Fundemental of Nursing skill lab manual - Copy.docx

Fundamental of nursing skill lab manual
December 1, 2022
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Table of contents
Table of contents ...........................................................................................................................................................1
List of acrnomies and abbreviations ............................................................................ Error! Bookmark not defined.
CHAPTER ONE:INTRODUCTION TO NURSING PROFESSION...........................................................................6
1.1. History of nursing................................................................................... Error! Bookmark not defined.
1.2. Nursing Processes.....................................................................................................................................6
CHAPTER THREE:INFECTION PREVENTION .....................................................................................................10
3.1. Hand Hygiene.........................................................................................................................................10
3.1.1. Hand washing........................................................................................................................10
3.1.2. Hand antisepsis .....................................................................................................................11
3.1.3. Antiseptic hand rub ...............................................................................................................12
3.1.4.Surgical hand scrub……………………………………………………………………………………………………….29
3.2. Donning and removing Personal protective equipment..........................................................................14
3.2.1. Donning and removing gloves ..............................................................................................14
3.2.2. Donning and removing surgical Gowns................................................................................18
3.2.3. Donning a Cap, Mask and goggle .........................................................................................19
3.3. Preparing and Maintaining a Sterile Field..............................................................................................20
3.4. Instrument processing.............................................................................................................................22
3.4.1. Decontamination, cleaning, drying and packing ..................................................................22
3.4.2. Sterilization...........................................................................................................................24
3.4.3. High level disinfection ..........................................................................................................25
3.5. Healthcare waste management ...............................................................................................................27
Waste Segregation...........................................................................................................................27
3.6. House keeping........................................................................................................................................28
3.6.1. Patient unit care.....................................................................................................................28
3.6.2. Terminal cleansing of the patient care unit ...........................................................................30
3.7. Linen processing ....................................................................................................................................31
CHAPTER FOUR:MANAGING PATIENT SAFETY AND COMFORT...........................................................33
4.1. Applying cotton rings.............................................................................................................................34
4.2. Applying foot – board ............................................................................................................................35
4.3. Applying pillows ....................................................................................................................................36
4.4. Applying air rings...................................................................................................................................37
4.5. Applying bed cradle ...............................................................................................................................38
4.6. Adjusting side rails of the bed................................................................................................................39
4.7. Applying sand bag..................................................................................................................................40
4.8. Applying splint.......................................................................................................................................41
4.9. Appling fracture board ...........................................................................................................................43
4.10. Applying back rest................................................................................................................................43
CHAPTER FIVE:BODY MECHANICS AND MOVING.....................................................................................45
5.1. Maintaining body alignment...................................................................................................................45
5.1.1. Checking proper/normal alignment of spine .........................................................................45
5.1.2. Checking proper standing body alignment............................................................................46
5.1.3. Checking proper sitting posture ............................................................................................47
5.1.4. Checking proper alignment of client in lying posture ...........................................................48
5.2. Lifting the patient ...................................................................................................................................50
5.2.1 Dangling.................................................................................................................................50
5.2.2. Log rolling ............................................................................................................................51
5.2.3. Moving patient up in bed with two nurses using draw sheet.................................................54
5.3. Positioning the patient............................................................................................................................55

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5.3.1. Front lying (prone) ................................................................................................................56
5.3.2. Semi-prone position(or Sims’ position) ................................................................................57
5.3.3. Supine (back lying)...............................................................................................................59
5.3.4. Dorsal recumbent position ....................................................................................................60
5.3.5. Lateral recumbent (on either side) ........................................................................................62
5.3.6. Knee chest.............................................................................................................................64
5.3.7. Fowler's position (semi-upright with back and knee rests elevated) .....................................66
5.3.8. Trendelenburg position .........................................................................................................67
5.3.9. Lithotomy position................................................................................................................69
5.4. Patient ambulation..................................................................................................................................70
5.4.1. Preparing the Client to Walk/ambulate .................................................................................71
5.4.2. Assisting patient with assistive devices.................................................................................72
5.4.2.1. Gait belt ...............................................................................................................72
5.4.2.2. Cane.....................................................................................................................73
5.4.2.3.Walker...................................................................................................................75
5.4.2.4. Crutch ..................................................................................................................77
5.4.2.1. Two-point gait .......................................................................................79
5.4.2.2. Three point gait......................................................................................80
5.4.2.3. Four point gait .......................................................................................81
5.4.2.4. Swing to gait..........................................................................................83
5.4.2.5. Swing through gait ................................................................................84
5.4.2.6. Up and down stair gait...........................................................................85
5.5. Patient transfers......................................................................................................................................87
5.5.1. Transferring a Client from Bed to Chair………………………………………………..115
5.5.2. Transferring a Client from Bed to Stretcher..................................................................... 886
5.6. Range of motion exercise/ROM.............................................................................................................90
CHAPTER SIX:ESSENTIAL ASSESSMENT COMPONENTS..........................................................................93
6.1. Measuring patient vital sign ...................................................................................................................93
6.1.1. Taking patient body temperature...........................................................................................93
6.1.1.1. Taking patient body temperature Oral……………………………………….122
6.1.1.2.Taking patient body temperature (axilary)............................................................95
6.1.1.3. Measuring rectal temperature ..............................................................................96
6.1.1.4. Measuring tympanic temperature.........................................................................97
6.1.2. Assessing patient pulse .........................................................................................................99
6.1.3. Assessing patient respiration...............................................................................................101
6.1.4. Assessing patient blood pressure.........................................................................................102
6.1.5. Measuring height and weight ..............................................................................................104
6.2. Collecting Specimen……………………….………………...……………...……………………………………146
6.2.1.Taking urine specimen .........................................................................................................105
6.2.1.1. Random collection .............................................................................................106
6.2.1.2.Timed urine specimen collection ........................................................................107
6.2.1.3.Mid stream (clean-voided) urine specimen.........................................................108
6.2.1.4.Catheterized urine specimen for female client....................................................110
6.2.1.5.Catheterized urine specimen for male client.......................................................111
6.2.2.Collecting stool specimen ....................................................................................................113
6.2.3.Taking blood specimen ........................................................................................................114
6.2.3.1.Vein puncture......................................................................................................114
6.2.3.1.Capillary or peripheral blood specimen ..............................................................116
6.2.3.1.Arterial specimen by puncture ............................................................................117
6.2.4.Taking sputum specimen......................................................................................................119
6.2.5.Obtaining wound drainage specimen for culture..................................................................120
6.2.6.Collecting Nose, Throat, and Sputum Specimens ................................................................122

