A course of study for nursing arts

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A COURSE OF STUDY FOR NURSING ARTS

A Project Presented to the Faculty of the School of Education The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Science in Education

by Marian Sievert Mosher August 1950

UMI Number: EP46486

Ail rights reserved INFO R M A TIO N TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

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T h is project report, w ritten under the direction of the candidate’s adviser and ap p ro ved by him , has been presented to and accepted by the F a c u lty o f the School of E d u catio n in p a r t ia l f u lf illm e n t of the requirements f o r the degree

of M a s t e r of

Science in E ducation.

Date...........................

A d v is e r

Dean

ii INTRODUCTION Because it was felt that there has heen too much repeti­ tion and duplication of teaching, the faculty of the Hunting­ ton Memorial Hospital-Pasadena City College School of Nursing is desirous of a greater degree of integration in its curric­ ulum*

Due to the large quantity of basic material, it has been

difficult to correlate nursing arts with the other nursing subjects. I.

THE PROBLEM

Statement of the problem. this course of study to:

(1)

It is the purpose in writing plan a course in nursing arts

which will lend itself for use at the Huntington Memorial Hospital-Pasadena City College School of Nursing;

(2)

group

the procedures so that they can be more easily integrated with the classes in other nursing subjects;

(3)

write an

outline which may be duplicated as a guide for students1 use; (4)

include some helpful suggestions for the teacher who is

to teach the course;

(5)

emphasize those aspects of nursing

which present greatest difficulty to the student nurse as revealed by a series of difficulty analyses;

(6)

assist in

the education of competent professional nurses, not merely skilled technicians. Importance of the study.

Most courses in nursing arts

are standard and require much altering for individual situa-

iii tions.

Since the content of the course deals largely with

nursing procedures and hospital routines, it would simplify teaching for the individual school to have its own outline of study.

Today we hear much about integration and total

nursing care.

Both of these terms call for close correlation

of subject matter between nursing arts and medical and sur­ gical nursing.

It is hoped that this course plan will elim­

inate much duplication of teaching.

An attempt has been

made to present, the material according to degree of difficulty and in the order the student will meet the situations on the ward. II. Nursing Arts.

DEFINITIONS OF TERMS USED This course is often thought to be no

more than teaching the skills used in the care of the sick. In order to beon WHY as well

asthe

the professional level it must include the HOW.

It should be based upon principle

rather than rule-of-thumb procedures or simple routine skills. Since an art involves complex tasks performed by the applica­ tion of principles, these principles should be taught so that they may be understood in a broad context. Integration.

By this term is meant the correlating of

all relevant factors pertaining to the subject being studied at the time.

This method should enable the student to have

a concept of all aspects of her patient with a specific condi­

tion.

For example, when the student is studying the gastro­

intestinal system in the medical and surgical nursing classes, the dietition will he teaching diet therapy as it pertains to the alimentary tract and the pharmacology teacher will be teaching drugs used in the treatment of gastro-intestinal con­ ditions.

At the same time, in nursing arts, attention will

be given to those treatments and procedures used in caring for the conditions of this system. Total nursing care.

By this term is meant the meeting

of the individual’s every need, whether it be medical, sur­ gical, emotional, psychological, economical, or otherwise. Frequently this involves the consultation of specialists in other fields but it is necessary that the nurse be able to recognize and act upon the many problems which influence the patient's condition. Health team.

The health team is that group of people who

work together in caring for the individual.

This team con­

sists of the doctor, nurse, dietitian, social worker, and any other specialists who may be necessary to meet the needs of the person as a whole.

Since the professional nurse has been

delegated more technical tasks it has been recommended that the practical nurse be educated to serve as her assistant and to become a member of the health team. III.

LITERATURE

There has always been a certain amount of literature

V

published regarding nursing and nursing education.

Most of

these publications were by the same group of people.

In the

late 1940's several publications appeared which have made great changes in the planning of nursing education.

There are

in nursing, as in other professions, certain authorities to .whom reference can always be made for basic information and principles. 1.

Nursing for the Future by Esther Lucile Brown.

This

publication is commonly referred to as the Brown Report. Probably no writing has done as much to stimulate thinking for the education of nurses as has this report. nursing education are analyzed.

All phases of

Recognition is given to accom­

plishments of the past and concrete suggestions made for future planning.

Among the topics considered in this report are the

future functions of the professional nurse and the development of two levels of nursing and the preparation of each.

Dr.

Brown recommended that nursing education be placed in the public schools and financed by public funds.

She emphasizes

the need for and the integration of academic and professional education.

The survey and report are made with the welfare

of society, not the nursing profession, in mind.

Many of the

suggestions duplicate those made in a report in 1923 by Jose­ phine Goldmark who made a similar survey. 2.

A Program for the Nursing Profession by the Committee

on the Function of Nursing.

This publication is frequently

vi referred to as the Ginzberg Report after Eli Ginzberg who was chairman of the committee.

This group centered their efforts

on reviewing a selected group of problems pertaining to the shortage of nursing personnel.

Analysis showed the shortage

of- nurses to be due primarily to lack of economic incentives and to the fact that the public is demanding more and more medical and health services including nursing care. the recommendations of the group are:

(1)

Among

greater efforts

be made in recruitment, especially in the smaller communities; (2)

administration of nursing schools and nursing services

be made more democratic;

(3)

more facilities be made avail­

able for the training of negro and male nurses;

(4)

the pro­

fessional and practical nurse work together on the health team with the professional nurse supervising the subsidiary workers; (5)

education be transferred from the jurisdiction of the

hospital to the universities and colleges; (6) analysis of nursing functions should be made; hours and conditions of nurses be improved. few summarizing recommendations.

a careful (7)

the working

These are only a

It will be noticed that

many of these suggestions coincide with those made in the Brown Report. 3.

A Curriculum Guide for Schools of Nursing prepared by

the Committee on Curriculum of the Rational League of Rursing Education.

This publication is just what the title suggests.

It was published in 1937*

The ideals and goals were placed at

vii such a level that few schools of nursing, if any, have reached them.

This hook indicates the basic model and content for

all of nursing education. 4.

Nursing in Modern Society by Mary Ella Chayer.

The

author emphasizes nursing as a social force and the action of social forces upon nursing.

Like the above publications, this

one also indicates the need for a differentiation of profes­ sional and non-professional functions.

Nursing should meet

the needs of the community and nurses should be educated with that in mind. IY.

PHILOSOPHY

The philosophy of this school of nursing is expressed in its aims.

One of the objectives of the school for which this

syllabus was written is: to educate students to become competent professional nurses;

(2)

(1)

self directing and mature

in social, intellectual, emotional, and professional living; (3)

aware of their individual roles as nurse and as citizens

in a democratic community;

(4)

aware of the trends in society

as well as in nursing and the interaction of each.

One may say

that the objectives have been formulated to comply with the recent publications in nursing. be true.

To a certain extent this may

However, the school has leaders with vision and

foresight who are constantly revising the curriculum for bet­ ter nursing education for the community and the future.

The

viii recent literature has only served as added stimulation and a further challenge.

ix' PREFACE TO INSTRUCTORS Did you ever wish you could teach a course without hav­ ing to jump back and forth through the book?

