseases example Lupus Erythromatous, Sarcoidosis. Cancer;- Renal, Leukemia, Lymphomas. Metabolic disorder:- Gout, Porphyrias
  4. 4. Types of Fever 1. Continued Fever: (Pneumonia, Typhoid Fever). The temperature remains above normal throughout the day and doesn’t fluctuate more than 10C in 24 hrs. 2. Intermittent Fever: The elevation of temperature is present only for some hours of the day and becomes normal for remaining hours. Examples; Malaria, Kala-azar, pyaemia or Septicemia. 3. Remittent Fever: The temperature remains above normal throughout the day and fluctuate more than 10С in 24hrs. Example; Infective Endocarditis, Pleurisy, Tuberculosis. 4. Hectic or Septic Fever: When the variation is extremely large. And temperature rises sharply by 2-40C and drops to normal and subnormal level. Example; Sepsis, Grave pulmonary tuberculosis. 5. Step-ladder Fever: temperature rises gradually to a higher level with every spike. 6. Irregular Fever: Variations are varied and irregular e.g. rheumatoid fever, endocarditis, sepsis, tuberculosis. 7. Inverse Fever: Temperature rises in the early hours of morning rather than in the evening e.g. Military tuberculosis, Sepsis and Brucellosis. 8. Relapsing Fever: Fever is marked by number of febrile attacks lasting about six days and separated from each other by apyretic intervals of about the same length e.g. Hodgkin disease. 9. Undulant Fever: Characterized by periodic elevation of temperature followed by its drop. 3 Phases of Fever - Onset phases (L. Stadium Incrementi):- temperature rises little by little. Patient experiences mild headaches, chills, feels, cold, reduce appetite, muscle aches, lethargy. A nurse has to cover the patient with blanket, put a lot of water bottle on the feet, and give a lot of warm tea. - Stationary Phase (L. Fastigium):- patient has the highest temperature, flushed skin, attention of mental status, feels hot. Nurse ha to apply a cold compress on the forehead, give a lot of juice, tea with lemon. - Resolution (L. Stadium decrement):- The temperature ma y decrease gradually, little by little during several days. Decreasing of Temperature Lysis:- Gradually decreasing from 39.5, 38.5, 37.5. Crisis:- Sudden drops 390C, morning 350C.Pulse is the vibration of each wave of blood giving through the arteries asthe heart beats. It is when left ventricle of heart contracts. Pulse can be taken in different places; Carotid, Radial, Brachial, Femoral,Popliteal, Posterior tibia, Dorsalis pedis. Properties of PulsePulse rate:- Number of pulse rate. Healthy normal Individual is 64-72 beatsminute. Women more than Men. Pulse accelerates with physical work,during digestion, breathing in, excitement and with diseases e.g.Myocarditis, Endocarditis, Pericarditis, Cardiac failure.
  5. 5. Rhythm of the Pulse:- The beats follow with equal intervals and are equalthat is regular pulse.Pulse Tension:- The pressure of blood exercised on the wall of artery. GivesInformation about arterial pressure and state of vascular system.Pulse filling:- Amount of blood in the vessel. This is done by using proximalfinger on the radial artery to press the vessel gradually.Pulse value:- Is a collective concept, uniting filling and tension. Depends onthe degree of the artery widening during systole and its collapse duringdiastole. How to take patient’s pulse Use your Index and Middle finger tips or all three middle finger tips andapply moderate pressure over the pulse point until you feel the pulsing.Then take the reading.Blood Pressure:- Is the force of the blood pushing against arterial walls. 2types; Systolic and Diastolic pressure. Blood pressure is measured in millimeters of mercury (mmHg) given assystolic pressure followed by diastolic pressure with a slash between. Increase in blood pressure is called Hypertension 140/90mmHg.Decrease in blood pressure is called Hypotension and its below 100mmHg. Blood pressure is measured with a blood pressure cuff, asphygmomanometer and Stethoscope. During the practice, the patient blood pressure and pulse rate wastaken. Arterial Pressure – 130/80mmHg Pulse rate – 86 bpm Arterial pressure – 140/110 mmHg Pulse rate – 115 bpm.Regimen: Is a prescribed systematic form of treatment such as regulationof mode of living, diet, course of drug, sleep, special exercise for a hygienicand therapeutic purpose for curing disease and improving health. The main part of the regimen is elimination or decreasing an affect ofdifferent unhealthy environmental factors to a patient.It is regulated by keeping a strict hospital routine. Regimen consist of the following; - Keeping protection of patient’s mentality - Strict keeping inside routine - Keeping rational moving activity of patients.Active regimen:- Patient may rise, walking around, do everything becauseof his capability.Bed regimen:- Patient lie in the bed because of his condition. Everything isdone in the bed. Semi strict bed regimen; patient may sit near the bed, sitnear the Fable and there is no moving in this case.Hygiene regimen:- keeping the patient clean.Sanitary regimen:- Cleaning of the units. TEACHER’S SIGNATURE