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CHAPTER SEVEN:MAKING AND MAINTAINING BED...............................................................................124
7.1. Stripping of a bed .................................................................................................................................125
7.2. Making unoccupied bed .......................................................................................................................126
7.2.1. Closed bed...........................................................................................................................126
7.2.2. Open bed .............................................................................................................................128
7.3. Making an occupied bed.......................................................................................................................130
7.4. Making cardiac bed ..............................................................................................................................132
7.5. Post operative/anesthetic bed making...................................................................................................134
7.6. Marking an amputation bed..................................................................................................................136
7.7. Fracture bed making.............................................................................................................................138
7.8. Baby crib ..............................................................................................................................................139
CHAPTER EIGHT:HYGIENE CARE AND GROOMING ...............................................................................141
8.1. Bed bath................................................................................................................................................141
8.2.Giving tub bath......................................................................................................................................143
8.3.Giving back care....................................................................................................................................145
8.4.Mouth care.............................................................................................................................................148
8.5.Care of dentures ....................................................................................................................................150
8.6.Giving bedpan and urinals.....................................................................................................................151
8.7.Perineal care ..........................................................................................................................................154
8.8.Sitz bath.................................................................................................................................................156
8.9.Hand and foot care ................................................................................................................................157
8.10.Facial hair shaving...............................................................................................................................160
8.11.Assisting individuals to dress ..............................................................................................................161
8.12.Giving hair Care ..................................................................................................................................162
8.13.Hair shampoo ......................................................................................................................................163
8.14.Giving pediculosis treatment...............................................................................................................165
8.15.Care of eye …………………………………………………………………………………………..192
8.16.Ear care/irrigation................................................................................................................................168
CHAPTER NINE:MEDICATION AND FLUID THERAPY .............................................................................170
9.1. Medication preparation.........................................................................................................................170
9.1.1. Withdrawing Medication from a Vial .................................................................................170
9.1.2. Withdrawing Medication from an Ampoule .......................................................................171
9.1.3. Mixing medications from two vials into one syringe..........................................................172
9.1.4. Preparing an Intravenous Solution ......................................................................................174
9.1.4.1.Plastic Bag ..........................................................................................................175
9.1.4.2.Glass Bottle.........................................................................................................176
9.2. Medication administration....................................................................................................................176
9.2.1. Administering oral medication (Per Os) (Po)......................................................................176
9.2.2. Administering sublingual medication .................................................................................178
9.2.3. Administration of eye drops and ointment ..........................................................................180
9.2.4. Administration of ear drops ................................................................................................182
9.2.5.Topical Administration of medication……………………………………………………211
9.2.6. Instillation of nasal drops....................................................................................................186
9.2.7. Administering rectal medications........................................................................................187
9.2.8. Administering Vaginal Medications ...................................................................................189
9.2.9. Administering nebulizer Medications .................................................................................191
9.2.10. Parentral medication administration..................................................................................193
9.2.10.1.Administering an Intradermal Injection............................................................194
9.2.10.2.Subcutaneous Injection.....................................................................................196
9.2.10.3.Intramuscular Injection.....................................................................................198
9.2.10.4.Intravenous Injections.......................................................................................201
9.2.10.5.Intravenous infusion .........................................................................................203

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9.2.10.6.Intravenous Therapy ........................................... Error! Bookmark not defined.
9.2.10.7.Administering an IV Solution...........................................................................205
9.2.10.8. Adding Solution to a Continuous Infusion Line ..............................................207
9.2.10.8.1..Infusion Controller or Pump Regulation ........................................208
9.2.10.8.2.Volume Control Chamber (Buretrol) Regulation ............................209
9.2.10.8. 3.Adding a Solution to an Existing Heparin or PI Lock ....................210
9.3. Blood transfusions................................................................................................................................210
CHAPTER TEN:SKIN INTEGRITY AND WOUND CARE .............................................................................215
10.1. Wound dressing..................................................................................................................................215
10.1.1. Dressing clean wound .......................................................................................................217
10.1.2. Dressing septic wound ......................................................................................................219
10.1.3. Dressing with Drainage Tube............................................................................................222
10.2. Wound Irrigation ................................................................................................................................224
10.3. Suturing..............................................................................................................................................226
10.4. Stitch removal ....................................................................................................................................228
10.5. Clips Application................................................................................................................................230
10.6. Removal of clips.................................................................................................................................232
CHAPTER ELEVEN:COLD AND HEAT APPLICATION...............................................................................234
11.1. Application of cold ...........................................................................................................................................234
11.1.1. Tipped Sponge Bath ........................................................................................................................234
11.1.2.Cold compress..................................................................................................................................235
11.1.3.Application of ice pack.....................................................................................................................237
11.1.4. Application of ice collar ..................................................................................................................238
11.2. Application of heat ...........................................................................................................................................239
11.2.1.Application of warm soak......................................................................................................................239
11.2.2. Applying Hot Compress........................................................................................................................242
11.2.3.Application of hot compress ..................................................................................................................242
11.2.4.Application of hot water bag..................................................................................................................243
CHAPTER TEWELVE:NUTRITON AND METABOLISM .............................................................................246
12.1. Feeding a helpletient ..........................................................................................................................246
12.2.Feeding the Helpless Patient General Instruction................................................................................246
12.3.Gastrostomy feeding............................................................................................................................266
12.4.Parentral Feeding.................................................................................................................................267
12.5.Nasogastric tube insertion ...................................................................................................................269
12.6.Nasogastric tube medication administration........................................................................................272
12.7.Gastric aspiration.................................................................................................................................273
12.8.Gastric lavage......................................................................................................................................276
12.9.Gastric Gavage ....................................................................................................................................279
12.10.Removal of a Nasogastric Tube.........................................................................................................282
12.11.Measuring Intake and Output ............................................................................................................283
CHAPTER THIRTEEN:ELIMINATION ............................................................................................................293
13.1. Urinary elimination..............................................................................................................293
13.1.1.Urinary catheterization.........................................................................................293
13.1.1.1..Catheterization using a straight or plain catheter................................293
13.1.1.1.1. Female urinary catheterizationwith plain or straight catheter
13.1.1.1.2.Male catheterization with plain or straight catheter295
13.1.1.2.Catheterization using indwelling catheter............................................293
13.1.1.2.Insertions of indwelling catheter for male patient .....297
13.1.1.2.Insertions of indwelling catheter for Female patient .299
13.1.2..Applying a Condom Catheter .............................................................................301

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13.1.3.Bladder Irrigation (open and closed method) ......................................................302
13.1.4.Suprapubic catheter care......................................................................................304
13.2. Bowel elimination...............................................................................................................304
13.2.1.Enema ..................................................................................................................304
13.2.1.1.Cleansing enema/evacuating enema/ ...................................................305
13.2.1.2.Retention enema ..................................................................................307
13.2.1.3.Rectal wash out....................................................................................308
13.2.2.Inserting a rectal tube...........................................................................................310
13.2.3.Colostomy care and irrigation..............................................................................311
13.2.4.Digital removal of fecal impaction ......................................................................314
CHAPTER FOURTEEN:PERI-OPERATIVE CARE.........................................................................................317
14.1. Preoperative care…………………………………….………….……..…………………………….307
14.2. Intraoperative care ………………………...…….……………………………….………………….307
14.3. Post operative care …………………………………………………………………..……………………………….………………….307
CHAPTER FITEEN:OXYGENATION ................................................................................................................324
15.1.Monitoring with pulse oximetery ........................................................................................................324
15.2.Oxygen Administration .......................................................................................................................325
15.2.1..Oxygen administration via face mask ...............................................................................326
15.2.2. Oxygen by Nasal cannula (nasal prongs)………………………………………………………….……..……….319
15.2.3. Giving oxygen by tent/blood…………………………………….……………………………..322
15.3. Airway suctioning …………………………………………………………………...………………324
15.3.1.Performing Nasopharyngeal and Oropharyngeal SuctioningError! Bookmark not defined.
15.3.2. Performing endotracheal/tracheostomy Suctioning………………………………….….328
15.4. Tracheostomy care .............................................................................................................................338
15.5. Postural drainage…………………………………………..……………………………….………..332
15.6. Cardiopulmonary resuscitation (CPR)………………………………………………………………343
15.6.1. Adult CPR…………………………………………………………………..……………344
15.6.2.CPR for child below 8 years old ........................................................................................351
15.6.3.One rescuer CPR procedure for infant (to approximate 1 year).........................................353
CHAPTER SIXTEEN:THERAPEUTIC AND DIAGNOSTIC PROCEDURE ................................................356
16.1. Assisting with thoracentesis ...............................................................................................................356
16.2. Assisting with Water-seal chest drainage system...............................................................................359
16.3. Assisting with Bronchoscopy.............................................................................................................361
16.4. Assisting with an abdominal paracentesis ..........................................................................................365
16.5. Assisting with liver biopsy .................................................................................................................366
16.6. Assisting with Bone marrow puncture/biopsy....................................................................................369
16.7. Assisting with Cast application and removal......................................................................................371
16.7.1.Cast application..................................................................................................................371
16.7.2.Care of patient with cast.....................................................................................................372
16.7.3.Cast Removal .....................................................................................................................373
16.9. Assisting with Traction Application..................................................................................................374
16.9.1. Skin Traction.....................................................................................................................374
16.9.2. Skeletal traction.................................................................................................................376
16.10. Assisting with lumbar puncture........................................................................................................378
CHAPTER SEVENTEEN:CARE OF THE TERMINALLY ILL AND POST MORTEM CARE.................380
17.1. Care of terminally ill patient………………………………………...………………………….……378
17.2. Post mortum care ……………….…………………………………………………………….……..380
References .................................................................................................................................................................386