Or, have you

tried to plan a course which can be coordinated with the other nursing subjects?

If you have struggled with these

difficulties, you will appreicate the effort which has been made in this syllabus and will be able to get some help from it. The problem approach has been used.

Most of the prob­

lems presented were compiled from a series of difficulty analyses done on student nurses and from comments which appear on anecdotal records of first year students.

When doing the

difficulty analysis, the students were given slips of paper on which to write the "How to" problems which have given them the greatest difficulty in their ward experiences. Specific directions may be obtained from the procedure manual for which this syllabus is a supplement.

It empha­

sizes principles and cautions, and presents some side lights on various aspects of the problems.

Because of limited time

and space, the answers are by no means complete.

Some re­

sponses are in themselves topics for lengthy discussions. References listed in the bibliography are those which are available at the Huntington Memorial Hospital-Pasadena City College School of Nursing library.

The activities hare

’. X

been planned for laboratory and ward experience.

It is hoped

that this outline will simplify your, the teacher’s, task. Thanks are due to Dr. Ted Gordon for his assistance with this project.

Other persons who have assisted the author

with previous and similar projects are Dr. Claude C. Crawford, professor of education, University of Southern California, and Dr. Thomas M. Riley, Principal of Lincoln High School in Los Angeles.

Also to be thanked is Mrs Mary Howe, night super­

visor at Huntington Memorial Hospital and a former member of the nursing school faculty, whose comments made on anecdotal records have been of great value.

Recognition is also given

to Miss Suzan Ferguson for reading and criticizing a large portion of the manuscript and to Miss Honora Moriarty for her assistance with the sketches.

Most of all, appreciation is

extended to the student nurses who participated in frequent difficulty analyses.

Without them there would have been no

course of study in Nursing Arts.

xi PREFACE TO NOVICE NURSES Welcome to the School of Nursing and to the class in Nursing Arts! As you begin your education to become a nurse, you im­ mediately start to learn many procedures which you will soon be putting into practice.

Much of the self-confidence which

you will want can be yours by getting off to a good start. It is hoped that your greatest reward in nursing will come from watching people find health and happiness as a result of your good nursing care. This syllabus is not a substitute for your textbook or procedure manual.

Instead, it is designed to be a supple­

ment, a study guide, and a source of ready answers.

At the

end of each chapter you will find a list of related referen­ ces.

The problems presented are primarily those of your

predecessors.

The answers are based upon principles and the

voice of experience. Let’s start so you, too, may acquire that voice of experience.

xii TABLE OF CONTENTS CHAPTER

PAGE PART I. THE SETTING HOW TO PLAN FOR THE PATIENT

1.

ENVIRONMENT:

2.

THE BED:

How to organize a pleasant atmosphere

3

How to insure a good foundation.... 10 PART II. THE PATIENT HOW TO MINISTER TO THE SICK

3.

ADMISSION:

How to greet the hospital guest.

...

4.

PERSONAL NEEDS:

5.

COMFORT:

How to put the invalid at e a s e .... 32

6.

SURGERY:

How to minister to the operative patient

7.

DISCHARGE:

How to meet individual necessities

How to bid the patient good bye.

...

17 24

39 43

PART III. THE ANALYSIS HOW TO ASSIST IN MAKING THE DIAGNOSIS 8.

EXAMINATION:

How to help with the investigation

of the i l l n e s s ....................... 9.

OBSERVATION:

10.

DIAGNOSIS:

11.

CHARTING:

How to take inventory of symptoms.

50 .

54

How to play your p a r t ................... 59 How to

keep a record..............

63

PART IV. HOSPITAL ORIENTATION HOW TO GET ALONG 12.

THE WARD:

How to

get a r o u n d .............

.69

xiii PAGE

CHAPTER

How to cooperate . . .................. 73

13.

COWORKERS:

14.

ORGANIZATION: . How to plan your work

............ 77

PART V. INFECTION HOW TO PROTECT EVERYONE 15.

SURGICAL ASEPSIS:

16.

PRECAUTION CARE:

How to keep away bacteria . . .

84

How to carry out medical asepsis

89

PART VI. MEDICATIONS HOW TO ADMINISTER DRUGS ........

96

How to inject medicines ..........

100

17.

ORAL:

How to give medicines by mouth

18.

PARENTERAL:

19.

MISCELLANEOUS: methods.

How to administer drugs by other ........ .......................

105

PART VII. MEDICAL-SURGICAL HOW TO TREAT INDIVIDUAL SYSTEMS 20.

ALIMENTARY TRACT:

How to attend to the intestinal

machinery..................... 21.

CARDIOVASCULAR CIRCUIT:

110

How to minister to the

circulatory apparatus....................... 22.

RESPIRATORY ORGANS:

How to relieve difficulties

of the bronchial tree. 23.

. . . . . . . . .

GENITO-URINARY MACHINERY: region . . . . . . . .

120

.......

125

How to nurse the pelvic

.................. . . . .

129

xiv CHAPTER 24.

PAGE

MUSCULO-SKELETAL SYSTEM:

How to handle bones and 135

muscles...................................... 25*

NEURAL CONDITIONS:

How to help with the neurologi­

cal patient. 26.

EYE, EAR, NOSE, AND THROAT:

13 How to apply remedies

to the orbit and upper respiratory area. . . . . .

142

BIBLIOGRAPHY FOR TEACHERS .............................

151

BIBLIOGRAPHY FOR STUDENTS .............................

156

LIST OF F I L M S ..........................................160

1

2

PART I.

THE SETTING

HOW TO PLAN FOR THE PATIENT

Adequate preparation for care is one of the prerequi­ sites for satisfactory recovery of the ill.

Therefore,

this unit provides the basis for nursing care in the home as well as in the hospital.

You are already familiar with

much of the material to be covered but probably have never done much about making a scientific application of the information. Emphasis will be placed on how we can make the work as easy as possible for ourselves and everyone else con­ cerned.

At the present stage of your nursing education

this may be harder than you think.

It will mean, for some

of you, the breaking of old habits and the forming of new ones.

Let's see how we can make life easier and pleasanter

for alii

CHAPTER 1. ENVIRONMENT HOW TO ORGANIZE A PLEASANT ATMOSPHERE A.

MOTIVATION:

Advantages to be had by being able to

plan a comfortable home for the invalid. 1.

BETTER SPIRITS:

Your mood is partially determined

by your surroundings. 2.

PRODUCTION:

Your preparations will determine the

ease with which you will work later. B.

DIRECTIONS:

Suggestions on how you may plan a unit

for a sick person. 1.

SELECTION:

How to pick a room.

a.

Avoid the noisy corners.

b.

Look for a good view.

c.

Pick a location which will be convenient for the persons caring for the invalid.

d.

Consider the stairs.

e.

Give the patient privacy.

f.

Plan for bathroom convenience.

g.

Think about the adaptability to the patient's mental and physical needs.

h. 2.

Don't forget the safety factors.

TRIM: a.

How to decorate the area.

Select bright colors if the individual needs stimulation.

b.

Use a soft green or mild contrasts for a restful atmosphere.

c.