  6. 6. DATE & TIME TEACHERS ACTION SIGNATURE Methods of taking the CBC, examination of serum glucose level,7 April, biochemical and bacteriological examination. TH 2010 Technique of subcutaneous, Intramuscular, Intravenous introduction of antibacterial drugs. Complete Blood Count (CBC):- Is one of the most common analyses of blood. CBC usually includes a numerical estimate of number of red blood cells, white blood cells and platelets. These numbers reflect the functioning of bone marrow, ability to carry oxygen to cells and the patient’s Infection Fighting Status and clotting abilities. Deficiencies or excesses of these cells indicate specific problems. Method of taking of CBC It is performed by obtaining a few milliliters of blood sample directly from the patient. The skin is wiped clean with an alcohol pad and then a needle is inserted through the area of cleansed skin into patient’s vein. The blood is then pulled from the needle by a syringe. This sample is then taken to the laboratory for analysis. The component of CBC and the Normal range White Blood Cells count, (WBC) ; 4.3-10.8x109/L Red Blood Cell count (RBC); 4.2-5.9x1012/L Hemoglobin (Hb); 8.1-11.2mmol/L For Men 7.4-9.9mmol/L For Women Hematocrit (Hcl); 45% - 52% For Men 37% - 48% For Women Platelet Count; 150-400x109/L Colour Index; 0.8-0.1 ESR; 2-10 for men, 3.15 for women Neutrophil; 65% Eosinophil; 1.5% Basophil; 0.5% Segmented Neutrophil; 3-5% Band Neutrophil; 37-72% Lymphocytes; 25%-30% Monocyte; 6-11% Certain diseases states are defined by an absolute increase or decrease in the number of a particular type of cell in the blood stream. Example;
  7. 7. Type of cellIncreaseDecreaseRed Blood Cell (RBC)EythrocytosisErythroblastopeniaWhite Blood Cell(WBC)LeukocytosisLeucopeniaLymphocyteLymphocytosisLymphocytopeniaGranulocytesGranulocytosisGranulocytopeniaNeutrophilsNeutrophiliaNeutropeniaEosinophilsEosinophiliaEosinopeniaBasophilsBasophiliaBasopeniaPlateletsThrombocytosisthrombocytopenia
  8. 8. DATE & TIME TEACHERS ACTION SIGNATURE Responsibilities of nurse for the diagnostic process in a therapeutic14TH April, hospital. Basic rules for preparing the patient for Gastroscopy, 2010 Retromanoscopy, Colonoscopy, and Ultrasound scan of abdomen. The main types of enema and rules for their using. Gastrocopy Is an examination of the upper digestive tract (The oesophagus, Stomach and Duodenum) using an endoscope; a long, thin, flexible tube containing a camera and a light. It is usually done to Investigate the cause of abdominal pain, vomiting or bleeding from digestive tract & to make or confirm a diagnosis. Prepare a patient for gastroscopy. You should tell the patient not to eat or drink anything for at least 6 hours before the test. Procedures • Patient is asked to lie on the table on his/her left side • Sedative will be given to patient by Injection. It will help to and may put patient to sleep. In some cases can be done without sedatives. • The back of the throat is sprayed with a local anaesthetic to make it numb. A small mouth guard is put between your teeth to stop patient from biting the endoscope. • Place endoscope on the patient’s mouth and instruct to swallow it down into the stomach. Make sure it doesn’t enter the windpipe so that there is plenty room to breathe around it. • Direct air into the stomach via endoscope. This will make viewing easier. This procedure takes about 15-30minutes. Contraindication:- Perforation, and penetration, bleeding, intoxication, heart failure, respiratory disease, asthma, epilepsy. Colonoscopy Colonoscopy is a procedure in which the inside of the large Intestine (Colon and Rectum) is examined using a Colonscope. Colonoscopy is commonly used to evacuate gastrointestinal symptom such as rectal and intestinal bleeding, abdominal pain or changes in bowels habits. Also perform in individual without symptoms to check for colorectal polyp or cancer. To prepare patient for colonoscope; he should be asked to stop eating solid food the day before the test. Drink plenty of clear fluids in 24hrs before the test. Take a strong laxative and needed to stay close to toilet. Procedure - wash your hand - Ask patient to lie on his left side - Gently insert the colonoscope into the rectum Lubricate jelly will be used to make this easy as possible. - Air is pumped through the colonoscope and into the bowel to make it expand and the bowel wall easier to see. - Patient may feel mild cramping during the procedure; cramping can be reduced by taking slow, deep breaths.