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CHAPTER ONE
INTRODUCTION TO NURSING PROFESSION
Definition of nursing by American Nursing Associations (ANA)
Nursing is the protection, promotion and optimization of health and abilities, prevention of
illness and injury, alleviations of suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families, communities, and
populations(ANA,2003).
 Nursing is an art and science. This means that a professional nurse learns to deliver care
artfully with compassion, caring and a respected for each client dignity and personhood. As
a science, nursing is based upon a body of knowledge that is always changing with new
discoveries and innovations. When nurse integrate the science with art of nursing into their
practice, the quality of care provided to clients is at level of excellence that benefits a clients
in innumerable ways
1.1. Nursing Processes
Nursing Process is a method of organizing through process for clinical decision making and
problem solving. Using nursing process, the nurse can focus on the unique responses of patient
to actual or positional health problems.
Characteristics of nursing process
1.
2. Based on scientific problem solving
3. Systematic
4. Client centered
5. Continuous
6. Dynamic
There are five steps, or phases, in the nursing process: assessment, diagnosis, planning,
implementation, and evaluation. These steps are not distinct; rather, they overlap and build on
each other. To carry out the entire nursing process, you must be sure to complete each step
accurately and then build upon the information in that step to complete the next one.
A. Nursing Assessment

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The first step, or phase, of the nursing process is assessment. During this phase, you are
collecting data (factual information) from several sources. The collection and organization of
these data allow you to:
1. Determine the patient’s current health status.
2. Determine the patient’s strengths and problem areas (both actual and potential).
3. Prepare for the second step of the process—diagnosis.
Subjective Data
 What the patient tells you
 The history, from chief complaint through Review of Systems
 Example: Mrs. G is a 54-year-old hairdresser who reports pressure over her left chest “like an
elephant sitting there,” which goes into her left neck and arm.
Objective Data
 What you detect on the examination
 All physical examination findings
 Example: Mrs. G is an older white female, deconditioned, pleasant, and cooperative.
 BP 160/80, HR 96 and regular, respiratory rate 24, afebrile.
Methods of assessment are:-
1. Nursing health history
2. Physical assessment
3. Diagnostic evaluation
B. Nursing Diagnosis
Diagnosis means reaching a definite conclusion regarding the patient’s strengths and human
responses. This diagnostic process is complex and utilizes aspects of intelligence, thinking, and
critical thinking.
Nursing diagnosis is a clinical judgment about individual, family, or community responses to
actual or potential health problems/life processes. Nursing diagnoses provide the basis for
selection of nursing interventions to achieve outcomes for which the nurse is accountable.
C. Nursing planning

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Planning involves a series of steps in which the nurse and the client priorities problems and sated
goals or expected out comes to resolve or minimize the identified problems of the client
D. Nursing implementation
Implementation refers to the action phase of the nursing process in which nursing care plan is put
into action.
It is focused on resolving the patient’s nursing diagnoses and collaborative problems and
achieving expected outcomes, thus meeting the patient’s health needs.
E. Evaluation
Evaluation simply means assessing what progress has been made toward meeting the expected
outcomes; it is the most ignored phase of the nursing process.
Summary of nursing process steps
Assessment
1. Conduct the health history.
2. Perform the physical assessment.
3. Interview the patient’s family or significant others.
4. Study the health record.
5. Organize, analyze, synthesize, and summarize the collected data
Diagnosis
1. Nursing Diagnosis
a. Identify the patient’s nursing problems.
b. Identify the defining characteristics of the nursing problems.
c. Identify the etiology of the nursing problems.
d. State nursing diagnoses concisely and precisely.
2. Collaborative Problems
a. Identify potential problems or complications that require collaborative interventions.
a. Identify health team members with whom collaboration is essential
Planning
1. Assign priority to the nursing diagnoses.
2. Specify the goals.
o Develop immediate, intermediate, and long-term goals.
o State the goals in realistic and measurable terms.
3. Identify nursing interventions appropriate for goal attainment.
4. Establish expected outcomes.
o Make sure that the outcomes are realistic and measurable.
o Identify critical times for the attainment of outcomes.
5. Develop the written plan of nursing care.
o Include nursing diagnoses, goals, nursing interventions, expected outcomes, and critical times.
o Write all entries precisely, concisely, and systematically.
o Keep the plan current and flexible to meet the patient’s changing problems and needs.
6. Involve the patient, family or significant others, nursing team members, and other health team members in all
aspects of planning
Implementation
1. Put the plan of nursing care into action.
2. Coordinate the activities of the patient, family or significant others, nursing team members, and other health
team members.
3. Record the patient’s responses to the nursing actions.
Evaluation
1. Collect data.
2. Compare the patient’s actual outcomes with the expected outcomes.
3. Determine the extent to which the expected outcomes were achieved.

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CHAPTER THREE
INFECTION PREVENTION
Definition- Largely depends on placing barriers between a susceptible host (person lacking
effective natural or acquired protection) and the microorganism
3.1. Hand Hygiene
Definition: Hand hygiene is a general term referring to any action of hand cleansing. It includes
care of hands, nails and skin.
Hand hygiene can be accomplished by:
 Hand washing
 Hand antisepsis
 Antiseptic hand rub
 Surgical scrub plain
3.1.1. Hand washing
Definition: Hand washing is process of mechanically removing soil and debris from the skin of
hands using plain soap and water.
Purpose
 Reduce number of resident and transient microorganisms on the hands
 Prevent transfer of microorganisms from health care personnel to the client
Indication
 Immediately after arriving and leaving work (the health facility)
 Before and after examining a client/patient
 After touching contaminated instruments or items
 After exposure to mucous membranes, blood, body fluids, secretions or excretions
 Before putting on gloves and after removing them
 Whenever our hands become visibly soiled
 After blowing nose or covering a sneeze
 Before eating or serving food
 After visiting the toilet

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Equipment
1. Tap water or water in a jug and a basin
2. Soap with soap dish
3. Clean towel (personal or disposable)
4. nail cuter
5. orange stick
6. wall clock
Procedure
1. Prepare necessary equipment
2. Remove all jewelry or false finger nails. Remove your watch or wear it well above the
wrist & examine hands well
3. Thoroughly wet hands.
4. Apply plain soap (antiseptic agent is not necessary).
5. Vigorously rub all areas of hands and fingers for 10–15 seconds with appropriate steps,
paying close attention to fingernails (if necessary, use orange stick) and between fingers.
6. Rinse hands thoroughly with clean water.
7. Dry hands with a paper towel or a clean, dry personal towel.
8. Use a paper towel when turning off water if there is no foot control or automatic shut-off.
1.1.2. Hand antisepsis
Definition: Washing hands with use of soap containing anti-microbial agent
Purpose
 To remove soil and debris

 Reduce both transient and resident flora on the hands.
Indication

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• Before Examining or caring for highly susceptible patients (e.g., premature infants,
elderly patients, or those with advanced AIDS)
• Before Performing an invasive procedure (e.g., intravascular device)
• Before Leaving the room of patients on Contact Precautions
Precaution
 Hand washing with medicated soaps or detergents repeatedly is irritant to the skin
Equipment
1. Tap water or water in a jug and a basin
2. Soap which contains anti-microbial agent (chlorohexidine, iodophors or triclosan) e.g.
Medicum, Life boy, Dettol and soap rack with drains
3. Clean towel (personal or disposable)
4. Orange stick
5. Wall clock
7. Nail cuter
Procedure
2. Remove all jewelry or false finger nails and your watch or wear it well above the wrist
assess hands well
3. Thoroughly wet hands.
4. Apply soap containing antimicrobial agent
5. Vigorously rub all areas of hands and fingers for 10–15 seconds following appropriate
step, paying close attention to fingernails (if necessary, use orange stick) and between
fingers.
6. Rinse hands thoroughly with clean water.
7. Dry hands with a paper towel or a clean, dry personal towel.
8. 0Use a paper towel when turning off water if there is no foot control or automatic shut-
off.
1.1.3. Antiseptic hand rub