Avoid monotony in color.

d.

Plan attractive flower arrangements.

TEMPERATURE: a.

How to regulate the air.

Keep the air at 62° to 70°F. depending upon the humidity and circulation.

b.

Plan to use whatever heating system is most available,

c.

Be cautious about fumes if using gas.

d.

Remember that electric heat is expensive.

e.

Use heat of sun whenever possible.

f.

Avoid overheating.

g.

Consider thepatient's condition and the amount of heat lost through evaporation ofperspiration.

h.

Remember that fresh air warms more quickly than does stale air.

i.

Regulate the humidity as necessary.

VENTILATION:

How to control air circulation.

a.

Open windows from top and bottom.

b.

Use transoms when possible.

c.

Get fresh air indirectly from another room.

d.

Arrange the screen for best air currents.

e.

Rearrange the furniture if necessary.

f.

Control drafts.

SCENT:

How to prevent odors.

a.

Discard all waste promptly.

b.

Avoid keeping food in the pattent*s room.

c.

Keep the room dry.

Moisture isessential for

the detection of odors, d.

Clean bed pans each time they are used.

e.

Cover all drainage bottles.

f.

Allow for adequate ventilation.

g.

If permitted, change dressings as necessary.

h.

Change the water on flowers daily.

i.

Use commercial deodorizers if indicated.

INSECTS:

How to eliminate the bugs.

a.

Be immaculate in your housekeeping.

b.

Wrap and dispose of all waste promptly.

c.

Avoid exposure of food.

d.

Arrange for screened doors and windows.

Be

sure these are kept whole and closed. e. f.

Swat every fly. Use insecticides freely but safely.

LIGHT:

How to illuminate to advantage.

a.

Dim the lights for a calming effect.

b.

Vary the amound according to the individual and his activities.

c.

Avoid glare.

d.

Plan for uniform diffusion and distribution.

8.

e.

Direct the light downward.

f.

Cover all light bulbs.

HARMONY*

How to keep the area neat.

a.

Improve your housekeeping.

b.

Prevent the accumulation of excess equipment.

c.

Put all unused supplies away.

d.

Keep articles off the floor.

e.

Arrange the patient’s materials so he can reach them.

9.

10.

f.

Plan for working convenience.

g.

Clean all equipment as you use it.

WASTE:

How to dispose of litter.

a.

Wrap all trash securely.

b.

Burn whenever possible.

c.

Throw down the trash chute.

d.

Handle as little as possible.

CLEANING:

How to care for used equipment.

a.

Dispose of plastic tubings.

b.

Wash rubber tubing from Central Supply with warm soapy water and place on shelf to be returned, being sure all adhesive tape has been removed.

c.

Remove all vaseline and feces from rectal tubes, rinse with cold water and soak in green soap solution.

7 d.

Sponge all other rubber goods with soapy water, rinse and dry.

e.

Cleanse all vaseline, oil, and ointments from rubber goods immediately as it causes it to deteriorate.

f.

Sterilize all metal supplies after washing them in soapy water.

g. C.

Take all glassware to the kitchen to be washed.

ACTIVITY ASSIGNMENTS:

Assignments which will aid you

in establishing favorable surroundings for the ill. 1.

Rearrange your room according to the principles mentioned.

2.

Select a room in your home suitable for an invalid. Draw a plan as it is at present.

Sketch a second

diagram indicating the changes you would make. 3.

Arrange with the Visiting Nurse Association to assist with preparing for an invalid in the home.

b.

Select a patient who is to leave the hospital soon. Direct his family in planning for his care at home.

D.

EVALUATIONS 1.

Samples of checks on ability to plan.

COMPLETIONS

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items.

8 _

a. The most restful color is

.

b. Stimulation may be secured by contrasts. c. The most cheerful room for the patient is one located on the ____ side. _ ________

d.

The most healthful temperature is degrees.

____________ e. If finance is a factor, you should avoid using ____ for heating. ________________ f . For greatest comfort, the humidity should be ____ . g. To eliminate odors waste should be before being discarded. ____________ h. Whenever possible, waste should be discarded by

.

i. For best vision, light should be directed

.

______________ 5. Adhesive tape should be removed from tubings and utensils by use of E.

REFERENCES t

.

Suggested sources to help clarify the

subject. 1.

BOOKS*

Pages to read in frequently cited texts.

Harmer and Henderson 90-132; Montag and Filson 57-7*+? Norlin and Donaldson 172-179? Rothweiler and White 168-179? Smith 132-11+2; Tracy 23-1+9? Wolf 113-137? Young 39-50. PERIODICALS:

Articles to read in the American

Journal of Nursing. a.

Bishopp, F. C., ’’Insect Control in Hospitals and Home,” *+7:613-17, September, 19^7.

10 CHAPTER 2. THE BED HOW TO INSURE A GOOD FOUNDATION A.

MOTIVATION:

Rewards to be derived from being able to

make a good bed. 1.

SELF ESTEEMS

A job well done is a boost to your

ego, 2.

GOOD GROUNDWORK:

A comfortable bed is the basis

for all of your bedside nursing and personal comfort of the patient, B.

DIRECTIONS:

Pointers that will help the bed to serve

its purpose. 1,

CHOICE:

How to select the equipment,

a. When possible, pick a standard size hospital bed as it will meet the needs of the patient and is more convenient for the nurse, b. Select materials for their ease of cleaning, c. Use materials which are attractive, d. Choose light weight materials, e. Consider the duration of the illness. 2.

OPERATION:*

How to work the bed.

a. Turn the crank at the foot or at the side to eleva‘te the head of the bed. b. Break the bed at the knees by turning the crank at the foot of the bed.

e.

Press the button to use the Silent Nurse.

d.

Elevate the foot of the bed by raising the springs.

Be sure the brace is secure in the

notch. e.

Unlock the casters to move the bed.

ACCOMPLISHMENT: How to make a good bed. a.

Select the necessary linen.

b.

Turn the mattress.

c.

Follow the directions in the procedure manual

d.

Watch the hems and corners of the sheets.

e.

Place the linen on the bed straight.

f.

For a secure corner, be sure the selvedge is at right angles to the mattress when making a mitred corner.

g.

Estimate the practical distance in placing covers by using the span of your hand.

h.

Pull all linen taut.

i.

Use proper body mechanics and make every movement count.

j.

Fold all linen but don’t fan the air in the process,

•PROTECTION: a.

How to preserve the linen.

Use waterproof materials wherever there is a possibility of damage by moisture.

b.

Cover all non-washable materials.

12 c.

Remove all stains immediately.

d.

Keep plenty of towels, disposable cloths, and newspapers handy.

e.

*

Conserve linen by changing only that which is necessary.

J>. APPLIANCES:

Laundries are hard on materials.

How to manipulate the attachments.

a.

Be sure that all apparatus is secure.

b.

Find out how the side rails work.

c.

Don’t let linen get caught in the equipment.

d.

Watch the wiring on electrical appliances.

e.

Use bolsters to keep the mattress from slipping.

f.

Attach the light cord securely and where the patient can reach it, but not so that it will tear the linen.

C.