  9. 9. - The colonoscope is slowly with drawn while the lining of the bowel is carefully examined. - The procedure lasts from 30minutes to 1hour. Rectoscopy Is a common medical procedure in which an instrument calledrectoscope is used to examine the anal cavity, rectum or sigmoid colon.Indication for Rectoscopy:- are distended vein, external and internalhemorrhoid, polyp, tumor, cancer, constipation, blood in faeces.Contraindication: diarrhea, hemorrhage, infection. Procedure • Wash your hands • Position patient in the left lateral decubitis in the buttocks at or over the edge of the couch. • Rectoscope is lubricated and inserted into the rectum. Ensure that there is no obstruction to the scope as it is passed. OR • Tip of the obturator and scope is then passed into the canal in the direction of the umbilicus. • Once the scope has passed through the canal the obturator is removed and the eyepiece secured, allowing an unobstructed view of the interior of the rectal cavity. • Procedure last for 1/2 hour Ultrasound Scan of the abdomen Ultrasound scan is a method of obtaining image of almost any part ofthe body.An ultrasound of abdomen gives a structural view of many abdominalorgans including the liver, spleen, gallbladder, kidney, urinary bladder,uterus, ovaries, pancreas and its duct, prostate gland, aorta, venal portal.Indication: For abdominal pain, Gallstone, Kidney failure, Liver diseases,Pregnancy, Ovarian cyst.Enema:- Is a medical procedure in which fluid or substances is injected intothe rectum to empty it.Indication:- To relieve constipation, prepare for an exam of the rectum,prior to surgery on the bowel, prior to certain x-ray Procedure, beforelabour, removes feaces. Types of Enema 1. Barium enema: x-ray film that visualized colon 2. Medication enema: anti-inflammatory drug for sleeping and anti- angina for pain. 3. Therapeutic enema: used to insert drugs to rectum 4. Siphon enema: is given to remove poison & toxic substance from the intestine. Procedure - Patient will be asked to lie on his/her left side. The right leg should be bent up forward the chest. This position helps the solution to flow easily in to the colon. - The solution most used is a mixture of mild soap and warm water known as soap suds enema. - This solution is placed into a small plastic container with s flexible tube. The tube is rubbed with lubricating jelly.
  10. 10. - The tube is inserted in the rectum about 10-12cm - The solution is then slowly released with the help of funnel. After an enema, patient is asked to hold the solution in the rectum for3minutes. After that he/she can expel the enema while sitting in the toilet.Contraindication:- diarrhea, collapse, hemorrhage, tumor. Preparation of patients and necessary equipment for taking stool,coprogram. Rules of taking urine, Zimniski Test, Addi-Kkovski test. Theirdiagnostic value.Stool SpecimenAre collected for many examinations. The most common is the ova andparasites test, a microscopic examination of faeces for detecting parasitessuch as amebas or worm. Supplies and equipment required for stool collection • Gloves • Clean bedpan and cover • Specimen container and lid • Wooden tongue blades • Paper bag for used tongue blades • Label • Plastic bag for transport of container with specimen to laboratory. Procedure for stool Specimen • Wear glass and give the bedpan when patient is ready • Remove the bedpan and use the tongue blade to transfer a portion of the feces to the specimen container. • Cover the container and label it with the patient’s name and social security number. • Take the specimen to the laboratory immediately examination for parasites, ova and organism must be made while the stool is worm. Rules of taking Urine - Instruct the patient to clean the urethral area thoroughly. This will prevent external bacteria from entering the specimen. Instruct the patient to void a small amount of urine into thespecimen cup and the last of the stream into the toilet. The midstreamurine is considered to be bladder and kidney washing - Complete laboratory request form, label the specimen container with patient identifying information and send to the laboratory immediately. - Wash your hand and instruct patient to do likewise.