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Definition- Use of a waterless, alcohol-based hand rub product to inhibit or kill transient and
resident flora
Purpose:
 Is to inhibit or kill transient and resident flora.
Equipment
1. Alcohol (60-90%)
2. glycerin
3. measuring glass
4. bottle
Preparation of hand rubs solution
 A nonirritating, antiseptic hand rub can be made by adding either glycerin, propylene
glycol or sorbitol to alcohol (2 mL in 100 mL of 60–90% ethyl or isopropyl alcohol
solution.
Steps:
 Apply enough alcohol-based hand rub to cover the entire surface of hands and fingers
(about a teaspoonful -5ml)
 Continue rubbing the solution over hands until they are dry (15-30 seconds)).
 Rub the solution vigorously into hands, especially between fingers and under the nails,
until dry.
1.1.4. Surgical Hand scrub
Definition: surgical hand scrub is mechanically removed of soil, debris, transient organisms
from the hands and forearm of sterile team member.
Purpose
 Remove as many microorganisms from the hands as possible before sterile procedure
 Decrease the risk of infection for high-risk groups (newborn, transplant recipients)
Equipment
1. Tap water or water in a jug and basin.
2. Soap/detergent on soap rack with drains
3. Sterile paper towel
4. Plastic nail stick
5. nail cleaner
Procedure

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1. prepare necessary equipment
2. Remove rings, watches, and bracelets & assess hands
3. open the tap and wet hands
4. Thoroughly wash hands and forearms to the elbow with soap and water
5. Clean nails with a nail cleaner & shortened the nail.
6. Rinse hands and forearms with water.
7. Apply an antiseptic agent (soap)
8. Vigorously wash all surfaces of hands, fingers, and forearms for at least 3-5 minutes.
9. Rinse hands and arms thoroughly with clean water, holding hands higher than elbows.
10. Keep hands up and away from the body, do not touch any surface or article. And dry
hands with a clean, dry towel.
11. Put on sterile or HLD gloves.
1.2. Donning and removing Personal protective equipment
Definition: PPE is an equipment that is fluid-resistant or water proof (e.g., plastic or rubber
aprons) can protect health care workers from exposure to potentially contaminated blood or other
body fluids and clients from microorganisms present on medical staff and others working in the
healthcare setting.
3.2.1. Donning and removing gloves
Purpose
 To reduce the risk of staff acquiring infections from patients
 To prevent transmitting of their skin flora to patients
 To reduce cross-contamination of microorganisms that can be transmitted from one
patient to another.
Indication
 Before contacting of blood or other body fluids, mucous membranes, or non-intact skin,
 Before performing an invasive medical procedure,

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 Before handling soiled instruments, contaminated waste items or touch contaminated
surfaces.
 When disposing contaminated waste items
 Handling chemicals or disinfectants
Types of gloves
A. Surgical glove
B. Clean glove
C. Elbow length glove
D. Heavy duty gloves
A. Surgical glove used when performing invasive medical or surgical procedures.
Purpose
 to ensure maximum asepsis to the patient and to protect the health care workers from
the patient's body fluid
Equipment
1. Table of soap or antiseptic
2. Elbow controlled tap of water
3. personal towels
4. Sterile gloves
5. Nail cuter
6. Orange stick
Procedure
1. Wash hands and dry them
3. Scrub for at least 2 minutes
4. Keep hands up and away from the body, do not touch any surface or article. and dry hands
with a clean, dry towel
5. Check the package for integrity. Open the first non-sterile packaging by peeling it
completely off the heat seal (cover) to expose the second sterile wrapper, but without
touching it
6. Place the second sterile package on a clean, dry surface without touching the surface. Open
the package and fold it towards the bottom so as to unfold the paper and keep it open.

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7. Using the thumb and index finger of one hand, carefully grasp the folded cuff edge of the
glove
8. Slip the other hand into the glove in a single movement, keeping the folded cuff at the wrist
level
9. Pick up the second glove by sliding the fingers of the gloved hand underneath the cuff of the
glove
10. In a single movement, slip the second glove on to the ungloved hand while avoiding any
contact/ resting of the gloved hand on surface other than the glove to be donned (contact/
resting constitutes a lack of asepsis and requires a change of glove)
11. If necessary, after donning both gloves, adjust the fingers and inter-digital spaces until
the gloves fit comfortably.
12. Unfold the cuff of the first gloved hand by gently slipping the fingers of the other hand
inside the fold, making sure to avoid any contact with a surface other hand the outer surface
of the glove (lack of asepsis requiring a change of gloves)
13. The hands are gloved and must touch exclusively sterile devices or the previously –
disinfected patient’s body area.
Removing gloves
14. Before removing the glove briefly immerse them in 0.5% chlorine solution,
15. Remove the first glove by peeling it back with the fingers of the opposite hand. Remove
the glove by rolling it inside out to the second finger joint
16. Remove the other glove by turning its outer edge on the fingers of the partially ungloved
hand
17. Remove the glove by turning it inside out entirely (ball forming) to ensure that the skin of
the health-care worker is always and exclusively in contact with the inner surface of the
glove.
18. Perform hand hygiene after glove removal according to the recommended indication.

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B. Examination glove
Purpose:
1. To reduce the risk of staff acquiring bacterial infections from patients.
2. To prevent staff from transmitting their skin flora to patients.
3. To reduce contamination of the hands of staff by microorganisms that can be transmitted
from one patient to another (cross-contamination).
Indication of donning Examination glove
1. When there is reasonable chance of hands coming in contact with blood or other body
fluids, mucous membranes or one intact skin
2. They perform invasive medical procedures (e.g., inserting vascular devices such as
peripheral venous lines)
3. When they handle contaminated waste items or touch contaminated surfaces.
Equipment
1. Table of soap or antiseptic
2. tap of water
3. towels
4. clean examination gloves
Procedure
2. Remove any jewelers below the wrist & examine your hands
4. Take out glove from box
5. Touch only restricted surface of gloves (at the top age of the cuff)
6. Done the first glove
7. Done the second glove and touch only restricted surface of the glove corresponding to the
wrist

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8. To avoid touching the skin of the forearm with the gloved hand, turn the external surface
of the glove to be donned on the folded fingers of the gloved hand, thus permitting to
glove the second hand
9. Once gloved, hands should not touch anything else that defined by indications and
conditions for glove use
Remove glove
10. Pinch one glove at the wrist level remove it, without touching skin of forearm, and pill
away from the hand, thus allowing the glove to turn inside out
11. Hold the removed glove in the gloved hand and slide the fingers of the ungloved hand
inside between the glove and wrist. remove the second glove by rolling it down the hand
and fold in to the first glove
12. Discard the removed glove
C. Elbow length glove
Purpose
 Used during manual removal of placenta and any other procedure where there is a contact
with a large volume of blood or body fluids.
D. Utility or heavy-duty gloves
Purpose
 used for processing instruments, equipment and other items,
 used for handling and disposing of contaminated waste, and when cleaning contaminated
surfaces
3.2.2. Donning and removing surgical Gowns
Purpose: -
 To protect patients from microorganisms, present on the abdomen and arms of the
healthcare staff during surgery.
 To protect the healthcare workers’ clothing.
Equipment
 Sterile gown
Procedure

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1. The sterile gown is folded inside out.
2. Grasp the gown inside the neckline, step back, and allow the gown to open in front
of you; keep the inside of the gown toward you; do not allow it to touch anything
3. Holding the neck band with both hand and gently shakes the folds from the gown
4. With hands at shoulder level, slip both arms into the gown; keep your hands inside
the sleeves of the gown
5. The circulating nurse will step up behind you and grasp the inside of the gown, bring
it over your shoulders, and secure the ties at the neck and waist.
6. Unfasten neck and then ties
7. Remove gown using a peeling motion; pull gown from each shoulder towards the
same hands.
8. Gown will turn inside out
9. Hold removed gown away from body, roll into a bundle and discard into waste or
linen receptacle.
3.2.3. Donning a Cap, Mask and goggle
Purpose
A. Masks
 are worn in an attempt to contain moisture droplets expelled as the health care
workers speak, cough or sneeze
 protect the wearer from inhaling both large and small particle droplets
B. Goggle/face shield
 prevent accidental splashing of the mouth and face during certain procedures.
C. Cap
 used to keep the hair and scalp covered so that flakes of skin and hair are not shed
into the wound during surgery
Equipment
1. Cap
2. Mask
3. Goggles/ Face Shield