ACTIVITY ASSIGNMENTS;

Procedures to make you adept at

•preparing beds for individual purposes. 1.

Make your bed.

2.

Make a bed in the hospital.

3.

Assist the family of a patient in the selection of bed and linen for use in the home.

Include a demon­

stration on how to prepare the bed for occupancy and how to manipulate it. D.

EVALUATION:

Samples of wavs of checking mastery of

bed-making principles.

TRUE-FALSEs

Place X in the correct space for true

or false. T a.

F

() ( )

The home style of bed should be used for the invalid as it is more com­ fortable than the hospital type of bed.

b.

() ( )

The casters of the bed should be kept locked at all times except when the bed is being moved.

c.

() ( )

You should bend from the waist when working with linen.

d.

() ( )

Wrinkles in the linen should be removed by patting.

e.

() ( )

Plastic is a good material with which to protect non-washable bedding.

f.

() ()

Newspaper is a valuable aid and should be used freely.

g.

() ( )

The light cord should be pinned to include the mattress covering.

h.

() ()

Side rails should not be up unless the patient wishes them for security.

i.

() C )

Bolsters should be used to keep the mattress in place.

J.

() ()

Stains should be removed before they become dry.

Ik 2. E.

RATING SCALE;

REFERENCES:

See Chapter 26, D.

Other sources of ideas for bed making and

maintenance. 1.

BOOKS;

Pages to read in repeatedly cited texts.

Harmer and Henderson 125-132; Huntington Memorial Hospital Procedure Manual; Montag and Filson M-9-56; Norlin and Donaldson 180-190; Rothweiler and White 168-179; Wolf 123-137.

15

16

PART II.

THE PATIENT

HOW.TO MINISTER TO THE SICK

This unit is devoted to the personal care of the patient, the most important person in the hospital.

Your

entire nursing education is centered around this individual. Since activity helps to put one at ease, we will first concentrate on learning procedures which will give you something to do when you have a personal introduction to this famous person. act as your patient.

In the laboratory a classmate will

17 CHAPTER 3 . ADMISSION HOW TO GREET THE HOSPITAL GUEST A.

MOTIVATION; 1.

FRIENDS:

Values to be had by being a good hostess. A good first impression by you may mean

permanent well-wishers. 2.

SELF ASSURANCE:

You will develop confidence in your­

self as you successfully introduce a patient to the hospital. B.

DIRECTIONSs 1.

APPROACH:

Hints How

on how to get off to a goodstart. to sell yourself.

a.

Introduce yourself.

b.

Remember the patient’s name.

c.

Give moral support and don't let your fear show.

d.

Meet the visitor first as a person and then as a patient, or as you would like to have a member of your family treated.

e.

Adapt yourself to the person and don't do or say anything which might antagonize.

f. 2.

Begin your

DRESS: a.

observations.

How to assist a person to

Handle the

clothing with care

disrobe. as it maybehis

best. b.

Proceed as you would in undressing yourself.

c.

Respect the individual's modesty.

d.

Refrain from cutting the clothes.

e.

If necessary, slit the garment along the seam.

f.

Remove clothing from the less painful side first.

g.

Encourage sending apparel home.

h.

Hang it carefully in the closet or place it neatly in the dresser drawer.

POSSESSIONS: a.

How to care for the belongings.

Request that all unnecessary articles be sent home with the family, especially valuables.

b.

Inform them, if necessary, that the hospital does not assume responsibility for articles lost.

c.

Urge the person to have money deposited at the main office as it will be applied to the bill but can be withdrawn at any time.

d.

Have articles of value put in the safe if they cannot be sent home.

REASSURANCE: a.

How to aid the ill to keep faith.

Compliment the person on the doctor of his choice.

b.

Remind him of the recent progress in medicine.

c.

Be calm.

d.

Don*t be fooled by outward expression of optimism.

e.

Assure him that everything necessary for recov­ ery will he provided.

CONVERSATION: How to talk with an invalid. a.

Try to get him to talk about himself or his family.

b.

Admire something which he has or has done.

c.

Find his interests or hobbies.

d.

Don’t be a chatterbox.

e.

Don’t gossip.

f.

Don't discuss personal affairs.

g.

Don’t argue because you may learn a lot about the other side of the picture by being a good listener.

h.

Stop conversations by assuring the patient that you will return to care for future needs.

FORESIGHT;

How to anticipate needs.

a.

Do the details when you are in the room.

b.

Check to be sure the person has everything with­ in reach.

c.

Replenish all supplies.

d.

Make the invalid comfortable before leaving.

e.

Before going, ask the patient if there is any­ thing else which he would like to have you do.

ADJUSTMENT: a.

Use tact.

How to adapt to the individual.

b.

Be calm.

e.

Show sincerity and interest.

d.

Cater to whims and fancies.

e.

Bespect the other person's viewpoint, especially the aged.

f.

Make the individual feel useful and important.

g.

Treat the patient as you wouldlike to have a member of your family treated.

This may make

the care of male patients easier. h.

Don't ridicule or criticize, even in the room of an unresponsive patient.

QUESTIONS: a.

How to manage inquiries.

Answer only those questions for which you are qualified and refer all others to the proper person.

b.

Be honest and don't alibi.

c.

Develop finesse and tact in your responses.

d.

Don't be afraid to say, "I don't know."

e.

Refrain from giving answers which will cause worry.

INSTRUCTION: a.

How to teach the patient.

Attach the light cord.

Explain and demonstrate

its use. b.

Inform the person of hospital routines, being sure to include such items as visitors, meals,

21 telephone calls, doctor1s orders, and what to expect within the next few hours. c.

Interpret doctor’s orders in language which the person can understand and give logical reasons for the instructions.

d.

Demonstrate good hygiene and help the patient to do likewise.

e.

Help to develop good mental hygiene by practic­ ing it yourself.

10.

SALESMANSHIP: a.

How to offer your services.

Impress upon the patient that you will do the work for him so long as it is necessary for him to conserve his energy.

b.

Assure the person that he will feel better after the treatment.

c. C.

Explain how the treatment will aid in recovery.

ACTIVITY ASSIGNMENTS:

Projects which will aid in learn­

ing admission procedures. 1*

Admit a person to the hospital.

Care for all the

details as indicated. 2.

Care for a patient who has Just been transferred to the ward from First Aid. procedures.

Take charge of all admission

22 D . EVALUATION:

Samples of checking the ability to admit

an individual to the hospital. 1.

TRUE FALSE:

Place X in the correct space for true

or false. T a.

F

( ) ( )

The person should be met first as a patient and then as an individual.

b.

( ) ( ) You may discard clothing which is damaged.

c.

( ) ( ) Money should be put in the safe.

d.

( ) ( ) Clothing should be removed from the painful side first when undressing someone.

e.

C ) ( 5

Clothing and valuables should be sent home.

f.

( ) ( ) You should assure the patient of his doctor's competence or otherwise.

g.

( ) ( ) You should always call the person by his name.

h.

( ) ( ) It is wise to let the invalid talk about himself.

i.

( ) ( ) Let the patient know when you do not agree with him.

j.

( ) ( ) You should cater to the individual's whims and fancies.

23 2. E.