  11. 11. Zimnistskiy MethodThis method helps to determine functional renal capabilities to osmoticconcentration and dilution in diurnal dieresis. Technique • Collect 8 portions of urine per24hrs. Patient performs this by avoiding every 3hrs. if patient needs to discharge between these hours, he urinates into container marked by the next hour. The following data are taken into account - Daily volume of urine (daily dieresis) - Night dieresis - Changes of specific gravity during 24hrs - Correlation of day time and nocturnal urine volume Addi-Kakovski Test Is quantitative estimation of urinary cellular excretion method ofcollecting the sediment (casts and cells) in a 12hrs (24hrs) urine sample.Technique: • The day before patient should take high protein and low fluid diet and should not drink at night time. • Collect all the urine into container during 12hrs (From 22pm – 8am)The normal values are;WBC – not more than 2,000,000 per 24hrsRBC – not more than 1,000,000 per 24hrsCylinders – not more than 20,000 per 24hrs
  12. 12. DATE & TIME ACTION TEACHER’S SIGNATURE The preparation and conduct of gastric and duodenal probing. Gastric21 April, lavage. st 2010 ECG registration is the easiest analyze its basic element Gastric Probing Research of secretory function of stomach due to elimination of stomach juice. Indication:- - Diagnostic - Determine the acidity of stomach - For stomach cancer Technique of Gastric Probing → Position the patient in a sitting position → Insert the tube through the mouth to the stomach → Aspirate all amount of stomach content and put in glass → In 1 hour take 5 portion of the content every 15 minutes for determination of the basal secretion →Stimulate stomach secretion by drug e.g. Pentagastrin for secretion Increase → After that, aspirate 9 portions in 2 hours. All portion should be examine for; general amount of acidity, volume of juice and free acidity of HCl. Duodenal Probing It determined the bile secretion. Indication: - Chronic cholecystitis - Hypofunction/hyperfunction, dysfunction of gallbladder. Contraindication: - Mechanical jaundice - Cholecystitis - Acute cholecystitis - Cancer of common bile duct Technique of duodenal probing • Position patient in sitting or lying to the right • Insert the tube through mouth to the duodenum • Aspirate a portion from the duodenum → colour of juice is yellow, specific gravity → 1.008 – 1.016 and PH → 7.8 • We need to open the sphincter artificially by induction of food or drinks but it’s better to give patient drug e.g. Magnesium Sulfate 25% in 20-50ml • In 10-15minutes, take B portion bile from gall bladder colour→ dark brown or dark Olive, specific gravity → 1.016 – 1.0034, Acidity → 6.5 – 7.3 • If in 15 minutes, bile doesn’t appear, prescribe subcutaneous
  13. 13. Injection of atropine Solution and take B portion after that take C portion from hepatic duct. Colour → White or Yellow, Viscocity → not so high, Specific Gravity → 1.007 – 1.010; PH → 7.5 – 8.2 Gastric Lavage Is used for therapeutic evacuation of undesirable stomach contentsfollowing orogastric or nasogastric tube placement. Also used to treatpatients who have ingested poisons or taken an overdose of medication.Indication: - Used before surgery to clear the content of digestive tract before it is opened - For overdosed on a drug - Poisoning Techniques or Gastric Lavage It involves the passage of tube via the mouth or nose down into thestomach. Followed by sequestrial administration and removal of smallvolume of liquid. The placement of the tube in the stomach must be confirmed either by; • Air sufflation while listening to the stomach • By PH testing a small amt of aspirated stomach content. This is to ensure that the tube is not in the lung. In adult, smallamount of warm water or saline are administered and via a siphoningaction removed again In children, normal saline is used as children are more at risk ofdeveloping. Hyponatremia if lavaged with water. Because of thepossibilities of vomiting, a suction device is always on hand in case ofpulmonary aspiration of stomach contents. Lavage is repeated until the returning fluid shows no further gastriccontents.If patient is unconscious, patient should be intubated beforePerforming lavage.contraindication: - Perforation, gastrointestinal hemorrhage, when patients have compromised, unprotected airway due to infection.Complication: - Aspiration pneumonia - Laryngospasm, hypochloremia - Hypoxia, hyponatremia - Bradycardia, mechanism injury of stomach - Epistasis, water intoxicationComplication: - Aspiration pneumonia - Laryngospasm, hypochloremia - Hypoxia, hyponatremia - Bradycardia, mechanism injury of stomach - Epistasis, water intoxication