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Procedure
1. Wash hands.
2. Apply cap to head, being sure to tuck hair under cap. Males with facial hair should use a
hood to cover all hair on head and face
3. Secure mask around mouth and nose. For masks with strings:
a. Hold mask by top and pinch metal strip over bridge of nose.
b. Pull two top strings over ears and tie at upper back of head.
c. Tie two lower ties around back of neck so that bottom of mask fits snugly under
chin
4. For goggle Place over face and eyes and adjust to fit
5. After performing necessary tasks, remove cap and mask before leaving room.
A. Untie bottom strings of mask first, then top strings, and lift off of face. Hold mask
by strings and discard.
B. Grasp top surface of cap and lift from head.
6. To remove goggle/ face shield handle by head band or ear pieces
7. After removing wash hands
8. Document the type of protective barriers used and client understanding of the procedures
3.3. Preparing and maintaining a Sterile Field
Definition-is the area of the operating room that immediately surrounds and is especially
prepared for the patient
Purpose
 To create an environment to prevent the transfer of microorganisms during sterile
procedure
 To create an environment that helps ensure the sterility of supplies and equipment during
a sterile procedure
Equipment
1. Antimicrobial soap for hand washing
2. Sterile drape
3. Sterile materials (antiseptic solution, bowl, Sterile solution dressing, instruments)

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4. Package of proper-sized sterile gloves
5. Additional sterile supplies (culture swab, gauze)
6. Container for disposal of waste materials
Procedure
1. Wash your hand
2. Inspect all sterile packages for package integrity, contamination or moisture
3. During the entire procedure, never turn your back on the sterile field or lower your hands
below the level of the field
Opening a sterile drape
4. Remove the sterile drape from the outer wrapper and place the inner drape in the center of
the work surface, at or above waist level, with the outer flap facing away from you
5. Touching the outside of the flap only, reach around (rather than over) the sterile field to
open the flap away from you
6. Open the side flaps in the same manner, using the right hand for the right flap and the left
hand for the left flap
7. Lastly, open the inner most flap that faces you, being careful that it does not touch your
clothing or any object
Adding sterile supplies to the field
8. prepackaged sterile supplies are opened by pealing back the partially sealed edge with both
hands or lifting up the unsealed edge, taking care not to touch the supplies with your hands
9. Hold supplies 10 to 12 inches above the field and allow them to fall to the middle of the
sterile field
10. Wrapped sterile supplies are added by grasping by the sterile object with one hand and un
wrapping the flaps with the other hand
11. Grasp the corners of the wrapper with the free hand and hold them against the wrist of the
other hand while you carefully drop the object on to the sterile field
Adding solutions to a sterile field
12. Read the solution label and expiration date. Note any signs of contamination

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13. Remove cap and place it with the inside facing up on a flat surface. Don't touch inside of
cap/rim of bottle
14. Hold bottle 6 inches above container on the sterile field and pour slowly to avoid spills
15. Recap the solution bottle and label it with date and time of opening if the solution is to be
reused
16. Add any additional supplies and don sterile glove before starting the procedure
3.4. Instrument processing
Definition: Instrument processing is a process of making instruments safer for handling and
making free from microorganisms.
3.4.1. Decontamination, cleaning, drying and packing
Definition
o Decontamination is a Process that makes inanimate objects safer to be handled by staff
before cleaning.
o Cleaning is a Process that physically removes all visible dust, soil, blood or other body
fluids from inanimate objects as well as removing sufficient numbers of microorganisms.
Purpose
 to reduce the number of microorganisms
 to removes all visible dust, soil, blood or other body fluids from inanimate objects
 to eliminate microorganisms from inanimate objects
Equipment
1. PPE (heavy duty glove/surgical
glove, plastic apron, gown, goggle,
mask)
2. Plastic bucket (3)
3. Water
4. Chlorine solution (0.5%)
5. Measuring Jug
6. Timer (watch)
7. Brush
8. Drying cloth
9. Drape
10. Drum

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Procedure
2. Prepare necessary equipment including 0.5% chlorine solution.
3. Don utility gloves or leave on surgical gloves after a procedure.
4. Place all instruments in 0.5% chlorine solution for10 minutes to decontaminate
immediately after completing the procedure and ensure instruments are fully immersed in
the solution.
5. Dispose off waste materials in leak proof container or plastic bag.
6. After 10 minutes remove instruments from chlorine solution and fully immerse in soap
water
7. Clean instruments immediately or leave in water until cleaning can be done.
8. If wearing surgical or examination gloves: immerse both gloved hands in 0.5% chlorine
solution.
9.
10. Remove gloves by turning them inside out.
11. Dispose in leak proof container or plastic bag if gloves are not to be reused
12. Leave utility gloves on until cleaning is completed.
13. Place instrument in container with clean water and mild non-abrasive detergent.
14. Under soapy water completely disassemble instruments and open jaws of jointed items.
15. Wash all instruments surfaces with a brush or cloth until visibly clean and Hold
instruments under water while cleaning. Pay special attention to serrated edges.
16. Wash surgical gloves inside out in soapy water.
17. Rinse all equipment/gloves until no soap or detergent remains
18. Dry instruments using clean dry towel or air dry.
19. Remove utility gloves and air dry
20. Pack the instrument with drape or drum

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3.4.2. Sterilization
Definition: - is the destruction of all microorganisms including bacterial endospores.
Purpose: to ensure instruments free from all microorganisms.
Equipments
1. Auto clave
2. Stove
3. Timer
4. Water
5. Time steam sterilizer indicator
3.4.2.1. Steam sterilization
Procedure
3. Place Time steam sterilizer indicator / an indicator tape on the container on packed items
4. Place instruments: gloves into steam pan
5. Stuck steam pans (maximum of 3 pans) on top of pan containing water for boiling.
6. Cover top of steamer pan with lid
7. Bring water to a rolling boil; wait for steam to escape from between the top pan and lid
8. Start timing and steam for 20 minutes with 121 degree centigrade, if the equipment is
uncovered
9. Remove steamer pans from heat; gently shake excess water from items and place on an extra
empty bottom pan
10. Allow to air dry and cool
11. Store in covered steamer pans
12. To Use immediately – remove items with high level disinfected forceps.
3.4.2.2. Dry heat sterilization
Procedure

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3. Place metal instruments or glass syringes in a metal container with a lid.
4. Put an indicator tape on the container.
5. place covered containers in oven and heat until 160ºc is reached and heat for two hours
6. Begin timing when 160ºc is reached and heat for two hours.
7. After instruments are cool; remove and store in sterile containers.
8. Wash hands and dry them.
3.4.3. High level disinfection
Definition: is a Process that eliminates all microorganisms except some bacterial endospores
from inanimate objects.
3.4.3.1. Chemical disinfection
Definition: This is the process of disinfecting used equipments by using
chlorine/Glutaraldehyde/ formaldehyde or peroxide.
Purpose: to eliminate microorganisms from inanimate objects.
Equipments
1. Chlorine, Glutaraldehyde, formaldehyde and peroxide.
2. Container for disinfection
3. Heavy duty gloves
4. Sterile containers
5. pick up forceps
Procedure:
3. Prepare fresh sterilant as per manufactures instructions
4. Submerge cleaned and dried items in: 2% Glutaraldehyde (cidex) for 8 – 10 hours 8%
formaldehyde solution – 24 hours
5. Ensure items are completely immersed
6. Remove items from chemical solution using sterile gloves, Forceps/pickups.
7. Rinse thoroughly with sterile water to remove all traces of chemical sterile
8. Use item immediately or store in sterile containers?