RATING SCALE:

REFERENCES?:-

See Chapter 26, D

Supplementary reading to make the subject

clearer. 1.

BOOKS:

Pages to read in frequently cited texts.

Day *+6-70; Harmer and Henderson 13*+-l*+8; H.M.H. Procedure Manual; Montag and Filson 119-127; Tracy 58-72; Wolf 138-150; Young 58-6*+. 2.

PERIODICALS:

Articles to read in the American

Journal of Nursing. a.

, “Patients Are People,11 *+9*199* April, 19*4-9.

2b CHAPTER b . PERSONAL NEEDS HOW TO MEET INDIVIDUAL NECESSITIES A.

MOTIVATION:

Rewards to be achieved by attending to

minute details. 1,

CONFIDENCE:

It is only by administering to these

special requirements can you become sure of your­ self. 2.

HOMAN UNDERSTANDING:

Only by caring for various

types of people intimately can you really under­ stand the how and why of human behavior. B.

DIRECTIONS:

Helpful suggestions in maintaining or

establishing a healthful regime. 1.

CLEANLINESS:

How to give a bath.

a.

Tell the patient what you are going to do.

b.

Arrange the room for safety and convenience.

c.

Insure privacy.

d.

Keep the patient as comfortable as possible. Prevent chilling.

e.

Avoid getting the bed or linen wet.

f . Use as much soap and water as when you are wash­ ing yourself. g.

Hold the wash cloth so it will not drip water.

h.

Dry the patient as you would yourself. pat.

Don*t

i.

Don't forget the eyes, ears, nose, and nails,

j.

Permit the person to "finish” the bath,

k.

Adapt your procedure to meet the needs of the invalid.

Special consideration should be given

to the persons who cannot move, must sit up all the time, or who have unusual dressings. 1.

Prepare the tub or shower if such is permitted and assist as necessary.

SKIN:

How to give special care to the epidermis.

a.

Apply lotions or powders as indicated.

b.

Massage areas to stimulate circulation.

c • Separate skin surfaces. d.

Keep the surface dry.

e.

Give good back care.

f.

Be alert for any breaks or discoloration

g.

Watch for pediculi.

ORAL HYGIENEr

How to keep the mouth clean.

a.

Have the patient brush his teeth twice daily.

b.

Remove dentures when present and brush under running water.

c.

Rinse the mouth and clean the tongue as necessary

d.

Prevent the oral cavity from becoming too dry.

e.

Treat sordes with cotton or gauze and lemon and glycerine.

f.

Use ointment freely.

g.

Aid in the elimination of mucus by aspiration or gauze.

h.

Unlock the jaws if the patient is uncooperative.

HAIR:

How to care for the tresses.

a.

Comb the hair daily by doing one side at a time.

b.

Use brush, alcohol, or oil to remove snarls.

c.

Watch for nits.

d.

Protect the head from odors and discharges.

e.

Plan a hair-do which is comfortable and conven­ ient.

f.

Give a shampoo only if you have a doctor's order.

LINEN:

How to change an occupied bed.

a.

Make the bed as flat as possible.

b.

Turn the patient to one side while making the opposite side of the bed.

c.

Prevent the patient from falling.

d.

Consider the comfort of the invalid.

NUTRITION:

How to meet the dietary needs.

a.

Requisition food from the diet kitchen.

b.

Help the individual to mark the menu.

c.

Insure comfort as you prepare the person to feed himself.

d.

Encourage the invalid to eat and help him to enjoy the meal.

e.

Carry trays so as not to rattle dishes or spill

liquids. f.

Elevate the head and use a drinking tube when giving a drink.

g.

Take your time and offer small portions when you feed a patient.

h.

Don't force.

Insure adequate nourishment by remembering the basic seven or the individual needs of the patient.

i.

Serve meals attractively.

j.

Respect likes, dislikes, and customs.

k.

Measure the "intake".

1.

Store foods properly.

Milk may be kept at the

bedside if surrounded by ice. ELIMINATION: a.

How to take care of body waste.

Offer the individual his own warmed bed pan or urinal as indicated.

b.

Place bed pans with care, using powder to make your work easier.

c.

Provide privacy and comfort.

d.

Leave patient with light cord and toilet tissue within reach.

e.

Clean patient carefully.

f.

Observe the contents as you empty the container.

g.

Be sure that elimination is adequate. doubt, check with nurse in charge.

If in

h.

Measure urinary output.

i.

Induce voiding if person is uncomfortable. Expect difficulties in bedridden patients.

C.

k.

Give special care to the incontinent.

1.

Collect specimen if ordered,

m.

Always clean utensils thoroughly,

n.

WASH HANDS, the patient*s and yours.

ACTIVITY ASSIGNMENTS: Experiences which will contribute to your ability to give total nursing care. 1.

Give complete morning care to one of your classmates.

2.

Take care of a patient for a forenoon.

Make appli­

cation of all the aspects mentioned in this chapter. D - EVALUATION:

Sample checks on competence to care for

personal needs. 1.

BEST ANSWER:

Place the number of the best answer

in the parentheses. a.

( )

The most satisfactory method of removing snarls from the hair is by using? (2)

b.

c.

( )

Water.

(3 ) Alcohol,

(if)

(1)

Soap

Cutting.

Nails should be cared for by use of: (1)

File.

(2)

(if)

Nothing.

Emery board.

(3 )

Scissors

( ) When not in use, dentures should be kept in:

(1)

Mouth cup.

(2)

Denture jar.

29 (3) d.

Gauze.

(*+)

( ) While the bed is being made, the patient should be turned: (3)

2.

Glass of water,

On abdomen.

(1) (1+)

Up.

(2)

On back.

On side.

TRUE-FALSE: 'Place X in the correct space for true or false, T

F

a.

( )( )

You should not force a person to eat.

b.

( )C )

Cook*s ointment should be used on the hair.

c.

( ) ( ) Racial and religious customs should be respected in planning a diet.

d.

( ) ( ) An occupied bed should always be made from the side^

e•

( ) ( ) You should change only that linen which is soiled,

f.

( ) ( ) Every patient should be given an alcohol back rub.

3. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Other sources of information on personal

care of the individual. 1.

BOOKS:

Pages to read in frequently cited texts.

Day 72-935 Harmer and Henderson 281-302; H.M.H. Procedure Manual; Montag and Filson 233-261;

Norlin and Donaldson 206-217? Wolf 231-250. PERIODICALS:

Articles to read in the American

Journal of Nursing. a.

Davis, Bernard D., HA Patient’s View of Backrubs,*1 47:112, February, 1947.

b.

Dericks, Virginia C., "Measuring and Recording Oral Fluid Intake," 47:319-20, May, 1947.

c.

Elman, Robert, "Fluid Balance from the Nurse’s Point of View," 49:222-23, April, 1949.

d.

Feamon, Geneva, "Better Care for Older Patients 48:702-5, November, 1948.

e.

__________ , "Foot Care for You and Your Patient 47:322, May, 1947.

f.

Hargiss, Clarice Osterus, "When Nurses Know the Patient," 47:831-32.

g.

Hollander, Lester, "Care of the Skin in Older People," 47:219-22, April, 1947.

h.