  14. 14. ECG (ELECTROCARDIOGRAPHY)Is a diagnostic tool that measures and records the electric activity of heartin exquisite detail. Being able to interpretate these details allows diagnosisof wide range of heart problem. Technique of ECGPatient is asked to lie on the back and the skin is clean with an alcoholwipe, If the patients are very hairy.ECB standard Leads There are three of these leads I, II, III.Lead I: - is place between the right arm and left arm electrodes, the leftarm being positive.Lead II:- between the right arm and left leg electrodes, the left leg beingpositiveLead III: - is between the left arm and left leg electrodes, the left leg againbeing positive. Chest Electrode Placement thV1- (Red) 4 Intercostal space to the right of the sternumV2– (Yellow) 4th Intercostal space to the left of the sternumV3 – (Green) directly between Leads V2 and V4 in diagonal line on top ofbreast tissue.V4 – (Brown) 5th Intercostal space at midclavicular lineV5 – (Black) Level of V4 at left anterior axillary line (directly under themidpoint of the armpit) The ECG records the electrical activity that results when the heartmuscle cell in the atria and ventricle contract. • Atria contraction shows up as the P-wave • Ventricular contraction show as a series known as ORS-complex • The third and last common wave is T-wave. It is produce when the ventricles are recharging next contraction (repolarizing). ECG Interpretation The graph paper that ECG records on is standardized to run at25mm/sec and is marked at 1sec intervals on the top and bottom. Thehorizontal axis correlates the length of each electrical even with itsduration in time. Each small block (defined by lighter lines) on thehorizontal axis represents o.o4 seconds. Five small blocks (shown by heavylines) is in large block and represents 0.02 seconds. Duration of waveform, segment or interval is determined by countingthe blocks from the beginning to the end of the wave, segment or interval.P-wave:- Represents atria depolarization. The time necessary for anelectric impulse from the S.A. node to spread throughout the atriamusculature. Location: preceded QRS Complex Amplitude: should not exceed 2 to 2.5mm in height Duration: 0.6 – 0.11 sec.P-R Interval :- Represents the time it takes an impulse from the atriathrough the AV node, Bundle of His and Bundle branches to thePurkinje fibres. Location: Extends from the beginning of the P-wave to the beginningof QRS Complex. Duration: 0.12 to 0.20 seconds.
  15. 15. QRS-Complex:- Represents ventricular depolarization. The QRS Complexconsists of 3 waves. The Q-wave, R-wave and the S-wave. • The Q-wave is always located at the beginning of the QRS Complex. It may not always be present. • The R-wave is always the first positive deflection. • The S-wave is the negative deflection, follows the R-wave. Location: follows the P-R Interval Amplitude: Normal values vary with age and sex. Duration: Not longer than 0.10 seconds.Q-T Interval:- represents the time necessary for ventricular depolarizationand repolarization. Location: Extends from the beginning of QRS Complex to the end ofthe T-wave (includes the QRS Complex, S-T Segment and the T-wave) Duration: varies according to age, sex & heart rate.T – wave:- Represents the repolarization of the ventricles on rareoccasions, a U wave can be seen following the T-wave. The U wave reflectsthe repolarization of the His – Purkinje Fibres. Location: Follows the S-wave and S-T Segment Amplitude: 5mm or less in standard leads I, II and III; 10mm or less inprecordial leads V1-V6. Duration: not usually measuredS-T Segment:- Represent the end of the ventricular depolarization and thebeginning of ventricular repolarization. Location: Extends from the end of the S-wave to the beginning of theT-wave. Duration: Not usually measured.