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3.4.3.2. Boiling
Definition: Boiling in water is an effective practical way to high level disinfectant instrument
and other items
Purpose:
 To kill all vegetative forms of bacteria, viruses (including HBV, HCV and HIV)
Equipment Water
1. Boiler
2. Stove
3. Sterile forceps
4. Sterile container (high level disinfected container)
Procedure
2. Decontaminate and clean all instruments and other items to be high level disinfected
4. Completely immerse cleaned instruments and other items in water
5. Cover boiler with lid and bring water to a gently rolling boil
6. Start timing when rolling boil beings
7. Continue rolling boiling for 20 minutes
8. Remove items with high-level disinfected forceps
9. Place instruments in covered high level disinfected container
Principles of Storing
 Store appropriately to protect them from dust, dirty, moisture, animals and insects.
 The storage area should be located next to or connected to where sterilization occurs, in a
separate enclosed area
 In smaller clinics, this area may be just a room close to the Central Supplies Department
or in the Operating Room

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3.5. Healthcare waste management
Definition: refers to all activities, involved in the collection, handling, treatment, conditioning,
transport, storage and disposal of waste produced at healthcare facilities
High Risk Wastes
 Infectious waste
 Anatomical waste
 Sharps wastes (used or unused)
 Chemical waste
 Pharmaceutical waste
 Radioactive wastes
 Pressurized containers
Low Risk Wastes
 Noninfectious waste/Communal
wastes
3.5.1. Waste Segregation
Definition: Waste segregation is separating waste by type at the place where it is generated
Purpose
 Protect people who handle waste items from injuries,
 Prevent the spread of infections to HCWs who handle waste,
 Prevent the spread of infection to the community,
 Protect the environment
Equipment
1. Three different colored bags (Red,
Yellow and Black)
2. Heavy duty glove
3. mask
4. gown
5. apron
6. boots
Procedure
1. Wash hands
2. Wear necessary personal protective equipment
3. Separate wastes based on their level of infection

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 Noninfectious (Black color code): Presents no risk. Examples: paper, packaging
materials, office supplies, drink containers, hand towels, boxes, glass, plastic bottles, and
food.
 Infectious (Yellow color code): Contaminated with human blood and has the ability to
spread disease. Examples: gauze, cotton, dressings, laboratory cultures, IV fluid lines,
blood bags, gloves, and pharmaceutical waste.
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 Sharp’s waste (Safety box, needle remover, or other puncture-resistant and leak-
resistant sharps containers): Syringes and needles should be discarded without
recapping.
4. Collect waste bags from the service point
5. Remove PPE
6. Wash hands
7. Documenting
1.6. House keeping
1.6.1. Patient unit care
Definition
 Patient's unit is a small separate room in which the patient rest during his/her hospital
stay. Patient's unit usually consists of basic furniture and standard equipment
 Cleaning of patient's unit is keeping of the patient’s room neat & orderly. There are two
types of cleaning that are concurrent and terminal cleaning
 Concurrent Cleaning is a daily cleaning of the patient’s room. It consists cleaning the
room by damp mopping the floor and dusting with damp cloth.
Purpose:
 To prevent accumulation of dirty
 To promote the pt's health and comfort physically & mentally
 To remove germs & dust particles

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 To prevent spread of micro organisms
 To have neat appearance of the unit.
Equipment
1. Basin of water
2. powder soap
3. Brush
4. 2 cleaning clothes
5. Scouring powder /vim/
6. stretcher
7. Dust bin
8. Mop
9. Glove
10. Broom
Purpose
To keep the room clean & tidy
 To minimize cross infection
 To create comfortable environment for the patient
 To make the room ready for a new patient
Equipment
1. Wheeled utility cart
2. Wheeled laundry hampers
3. Cleaning cloths
4. Waste basket with paper bag / plastic
liner
5. Basin of prescribed detergent, germicide
solution
6. Utility glove
7. Mop
8. Chair
9. Clean water with bucket
Procedure
1. Hand washing
2. Assemble the equipment in the utility room & take it to the patient unit
3. Wear heavy duty/ utility glove
4. Clear the bed side cabinet and over bed table if used and discard any waste in the waste
basket
5. Strip the bed, remove pillow, and place the pillow on the chair & pillow case in the
hamper. Place all the line in the hamper and place blanket on the cart for special laundry

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6. Clean the bed, wash the top of mattress cover
7. Turn the other side & clean the spring
8. Wash the cabinet, inside & out
9. Complete the unit cleaning by washing the chair, bed lamp ( cord unplugged) , singe cord
& over bed table
10. discard the waste if cleaning cloth are to be reused place them in the laundry hamper
11. Wash the collected utensils and place them in the utensils boiler (sanitizer) for a 30
minute
12. Remove the clean utensils from the utensil boiler ,dry and return them to the storage shelf
13. Wash hand
14. Record the procedure
1.6.2. Terminal cleansing of the patient care unit
Definition: The sanitation of the bed, bedside cabinet, and general area of the patient care unit
with a detergent/germicidal agent after the patient is discharged or transferred from the nursing
care unit.
 Performed at every patient care unit before the area is prepared for the next patient.
Purpose
 Prevention of the spread of microorganisms.
 Removal of encrusted secretions from framework or bedside rails.
 Removal of residue of body wastes from the mattress.
 Deodorizing of the bed frame, mattress, and pillow.
Guidelines for Terminal Cleaning.
 Reviews ward SOP for specific procedures.
 Use only authorized disinfectant/detergent or germicidal solution for cleaning.
 Check to ensure the bedside cabinet is cleared of any valuables belonging to the patient.

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 Check bed linens for personal items (dentures, contact lenses, money, jewelry, etc.)
belonging to the patient.
 Prevent spread of microorganisms by carefully removing linen from the bed.
 Use caution when cleaning the under frame and bedsprings.
 Replace any torn mattress or pillow covers.
 Allow the mattress and pillow to air-dry thoroughly before remaking the bed.
1.7. Linen processing
Definitions: Processing linen-: consists of all the steps required to collect, transport and sort
soiled linen as well as to launder (wash, dry and fold or pack), store and distribute it.
Equipment needed
1. Heavy duty gloves
2. Mask
3. Protective eyewear
4. Plastic or rubber aprons
5. Closed shoes
6. Plastic bag (hamper)
Procedure
A. Collecting soiled linen
1. Wear gloves and other PPE as appropriate
2. Roll heavily contaminated linen into the center
3. Collect used linen in cloth or plastic bags or containers with lids.
4. If carts or containers are available for soiled and clean linen should be labeled
accordingly.
5. Count and record the linen before transporting to the laundry.
B. Transporting soiled linen to Laundry
6. Transport clean and soiled linen separately.
7. Use different carts or containers to transport clean and soiled linen, or wash and label
before transporting clean linen.

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8. Cover linen during transport.
9. Thoroughly clean container (plastic bag) that used to transport soiled linen.
C. Sorting Soiled Linen
10. Keep clean linen in clean, closed storage areas.
11. Separate folding and storage room from soiled areas.
12. Keep shelves clean.
13. Handle stored linen as little as possible.
14. Ensure adequate ventilation and physical barriers between the clean and soiled linen
areas.
15. Wash hands after removing the gloves.
D. Distributing
16. Protect clean linen until it is distributed.
17. Do not leave extra linen in patient rooms.
18. Handle clean linen as little as possible.
19. Avoid shaking.
 Clean soiled mattresses before putting on clean linen

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CHAPTER FOUR
MANAGING PATIENT SAFETY AND COMFORT
Safety and Comfort devices
o Safety: - It is to protect oneself from harm, e.g. mechanical injury.
 Safety is typically responsibility shared by everyone present in an environment, but this may not
be applicable in the health care environment because of different reasons such as
 Altered level of consciousness
 Loss of ability to move
 Loss of ability to think clearly
o Comfort:-Comfort is a feeling of physical and mental wellbeing freedom from worry, fears
or pain. In general comfort measures are aimed at reliving debilitating symptoms to conserve
energy for healing & fighting infection.
o Are the mechanical devices to promote comfort to the patient
o Are invented articles which would add to the comfort of the patient when used in the
appropriate manner, by reliving the discomfort and helping to maintain correct posture.
Causes of discomfort:-
1. Pain
2. Restriction of movements due to weakness
3. Wrinkled, soiled and wet sheet
4. Delayed or inadequate attention to meet the personal needs.
5. Lack of exercise
6. Temperature extremes
7. Too bright lights and glares
8. Fear and anxiety due to illness
9. Insecurity feeling
10. Lack of sleep
11. uncomfortable position
12. indigestion and irregular bowl movements
Purpose of patient safety and comfort:-