Irene, Bernice Wunderlick, "Foot Supports in Polio," 47:323-24, May, 1947.

i.

___________ , "Posture Fundamentals Illustrated: The Nurse," 46:122-23, February, 1946.

j.

, "Posture Fundamentals Illustrated: The Patient," 46:20-21, January, 1946.

k.

Weiss, Mary, "Who Said "lice"?", 46:225, April, 1946.

FILMSs

Movies listed in the bibliography which

demonstrate personal care of the patient. a.

Bathing the Patient (Home CareK

b.

Feeding the Patient.

32 CHAPTER 5. COMPORT HOW TO PUT THE INVALID AT EASE A.

MOTIVATION:

Outcomes to be achieved by Increasing the

comfort of the patient. 1.

PEACE OF MIND:

Safety of the invalid is necessary

for your mental ease* 2.

APPLAUSE:

You will be cheered by the person whom

you make comfortable. 3.

LOWER TAXES* Directing someone into productivity during illness may keep that person from becoming a public charge at your expense.

B.

DIRECTIONS:

Practical suggestions which will help you

to keen the invalid happy and comfortable. 1.

CHANGES

How to lift and move the patient

easily.

a.

Use good body mechanics.

b.

Secure help if task will be difficult.

c.

Roll the bed flat whenever possible.

d.

Enlist the assistance of the patient.

e.

Watch the safety factors.

f.

Support painful areas when turning.

g.

Slide your hands under the shoulders and hips before trying to lift.

h. 2.

Teach the patient to help himself.

POSITIONS

How to settle the patient forcomfort.

a.

Maintain special positions when ordered.

b.

Use pillows freely.

c.

Watch body alignment.

d.

Allow for a variety of changes.

e.

Keep linen straight.

PILLOWSt

How to arrange the supports.

a.

Fluff frequently.

b.

Select sizes according to their purpose.

c.

Protect those which might become soiled.

d.

Overlap for gradual elevation.

e.

Roll to form bolster or more firm support.

PHYSIOLOGY*

How to provide the normal functions.

a.

Maintain adequate airway.

b.

Avoid snoring.

c.

Allow for chest expansion.

d.

Be sure not to obstruct circulation.

e.

Elevate portions of body to facilitate lymph and blood drainage.

f.

Support the feet to prevent foot drop.

g.

Apply fundamentals of good posture.

DEVICES* a.

How to use tricks for comfort.

Make cotton doughnuts of any size or shape to suit the purpose.

b.

Use rubber rings but watch the degree of infla tion.

c.

Employ cradles or frames for protection.

d.

Make pillows serve their purpose.

e.

Massage fatigued areas.

f.

Arrange lap trays or overbed tables for the person who must sit up all the time.

DECUBITUS s. How to deal with a bed sore. a.

b.

PREVENTION:

How to avoid pressure areas.

1)

Keep the bed dry and clean.

2)

Plan for frequent changes of position.

3)

Change pressure points frequently.

*+)

Maintain circulation.

5)

Be sure there are no wrinkles in the linen.

6)

Avoid irritation from rubbing.

TREATMENT: 1)

How to cure the ■ulcer.

Provide good nutrition.

Frequent small

feedings may be better than regular meals. 2)

Ask the doctor if he wants a medication used.

3)

Apply radiation therapy to dry the area.

b)

Massage the area to stimulate circulation,

5)

Cover the sore with a clean dressing but do not use adhesive tape.

6)

Clean the ulcer daily.

INFECTIONt

How to avoid irritations.

35

8.

a.

Wash your hands frequently.

b.

Relieve itching to prevent scratching.

c.

Don't burn the patient.

d.

Keep your finger nails short.

e.

Beware in handling sharp objects.

RESTRAINTS: a.

How to restrict the irresponsible.

Pad the side rails to prevent injury.

Keep them

up at all times, b.

Use soft restraints or flannel bandage to tie one or more of the hands or feet.

c.

Apply a Posey belt and be sure it is done properly.

d.

Utilize sheets to restrict body movements.

e.

Put patient into a jacket only if absolutely necessary.

f.

Employ locked restraints. •

g.

Obtain a doctor^ order for any of the above except side rails.

9.

DIVERSION: a.

How to occupy time.

(Convince the patient that he is still a useful person and can do something constructive.

b.

Stimulate the individual by finding out his interests and hobbies.

c.

Start-with something small and simple.

36 d.

Consider the physical ability of the person. How is the eye sight, muscle coordination, strength, and range of motion?

10.

e.

Try to meet the physical and mental needs.

f.

Plan for a reward of some kind.

g.

Encourage interest in that which is available.

h.

Arrange for active and inactive pastime.

AMBULATIONs a.

How to assist the patient to his feet.

Push and hold the cart against the edge of the bed when assisting a person onto a stretcher.

b.

Assist the individual to dangle by helping him to sit on the edge of the bed with the legs swinging.

c.

Use great caution when helping someone out of bed.

Place a footstool in convenient position

and steady the person as he stands on his feet. d.

Hold the wheel chair securely while the patient is assisted into and out of it.

Adjust it to

meet the person's needs. e.

Put your arm around the patient to stead him while he takes his first steps in walking.

C.

ACTIVITY ASSIGNMENTS:

Projects which will be of value in

mastering the art of giving comfort. 1.

Assist another nurse in caring for a helpless patient.

2.

Give complete nursing care to an unconscious person

3.

Arrange with the Visiting Nurse Association to assist in the home care of an invalid.

D.

EVALUATION;

Testing samples for checking on methods

of creating comfort. 1.

COMPLETION j

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. ______ a. You should lift a patient by using

b. A person who needs to have the head of the bed elevated should be placed in _____ position for comfort. c. Pillows should be selected on the basis of ____. d. The head and shoulders should be positioned to provide for ____ . e. Foot drop can be prevented b y ___ f . Pressure areas on the coccyx can be relieved by use of ____ . g. Sheet burn can be prevented by use of ____ . h. Finger nails should be kept

.

i. A hand or foot should be made secure

3. When assisting a person Into a wheel chair, you should be sure to

2. E.

RATING SCALE:

REFERENCES: 1.

BOOKS:

See Chapter 26, D.

Other sources of comfort ideas, Pages to read from frequently cited books.

Day 115-128, 13*4— 1685 Harmer and Henderson 352-372, 382-395; Montag and Filson 262-293, 315-337; Norlin

2.

and Donaldson 263-276$

Rothweiler and White 180-186,

875-899; Wolf 281-295,

301-307; Young *4-51—*5-5^.

PERIODICALS: Articles

to read in the American

Journal of Nursing. a.

Collins, Elizabeth M . , and Solowinski, Helen, "Bedsores-Their Prevention and Treatment,'* *+9:688-690, November, 19*i9.

b.

Dade, Lucy, "Diversional Activities for Patients, *+7:38*+-87, June, 19^7.

c.

Morrissey, Alice B., "The Nursing Technics in Rehabilitation,” *+9:5*+5-55l, September, 19*+9.

d.