  16. 16. TEACHER’SDATE & TIME ACTION SIGNATURE Working of the manipulation room and office duties of nurses for their28th April, support. Technique of application of compresses, mustards plaster, 2010 cupping glass, using a hot water bottle, ice bottle. The use of medicinal leeches, their storage conditions. Oxygen therapy: Indication, equipment, methods of administration. Physiotherapeutic procedures (hydrotherapeutic, light, electromagnetic). Manipulation room is room for taking of Injection room for procedures. Duties of Nurses in manipulation room: Includes • Check for list of administration of drug • Giving note of x-ray • Sterilization of used equipment and their disposal • Disinfecting and cleaning of the room ever week • To check the result of the cleaning of room • Ordering of filling by the physician Compresses:- Are absorbant pad press on to part of the body to relieve inflammation or stop bleeding. 2 Types are distinguish - Hot compresses which are used to treat old injuries, muscle pain rheumatic pain, menstrual cramps, boils and toothache. - Cold compresses that are used for recent sprains, bruising, swelling and inflammation, fever, headaches. Technique of hot Compresses Take about a pint of hot water as you can comfortably stand it and add about 4 drops of essential oil to it. Then place your folded pieces of material, bandage or small towel, on top of the water and let it soak it up. Next wring out the excess water and place it over the area to be treated. Cover the warm compress with either cling wrap or a plastic bag and another towel on top to keep it in place. You may bandage the compress lightly if applied to an awkward place where it keeps slipping off, leave and replace with a new compress as soon as it has cooled to body temperature. Technique of cold compresses It is made exactly the same as the hot compresses but ice or refrigerated water is used instead of the hot water and the compress is replaced when it has heated up to body temperature. Mustard Plasters Are oily or waxy mixtures blended with herpes and applied to the chest and abdomen to stimulate internal organs, relieve pain and have an anti- inflammatory effect. It’s used for the treatment of bronchitis, bronchopneumonia, hypertension crisis, cardiac pain. Contraindication: High temperature. Techniques of Mustard Plasters
  17. 17. Soak the Mustard Plaster in moderate warm water and put to the affected area except the trunk, cover worth towel and blanket. Asked patient to lie on his front part of the body because the Mustard Plaster is applied to the back. After that take off and clean the sediment of the Plaster with a clean towel. Cupping Glass Is a practice of applying a heated cup to the skin and allowing it to cool which causes swelling of the tissues, beneath and an increase in the flow of blood in the area. Technique of Cupping Glass • Lubricate the patient’s body • Fire or spirit is put into the glass and close. • Soon as possible so that it will be air free. • After 20-30minutes, remove the glass by pressing the skin so that air will enter for easily removal. Hot water bottle Are use for bruises, burn, trauma, reduce swelling, headache, causes vasodilatation. Technique of Hot water bottle 2 • /3 of the bottle is filled with a hot water (600C -700C), the reason for this is for flexibility. • Make sure that there is air in the bottle • Place a special cloth on the affected area and then apply the hot bottle on it for about 20-30minutes. Ice Bottle Are used for inflammation. It causes vasoconstriction; it reduces muscle spasm and pain. It also reduces swelling. Technique • Put a piece of crushed ice in the bottle, make sure is flexible. • Place a cloth on the affected area and then apply the bottle on it for about 20-30minutes. The use of Mechanical Leeches Leeches:- are small worm-like animal that can attach themselves to human body and suck out blood thereby removing about 20ml of blood before falling off. Uses:- • Reduce blood coagulation • For venous insufficiency • Used to repair venous system in damaged area • Restore normal blood flow in certain damaged part of the body. Internal means of hydrotherapy range from drinking the recommended amount of water daily or receiving an intravenous (IV) Infusion, to getting a large amount of water in an enema. Hydrotherapy can be useful for patients with severe burns, rheumatoid arthritis, spinal cord injuries and bone injuries. People with diabetes, numbness or poor sensation may be at higher risk of scalding or burn from hot soaks or warm compresses.NO PRACTICAL SKILLS MADE
  18. 18. 1. Checking the medication package in the medication administration area (Infusion unit) 4 times2. Filling in nurse’s documentation of therapeutic department. 4 times3. Filling in nurse’s documentation of Infusion Unit. 5 times4. Measurement and recording body temperature 6 times5. Measurement and recording radial pulse 8 times6. Measurement of blood pressure. 8 times7. Taking blood for biochemical examination. 8 times8. Collection of urine specimen. 9 times9. Collection of stool specimen for coprological and bacteriological 7 times tests.10. Doing of Subcutaneous Injections 6 times11. Doing of Intramuscular Injections 7 times12. Doing of Intravenous Injections 6 times13. Taking part in doing of IV Infusion 5 times14. Calculate of doses, dilution of antibiotics according to medication order 6 times15. Taking part in managing equipment 5 times16. Assist with a sterile procedure 7 times17. Taking of throat and nasopharynx specimen 9 times18. Giving enemas 6 times19. Taking part in Gastric and Duodenal Intubations times20. Preparation patient to abdomen’s US and X-ray examination 7 times21. Taking 12-leads cold compress 5 times22. Applying of hot/cold plaster 8 times23. Applying of a Mustard Plaster 8 times24. Taking part in physical therapy’s procedures 8 times