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 To relieve pain and worry
 To provide position of comfort and ease
 To place patient in comfortable bed.
 To provide proper atmosphere to increase the moral of patient during illness.
 To adjust bed and other apparatus in the proper manner
 To give maximum rest and sleep during illness
1.1. Applying cotton rings
Objectives: - At the end of this lesson, learner will be able to:-
 Define cotton rings
 List the Purpose of cotton rings application
 Describe the indications of cotton rings application
 Demonstrate application of cotton rings
Definition: - Cotton rings are small circle of cotton rolled with bandage or gauze with a
hole in the middle.
Purpose
 Used to lift the hip from bed to prevent bed sores or pressure sore or decubitus ulcer.
 To relieve pressure from small bony prominent areas such as sacral, heel, Elbow,
occipital.
 Improves the circulation.
Indication
 Bed ridden patients
 Unconscious patients.
Size: - Based on the body areas we are going to apply. The size differs from small to medium
size of bony prominent areas.
Equipments
1. Cotton

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35
2. Bandage
3. Chart showing human body prominent areas
Procedure
1. Explain the procedure to the patient
2. Wash hands
3. Assemble the necessary equipment
4. Prepare cotton ring based on the size of body to be applied.
5. Place cotton ring under the bony prominence such as elbow and heel
6. Wash hands
7. Document procedure
1.2. Applying foot – board
Definition: - A footboard is a flat plane often made of wood or plastic placed at the foot of
the bed.
Purpose
 To provide support for the client’s feet and maintain a natural foot position.
 To keep the top bed covers off the client’s felt relieving pressure.
 To make the foot comfortable/prevent foot drop.
 To prevent sagging of patient in to bed.
Indication
 Unconscious patients
 Patient with fracture
 Bedridden patients
Types of foot board:

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 Foot boards are often made in an L shaped – so that the base of L fits under foot of the
mattress.
 Some foot boards can moved along the mattress to adjust to the clients foot drop from
their normal right angle to the legs and assume plantar flections position.
Foot drop:-is a condition of plantar flexions or a muscular which occurs from poor foot or leg
alignment.
Cause –when patient in bed for long time when the top sheet and blanket are tightly tucked.
Equipments
1. A firm pillow
2. Box of board
3. Cotton/sheet of cotton
4. Bandage
Procedure
2. Wash hands
3. Prepare the equipment
4. Move the patient up in the bed to allow room for the footboard.
5. Loosen the top linens at the foot of the bed, and then fold them back over the patient to expose his
feet.
6. Lift the mattress at the foot of the bed, and place the lip of the footboard between the mattress and
the bedsprings. Alternatively, secure the footboard under both sides of the mattress.
7. Adjust the footboard so that the patient's feet rest comfortably against it. If the footboard isn't
adjustable, tuck a folded bath blanket between the board and the patient's feet.
8. Unless the footboard has side supports, place a sandbag, a folded bath blanket, or a pillow alongside
each foot to maintain 90-degree foot alignment.
9. Fold the top linens over the footboard, tuck them under the mattress, and miter the corners.
1. Wash hands
2. Document
1.3. Applying pillows

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Definition:-Pillows are used to give comfort, support and to position patient properly.
Pillows are placed:
 Under the head
 Under the back
 Between the knees
 At the foot of the bed
 Under the arm
Purpose:
 To elevate body part
 To support patient on side
 To prevent pressure on the skin
 To increase comfort
Necessary equipments
 Pillows
 Pillows case
1.4. Applying air rings
Definition: Air rings are used to relieve pressure from the buttock and other bony prominent
areas. For application they should be filled with air and covered with
pillow case
Purpose
 Used to lift the hip from bed to prevent bed sores or pressure sore or decubitus ulcer.
 To relieve pressure from small bony prominent areas such as heel, Elbow, occipital.
 Improves the circulation.
Indication
 Bed ridden patients
 Unconscious patients
Equipments:
1. Plastic air rings
2. Covering towel or pillow case
3. Chart showing body’s prominent areas
Procedure
2. Wash hands
3. Assemble the necessary equipment.

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4. Support the appropriate site
5. Applying air ring to body prominent area.
6. Observe patient comfort status
7. Wash hands.
8. Document
1.5. Applying bed cradle
Definition: Bed cradle is sometimes called an Anderson frame. It is a device designed to keep
the top bed clothes off the feet, leg, abdomen and chest of a client
Types: there are several types of bed cradles; the most commonly used is curved metal rod.
Purpose
 To keep bed top linen off the injured part of the body.
 To prevent the weight of the bedding from resting on some part of the body.
 To apply heat in case of drying plaster casts.
 In case of electronic bed cradles are used to supply the desired warm in the case of
shock.
Indication
 Client with fracture or soft tissue
injury.
 Client with burn.
 Client with some skin lesions.
Equipments:
1. Bed cradle
2. Roll gauze/bandage
3. Small size blanket
Procedure:
2. Wash hands
4. Loosen and remove top linen.
5. However the cradle on to patients bed.

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6. Secure it in place.
7. Wrap gauze roll around both sides of the cradle.
8. Cover the cradle with top linen.
9. Wash hands.
10. Document
1.6. Adjusting side rails of the bed
Definition: Adjustable full or half said rails are used on hospital beds and stretchers to prevent
accidents
Types: they can be of various shapes and sizes usually made of metal
Position: side rails have two or three positions.
 These are high, intermediate and low.
 The down or low positions are employed when a side rail is not needed.
 The up or high side rail position is used when a client is in bed and requires protection.
Purpose
 Help weak patient turn independently
 Protects patient from falling out of bed
Indication:
 For unconscious patient.
 For weak and unable to control his/her body movement.
 For small children.
 For elderly patients
 Patient with seizure disorder
 Post operatively until the patient awake from anesthesia.
 When changing position.
 When making certain procedure.

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Equipment: bed with side rails
Procedure
2. Wash hands
4. Position the side rail to the needed height
5. Secure lock and it should be far from reaching by the patient
6. Wash hands.
7. Document
1.7. Applying sand bag
Definition: Sand bags are canvas, rubber or plastic bags filled with sand and sewed.
Purpose
 To relive discomfort
 Sand bags are used for supporting or immobilizing limbs
 Used to support as in fractures bone
 They should be covered with towel and placed on either side of the limb
 To prevent foot drop or wrist drop
 To prevent contracture
Indication
 Fractured limb
 Amputated limb.
Equipments:
1. Bag
2. Rope
 Sand
 Covering towel

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 Weight scale
 Adhesive plaster for labeling
Procedure
1.Explain the procedure to the patient
2.Wash hands
. 3. Assemble the necessary equipment.
4. Positioning the patient
5. Apply the sand bags on the side of the area to be supported.
9. Wash hands.
10. Document and report
1.8. Applying splint
Definition: splints are devices applied to the arms, legs, or trunk to immobilize the injured part
of the body when it is needed.
Purpose
 To prevent movement of injured part of the body.
 To prevent further damage when transporting injured patient.
 To provide complete rest for injured part.
 To relieve pain and discomfort and encourage healing.
Types:-There are many varieties of splints available and they can also be made locally from
different material.
1. Wooden: straight pieces of woods of varying length and width.
2. Metal: Splints made of a tin end of aluminum which are molded to fit with natural
curvature of the body part.
3. Wire: It can be quickly cut to required length and easily bent to support a limb in
desired position.

