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Practical exam preparation for nursing students


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This power point presentation slide is very helpful to my students and friend's to increasing the practical knowledge of different -different clinical Department.

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Practical exam preparation for nursing students

  2. 2. /
  3. 3. UROBAG
  4. 4. • Urine • Volume: Usually less than 100 mL/24 hr (anuric phase) or 400 mL/24 hr (oliguric phase), which occurs within 24–48 hr after renal insult. Nonoliguric (more than 400 mL/24 hr) renal failure also occurs when renal damage is associated with nephrotoxic agents (e.g., contrast media or antibiotics). • Color: Dirty, brown sediment indicates presence of RBCs, hemoglobin, myoglobin, porphyrins. • Specific gravity: Less than 1.020 reflects kidney disease, e.g., glomerulonephritis, pyelonephritis with loss of ability to concentrate; fixed at 1.010 reflects severe renal damage. • pH: Greater than 7 found in urinary tract infections (UTIs), renal tubular necrosis, and chronic renal failure (CRF). • Osmolality: Less than 350 mOsm/kg is indicative of tubular damage, and urine/serum ratio is often 1:1. • Creatinine (Cr) clearance: Renal function may be significantly decreased before blood urea nitrogen (BUN) and serum Cr show significant elevation. • Sodium: Usually increased if ATN is cause for ARF, more than 40 mEq/L if kidney is not able to resorb sodium, although it may be decreased in other causes of prerenal failure. • Fractional sodium (FeNa): Ratio of sodium excreted to total sodium filtered by the kidneys reveals inability of tubules to reabsorb sodium. Readings of less than 1% indicate prerenal problems, higher than 1% reflects intrarenal disorders. • Bicarbonate: Elevated if metabolic acidosis is present. • Red blood cells (RBCs): May be present because of infection, stones, trauma, tumor, or altered glomerular filtration (GF). • Protein: High-grade proteinuria (3–4+) strongly indicates glomerular damage when RBCs and casts are also present. Low-grade proteinuria (1–2+) and white blood cells (WBCs) may be indicative of infection or interstitial nephritis. In ATN, proteinuria is usually minimal. • Casts: Usually signal renal disease or infection. Cellular casts with brownish pigments and numerous renal tubular epithelial cells are diagnostic of ATN. Red casts suggest acute glomerular nephritis.
  5. 5. Closed circuit suctioning
  6. 6. Renal biopsy needle
  7. 7. Bone Marrow Biopsy And Aspiration Needle
  12. 12. Deaver retractor • Deaver retractor - used to retract deep abdominal or chest incisions. Used in Cholecystectomy (removal of gallbladder) for retraction of right lobe of liver. Used in Truncal vagotomy (division of the main trunk of the vagus nerve) for retraction of left lobe of liver.
  13. 13. Deaver’s Retractor  Used in Cholecystectomy for retraction of right lobe of liver.  Used in Truncal vagotomy for retraction of left lobe of liver.  Used in kidney operations toretract the anterior abdominal wall.
  14. 14. • A retractor is a surgical instrument by which a surgeon can either actively separate the edges of a surgical incision or wound, or can hold back underlying organs and tissues, so that body parts under the incision may be accessed. The two are each available in many shapes, sizes, and styles.
  15. 15. Surgical retractor • A retractor is a surgical instrument used to separate the edges of a surgical incision or wound, or to hold back underlying organs and tissues so that body parts under the incision may be accessed. The general term retractor usually describes a simple handheld steel tool possessing a curved, hooked, or angled blade and fitted with a comfortable handle, that when in place maintains the desired position of a given region of tissue.
  16. 16. Babcock tissue forceps • Babcock Forceps are finger ring, ratcheted, non-perforating forceps used to grasp delicate tissue in laser procedures. They are frequently used with intestinal and laparotomy procedures. Babcock Forceps are similar to Allis forceps; however, may be considered less traumatic due to their wider, rounded grasping surface. The jaws are circumferential and the tips are triangular and fenestrated with horizontal serrations.
  17. 17. Babcock’s TissueForceps  Used to pick up appendixduring appendectomy.  Used to hold delicate visceral organs.  Used to hold cut margins of bladder during open prostatectomy.