Schwartz, Doris R., "Assisting Helpless Patients to

a Chair,” *+7:10-11, January, 19^7•

39 CHAPTER 6. SURGERY HOW TOMINISTER TO THE OPERATIVE PATIENT A.

MOTIVATIONS

Benefits to be derived from good care of

the surgical guest. 1.

SMOOTH SAILING?

Postoperative nursing troubles are

frequently prevented by good care beforehand. 2.

GRATEFUL PATIENTS: to make

B-

DIRECTIONS:

The ill appreciate those who help

their hospital stay as short as possible. Key points to be considered when caring

for surgical patients. 1.

PREPARATION:

How to get the patient ready for an

operation. a.

Watch your conversation.

b.

Give moral support.

c.

If an emergency, shave the required area by the dry method.

d.

Do all ordered treatments in the sequence which gives greatest safety to the patient.

e.

Dress the person plenty in advance and check for cleanliness, jewelry, artificial appliances, and elimination.

f.

Administer the basal anesthetic according to orders.

g.

Double check the chart and orders.

ko h.

Assist in transferring the patient to the stretcher.

i.- Accompany the person to the operating room.

Take

the completed chart with you hut do not enter the operating room unless requested to do so. Bring the pillow back to the room. 2.

POSTOPERATIVE CARE: a.

How to insure a speedy recovery.

Prepare the anesthetic unit, being sure that It is complete with adaptations to the person's individual needs.

b.

Upon return from the operating room, place the patient in the position indicated by the type of surgery done.

c.

Watch the airway, circulation, site of incision, and vital signs.

d.

Start ordered treatments as soon as possible.

e.

Give only the necessary medications,

f.

Prevent nausea.

g.

Do not leave alone until safe to do so.

h.

Prevent complications such as thrombophlebitis, aspiration or hypostatic pneumonia, infection, atelectasis, and gastro-intestinal disturbances.

C.

ACTIVITY ASSIGNMENTS: Pro.iects which will help to nut you at ease with the operative patient.

Ifl 1.

Admit, prepare, and take a patient to the operating room.

Prepare for and care for the patient upon

return. 2.

Take care of an accident patient before and after surgery.

D.

EVALUATIONt

Sample text questions to determine ability

to care for surgical patients. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F

C) ( ) The surgical shave is always done with soap.

b.

() ( ) The size of the area shaved is kept to a minimum.

c.

() ( ) It is best to dress the patient for the operating room before giving the basal anesthetic.

d.

() ( ) It is not necessary for you to accom­ pany the person to surgery.

e.

( ) ( ) Dentures should always be removed as part of the dressing procedure.

f.

(

) ( ) The recovery bed should be thoroughly warmed.

g.

() ( ) All clothing and unnecessary equipment

should be put away as you make up the anesthetic unit. h.

( ) ( ) It is all right to leave an anesthetized patient if the family is present.

i.

( ) ( 5 Patients should be kept as quiet as possible.

j.

( ) ( ) Fluids should be given in small quan­ tities after an anesthetic.

2. E.

EATING SCALE:

REFERENCES:

See Chapter 26, D.

Other places where you can get help regarding

the care of the surgical patient. 1.

BOOKS:

Pages to read in frequently cited texts.

Day 302-310; Harmer and Henderson 805-8*+}+; H.M.H. Procedure Manual; Montag and Filson 355-368; Rothweiler and White 713-720, 73 5-7*+9 > Tracy *+28-1*50; Young *+73-^98.

*+3 CHAPTER 7. DISCHARGE HOW TO BID THE PATIENT GOOD BYE A,

MOTIVATION:

Rewards to be obtained by a proper send

off. 1.

SATISFIED GUEST:

Your friendly and helpful dismis­

sal may soothe many previously ruffled feathers. 2.

TEACHING EXPERIENCE:

This is your opportunity

to try your skill by instructing the patient how to care for himself after leaving the hospital. B.

DIRECTIONS:

Helpful hints on how to leave a good

impression. 1.

PREPARATIONt

How to help the person get ready to

leave. a.

Begin upon admission to the hospital.

b.

Assist with making a plan for care at home.

c.

Teach the patient or a member of the family the procedures to be done.

2.

d.

Check that all supplies have been obtained.

e.

Rehearse and interpret the doctor's orders.

f.

Help to assemble and pack all belongings.

DRESSING:

How to aid in donning the going-away

togs. a.

Proceed in the same order as in dressing your­ self.

b.

Put each article on completely before donning another.

c.

Be sure the garment is on smooth and straight.

d.

Slip the clothes over the head or the feet, whichever is easiest.

e.

Use care not to injure the clothing.

ADIEUt a.

How to see the convalescent on his way.

Check to see that the doctor has written permis­ sion for the person to leave.

b.

Instruct the person taking the patient where to park the car.

c.

Take the invalid to the car by wheel chair.

Do

not let him walk. d.

Stop to pay the bill on the way out unless other arrangements have been made.

e.

Voice your hope for a rapid convalescence.

f.

See the individual to the elevator if leaving by ambulance.

g.

Record the details of discharge and the apparent condition of the person upon departure.

AFTER CARE OF UNIT:

How to clean up after the visitor

has left. a.

Discard all washable linen, except the rubber sheet, down the linen chute.

^5 b.

Take all glassware to the kitchen for washing.

c.

Remove all utensils to the utility room for washing and sterilizing.

This includes the

thermometer. d.

Place any forgotten articles of the patient in a Lost and Found bag and take to the house­ keeping department.

5.

EXPIRATIONS;

How to care for the dead.

a.

Prepare the family when possible.

b.

Give moral support to the relatives.

Your

presence as a professional person is appreciated. c.

Be cautious about answering questions.

d.

Provide privacy to the patient and family. .

e.

Ask about religious sacraments.

f.

Call a doctor to verify death as soon as res­ pirations have ceased.

g.

Save all possessions as they may have sentimen­ tal value.

h.

Follow the procedure manual when preparing the body for the morgue.

i.

Take to the morgue within 30 minutes after respirations have stopped.

j. C.

Avoid putting pressure on the body at any place.

ACTIVITY ASSIGNMENTS:

Experiences which will help you

in discharging patients.

k6 Select a patient who is to leave the hospital in a few days.

Prepare that person to care for

himself upon discharge.

Take care of all the

details of seeing him on his way. Prepare for and discharge a patient who leaves the hospital by ambulance. >. EVALUATIONS

Samples of measuring the ability of direct­

ing the dismissal of a patient. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F Whenever possible, the patient should be taught to do his own treatments.

b.

It is wise to let the individual pack his own belongings.

c.

You should interpret the doctor’s orders to the patient.

d.

Assisting with plans for home care is part of your responsibility.

e.

You may discharge a patient anytime that he wishes to leave.

f.

Providing an opportunity to see that the bill is paid is not among your duties. Permit the patient to leave the hos-

pital walking if he wishes to do so. h.

() ( ) Discharging of the patient should be recorded in detail.

i#

( ) ( ) All personal possessions which have been forgotten should be burned at once. *

3#

(

) ( ) You should not tie the jaws of the person who has expired.

2., BATING SCALE; E.

REFEBENCES: 1.

BOOKS;

See Chapter 26, D.

Other sources of help. Pages to read in frequently cited texts.