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4. Plaster (P.O.P):-Often used by surgeon.
Nursing consideration
There are a number of important points to remember.
1. Choice:-The splint chosen should be sufficiently strong and of suitable length and width.
2. Padding:-The splint should be covered with cotton wool to prevent discomfort or damage.
3. Molding:-Choose one which is most suitable mold to fit the natural curvature of the limb.
4. Fixation:-Splints must be fixed to the insured fracture limbs by bandage placed above and
below the injured part. Do not apply bandage directly on the injured part.
Equipment
 Splints (wooden, metallic)
 Dressing material (if there is open wound)
 Glove
 Padding for splint (rolled bandage to cover the splint)
 Elastic bandage or roll bandage (to hold the splint in place)
Procedure
1.Explain the procedure to the patient
2.Wash hands
. 3. Assemble the necessary equipment.
5. First tie the bandage above the injured part
6. Joints must be immobilized above and below the location of injury.
7. Wash hands.

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Follow up phase: - [ check compartment syndrome ]
Observation:-Look for the following condition.
 Presence of adequate circulation.
 Presence of adequate pulsation.
 Presence of any color change.
 Presence of numbness and tingling.
N.B:- Rings, bracelets and watch should be removed.
1.9. Appling fracture board
Purpose
 To maintain good body alignment.
 To prevent bed from sagging.
 To support the injured part when the patient has fractured spine, hips, lower limps.
Equipment
1. Fracture board
2. Thin foam mattress
Procedure
2. Wash hands
5. First tie the bandage above the injured part
6. Joints must be immobilized above and below the location of injury.
7. Wash hands.
1.10. Applying back rest
Back rest is used for elevating and supporting the head and back of the patient

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When back rest is used for the patient is liable to slip down to the foot of the bed,
therefore a foot board might be used.

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45
CHAPTER FIVE
BODY MECHANICS AND MOVING
4.1. Maintaining body alignment
Definition
 Body alignment (posture) refers to the relative position of body parts in relation to each other when
lying down, standing, sitting, or any other activity results in balance, which is an individual’s ability
to maintain equilibrium
Purpose
 To promote client comfort
 To prevent contractures
 To promote circulation
 To lessen stress on muscle, tendons, nerves, and joints
 To Prevent foot drop (plantar flexion)
 Gives an appearance of confidence and health
4.1.1. Checking proper/normal alignment of spine
Definition
1. Proper/normal alignment of the spine refers to cervical concavity, a thoracic convexity, and a
lumbar concavity in standing patients ( Figure.-----)
Purpose
2. To check the normal posture of spine
Equipment
1. Pen
2. Documentation/charting format
Procedure
1. Greet the patient and explain the purpose

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2. Instruct the patient to get stand
3. Observe the lateral view for cervical concavity, thoracic convexity and lumber concavity
4. Observe the posterior view (scapula, iliac crest and gluteal fold)
5. Document the findings
Figure. ----- Proper Spinal posture
4.1.2. Checking proper standing body alignment
Definition: Proper standing alignment cauterized by head upright, face forward, shoulders square, back
straight, abdominal muscles tucked in, arms straight at side, hands palm forward, legs straight and feet
forward with the center of gravity in the middle of the pelvis( about halfway between the umbilicus and
the symphysis pubis) (figure.-----)
Purpose
3. To check the normal posture in standing posture
Equipment
 Pen
 Documentation/charting format
Procedure

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2. Instruct the patient to get stand and face you
3. Let the patent put arms at the side and palm foreword
4. Feet flat on the ground and straight forward
5. Observe the patients shoulder, back, abdominal muscles, and arm. hands palm, legs and feet
Figure.----- Proper Alignment and Posture: Standing Male andFemale
4.1.3. Checking proper sitting posture
Definition
 Proper/normal alignment on sitting posture has similar characteristics with standing posture
except the hips and knees are flexed ( Figure.-----)
Purpose
 To check the normal posture on sitting posture

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Equipment
1. Pen
3. Chair
Procedure
2. Instruct the patient to sit on chair facing you
3. Let the patent put arms on the respective thighs with palms facing downward
4. Feet flat on the ground , straight forward and thigh together
Figure.------- Proper sitting posture and center of gravity
4.1.4. Checking proper alignment of client in lying posture
Definition
Proper/normal alignment on sitting posture has similar characteristics with standing posture except
that the patient is in supine position ( Figure.-----)
Purpose
To check the normal posture on lying posture n

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49
Equipment
1. Pen
3. Bed or examination couch
Procedure
2. Instruct the patient to lie flat on bed or examination couch
3. Let the patent put arms at the side with palms facing downward, neck straight, leg extended and
toes facing upward on the respective thighs
Figure. -----. Proper lying posture with center of gravity
4.1.5. Application of principles Body mechanics
Definition
 Body mechanics is the coordinated use of the body parts to produce motion and to maintain balance
Propose
 Promotes the efficient use of muscles and conserves energy
Principles/steps in moving or lifting objects
1. Face the direction of movement

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2. Use large muscle groups of the legs, arms, and shoulders to lessen the strain on the back and
abdominal muscles.
3. Bring the object to be lifted or carried as close to the body as possible before lifting. (This keeps both
centers of gravity close together.)
4. Bend the knees and keep the back straight when leaning over at work level.
5. Kneel on one knee, or squat, and keep the back straight when working at the floor level.
6. Push, pull, slide, or roll a heavy object on a surface to avoid unnecessary lifting.
7. Obtain help before attempting to move an obviously unmanageable weight.
8. Use of supportive devices (wheel chair )
9. Work in unison with an assistant. Give instructions and agree on the signal to start the activity
4.2. Lifting the patient
4.2.1. Dangling
Definition: 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
Indication
 Moving patient out of bed
Contraindication
 Uncurious 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
Equipment

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 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
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
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
4.2.2. Log rolling
Definition: Logrolling is a technique used to turn a patient whose body must at all times be kept in a
straight alignment.

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Purpose
 To turn a patient to the side of bed
Indication
 Spinal injury
Note: logrolling is accomplished by two or three nurses working in a coordinated fashion( Figure …)
Figure … Log rolling

December 1, 2022
53
Equipment
1. Hospital bed with side rails
2. Turn sheet or draw sheet
3. Pillows
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
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.
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.
17. Report and record as appropriate

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5.2.3. 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
Procedure Steps
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

December 1, 2022
55
5.3. 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. Fowler's position (semi-upright with back and knee rests elevated)
8. Trendelenburg position
9. Lithotomy position

December 1, 2022
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5.3.1. 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(figure.---).
Purpose
 To Promotes drainage from mouth
 To prevent contractures of hips and knee
 To examine the spine and the back
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
 Pregnant women
 Clients with abdominal incisions
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
3. Collect all necessary equipments
4. Provide privacy
5. Elevate bed to highest position.

December 1, 2022
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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.
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
Figure. ----- Proper prone position
5.3.2. Semi-prone position (or Sims’ 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 (Figure.--) .
Purpose
 To promotes drainage from mouth
 To prevents aspiration

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58
 Comfortable for sleeping.
 sacrum and greater trochanter of hip
 Promotes comfort especially in pregnant clients
Indication
 For rectal examination
 Pressure sore on the buttocks/sacrum and hips
Contraindication
o lumbar lordosis
o Foot drop
o client with leg injuries or arthritis
Equipment
1. Small pillow (3)
4. Sand bag
6. Receiver for drainage( if any)
Procedure
1. Great the patient ( if conscious ) and explain the procedure
4. Provide privacy
7. Flexed at shoulder and elbow
8. Position lower arm behind and away from the back
9. Put pillow between chest and upper arm;
10. Flex both legs in front with more flexion in upper leg.
11. Put pillow between legs

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12. Support ankle with sand bag (if necessary )
14. Wash your hand
Figure.--- Proper Semi prone position
1.3.3. Supine (back lying)
Definition: Supine position is putting patient in back lying often with a small pillow to support the head
and shoulder (Figure---).
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
Contraindication
 Spinal injury
 Cardiac patient (CHF)
 Breathing impairments
 Pressure sore (buttock, scrum, heal and shoulder )

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Equipments
1. Pillow of different size (3)
4. Wrist splint
5. Air rings
6. Cotton rings
7. Footboard or high-top tennis shoes
Procedure
1. Great the patient (if conscious) and explain the procedure
4. Provide privacy
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.
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
15. Wash your hand
1.3.4. 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 (figure….).

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