  18. 18. RAMPLEY’S SWAB HOLDING FORCEPS  Used for cleansing theskin with swab  It is used for removing laminated membrane and daughter cysts fromHydatid cyst.  Used to hold fundus and Hartman’s pouch during cholecystectomy.
  19. 19. Bard Parker’s Handles  Blades 10,11,12 and 15 fit in B.P handle3.  Blades18,19,20,21,22, 23 and 24 fit in B.P handle 4.
  20. 20. Spencer Well’s HaemostaticForceps  Used to hold bleeding vessels.  Used to split internal oblique and transverse abdominis during appendectomy.  Used to doblunt dissection.
  21. 21. Kocher’s Haemostatic Forceps  Used to crush the base of the appendix during appendectomy.  Used to hold meniscus during menisectomy.  Used to do subtotal thyroidectomy.
  22. 22. Mosquito Haemostatic Forceps  Used to hold fine bleeding vessels.  Used to puncture the mesoappendix at an avascularsite.  Used in operations of infants.
  23. 23. Lister’s Sinus Forceps  Used to do I&D of abscess by Hilton’s method.  Used to hold gauge swab to cleanabscess cavity.
  24. 24. Allis’ Tissue Forceps  Used to hold skin while raising skin flaps.  Used to pick up a fold of peritoneum during laparotomy.  Used to hold lineaalba while closing midline incisions.
  25. 25. Plain Dissecting Forceps  Used to hold delicate visceral organs  Used to hold blood vessels and nerves whiledissecting.  Used to hold the hernial sac in hernia repair.
  26. 26. Toothed Dissecting Forceps  Used to hold tough structures like skin while suturing.  Used to hold scalp while scalpsuturing.  Used to hold rectus sheath while closureof abdomen.
  27. 27. Needle Holders  Used to hold needles while suturing.
  28. 28. Mayo’s Scissors  Used to tough structures like linea alba,rectussheath during entry in to the abdomen.  Used to cut delicate structures like hollow viscus, investing layer of deep fascia of the neckin thyroid surgery.  Used to raise skin flapsby sharpdissection.
  29. 29. Heath’s Suture Cutting scissors  Used to cut sutureson skin and mucous membrane.
  30. 30. Langenbach’s Retractor  They are used to help better visualization of theoperative field, tissue handling is minimized and bleeding better seen and controlled.
  31. 31. Morris Retractor  Used while making and closingabdominal incisions for ease of working in the deeper layers.  Used to retract Pectoralis major in MRM for better visualizationduring axillary dissection.
  32. 32. Joll’s Thyroid Retractor  It is a self retaining retractor used in thyroid surgeries to retract theskin.
  33. 33. Metallic Probe  Used in fistulectomies.  Used to assess the depth of penetrating injuries.  Used to assessthe length of sinus.
  34. 34. Lahey’s Right Angled Forceps  Used to dissect thecystic duct and artery in cholecystectomy.  Used in Vagotomies to dissect the vagus nerveand pass ligatures aroundthem beforedivision.  Used in thyroid surgeries to dissect and ligate middle thyroid vein,superiorthyroid pedicle,etc.
  35. 35. Desjardin’s Choledocholithotomy Forceps  Used to removestones from common bile duct.  Used to remove stone from kidney, bladder stone.
  36. 36. Metallic Bougie  Used to dilateurethra in urethral strictures.  Used to dilateurethra beforecystoscopy.  Used to repair ruptured urethra by railroad technique.
  37. 37. Bakes’ Dilator  Used in Choledocholithotomy, after removing the stones from the bile duct, it is used to sound the bile duct for any retained stones.  The patency of theampulla can checked, In impacted stones or ampullary stenosis,it is not possibleto pass the dilator in to the duodenum
  38. 38. Doyen’s Intestinal Clamps  Used in gutresection and anastomosis.
  39. 39. Suprapubic CystolithotomyForceps  Used in suprapubic cystolithotomy to extract the stonefrom the bladder.
  40. 40. Mayo’s Veinstripper  Used to do strippingof varicoseveins.
  41. 41. Giglie’s Saw  Used to cut bonesin amputations.  Used to do craniotomies.
  42. 42. Suprapubic Cystostomy Trocarand Cannula  Used to perform suprapubiccystostomy secondary urethral rupture to relieve urinary retention.  Used to perform suprapubiccystostomy secondary to distal urethral obstruction.
  43. 43. Bone cutter and BoneNibbler  Used to reshape the bone during osteotomies, amputati ons.
  44. 44. Bone Chisel and Osteotome  Used to chip outbone.  Used toperform osteotomies.
  45. 45. Rib Cutter  Used to cut ribs incase of draining empyema thoracis.  Use to resecta partof the rib.
  46. 46. Bone Saw  Used to cut bonein caseamputation.  Tocutcasts.
  47. 47. Periosteum Elevator  Used to elevate the periosteum during amputations.