Day *+6-70; Harraer and Henderson l^-lMS, ^11-^20; H.M.H. Procedure Manual; Montag and Filson 119-127, 135-139, 395-^08; Tracy 58-72;; Wolf *+93-505;. Young

48

A-

49

PART III.

THE ANALYSIS

HOW TO ASSIST IN MAKING THE DIAGNOSIS

There is an art in the observation and recording of pertinent information.

Part of your nursing responsibilities

is to assist in the observation and evaluation of the inva­ lid's condition and progress.

This may involve cooperating

with other departments which do the actual work or doing the testing yourself.

The results of these studies are of little

value unless recorded in such a way as to be of benefit to other professional persons. will be very conspicuous.

Your ability, or lack of such,

50 CHAPTER 8. EXAMINATION HOW TO HELP WITH THE INVESTIGATION OF THE ILLNESS A. MOTIVATION:

Advantages to be gained by being a good

assistant, 1,

A JOB:

The doctor will single you out if your dem­

onstrations are good, 2,

SALESMANSHIP:

You are in a position to sell ade­

quate medical care if you know how to do it, B. DIRECTIONS:

Some

suggestions on how to contribute to an

early diagnosis. 1.

EQUIPMENT: a.

How to set up for a physical examination.

Selectthe tools appropriate for the type of examination to be made,

b.

2.

3.

Test all equipment to be sure it works.

c.

Secure more supplies than you expect to use.

d.

Alwayshave a good light.

PREPARATION:

How to allay the patient's fears.

a.

Explain the procedure.

b.

Be generous with your time.

c.

Assist the person onto the examining table.

d.

Do not leave the patient alone.

PROTECTION: a. b.

How to drape the individual.

Place the patient in the position of choice. Insuremodesty.

51 c. Use a bath blanket to cover the person.

4.

d.

Avoid unnecessary exposure.

e.

Hold or pin the drape in place if necessary.

ASSISTANCE: a.

How to be of help to the doctor,

Have the patient and supplies in readiness.

b. Hand equipment to the examiner. c.

Keep frequently used articles within easy reach.

d. Clean instruments promptly. e. Make records if requested to do so. f. Maintain a cooperative attitude C.

ACTIVITY ASSIGNMENTS:

between everyone.

Projects which will assist you to

meet the examining situations. 1.

Visit the various clinics at the Dispensary and assist with examining the patients.

2.

Assist with the examination of a patient in the hos­ pital.

3.

Have a physical examination.

Evaluate the perform­

ance of the assistant. D.

EVALUATION:

Samples of techniques which can be used to

test ability to assist with an examination. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short blanks within the items.

_______________ a. To examine an ear, you should be sure to have a ____ available. ____________ b. You should have among your equip­ ment a

__ to listen to the heart

and lungs. ____________ c. Modesty can be insured by ____ . ____________ d. The most common position for a vag­ inal examination is

.

TRUE-FALSE: Place X in the correct space for true or false. T a.

F

( ) C )

A retinoscope is used to examine the cornea.

b.

( ) ( )

You should have a speculum available for a nasal examination.

c.

( ) ( ) You should plan to leave the room at some time during the examination.

d.

() ( ) The drape should be pinned if it will not stay in place.

e.

( ) ( ) The patient should be placed in a Sim's position for a rectal examination.

f.

( ) ( ) You should always ask the doctor if he will want a light.

RATING SCALE:

See Chapter 26, D.

E.

REFERENCES:

Other sources of assistance on examining

the patient. 1*

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 421-423j H.M.H. Procedure Manual; Rothweiler and White 218-233; Montag and Filson 181-196; Wolf 154-16?.

54 CHAPTER 9. OBSERVATION HOW TO TAKE INVENTORY OF SYMPTOMS A.

MOTIVATION:

Benefits to be obtained by Being a good

spy. 1.

PROFESSIONAL STATUS:

Your ability to recognize

symptoms is an ear mark of a superior nurse. 2.

BETTER JUDGMENT:

Experience will teach you selec­

tivity. B.

DIRECTIONS: 1.

ACCURACY: a.

Some principles to guide you in your looking. How to see correctly.

Ask yourself, '‘How does this deviate from the normal?**.

b.. Consider possible causes. c.

Keep calm because excitement and fear cause exag­ geration.

2.

d.

Look for related symptoms.

e.

Make a mental description on the spot.

COMPLICATIONS: a.

How to detect something wrong.

Look at the patient for color, temperature, and amount of moisture on the skin.

b.

Note the expression of the eyes and face.

c.

Take the pulse and observe the quality as well as rate.

d.

Count the number of respirations per minute and note their character.

e.

Be alert to the position of the person and the condition of the bed.

f.

If you have had prior contact with the patient, notice changes in mental state or behavior.

BEHAVIORi

How to interpret mental states.

a.

Compare with the person*s normal response.

b.

Determine degree of orientation.

c.

Discover the state of consciousness.

d.

Be keen to sense varying moods.

e.

Question any suicidal tendencies.

f.

Stay with the individual long enough to make a good observation.

TEMPERATURE:

How to take the body temperature.

a.

Select the method appropriate for the circumstance

b.

Do the procedure at the correct time.

c.

Shake the mercury down to 96°F.

d.

Allow adequate time for the instrument to register

e.

Check suspected errors by using another thermom­ eter.

f.

Avoid breakage.

g.

Read and record the temperature accurately.

PULSE:

How to note the beatings of the heart.

a.

Use the most convenient artery.

b.

Note the rate, rhythm, volume, and strength of the beat.

e.

Take an apical pulse when ordered,

d.

Count the beats for 30 seconds and multiply by 2

6.

.

RESPIRATION: a.

How to count the rate of breathing.

Try not to let the patient know when you are counting the respirations.

b.

Focus your eye on some other area than the chest.

c.

Count for one minute.

d.

When respirations are shallow, place cotton at the nares.

e.

Note the depth, ease or difficulty, muscles used, and character of respiration, as well as the rhythm.

f. C.

Be alert to characteristic irregularities.

ACTIVITY ASSIGNMENTS:

Projects which will assure ease

in making observations. 1.

Take care of several patients. your observations of each.

Make comments on

Check your notations

with the nurse in charge or the doctor. 2.

Ask to care for patients which are diagnostic problems.

3.

See what contributions you can make.

Visit the Dispensary where you can sit in on the interview with the patient.

Assist the doctor in

57 verifying the symptoms and confirm your observations. D.

EVALUATION:

A sample of a checking device on ability to

recognize and interpret symptoms. 1,

TRUE-FALSE:

Place X in the correct space for true

or false, T a.

F

() ( ) The expression on the face should be one of the first things to be observed when approaching a person.

b.

() ( ) You should ask the patient about any irregularities which you notice.

c.

( ) ( )

When discovering something unusual, you should record it immediately.

d.

() ( ) Calmness will contribute to accuracy.

e.

() ( ) It is wise to ask your patient's coop­ eration while you count the respira­ tions.

f.

( ) ( )

The radial pulse is usually the easiest and most accurate.

g.

() ( ) You should allow three minutes for an oral thermometer to register.

h.

() ( ) You should check the apical pulse of all cardiac patients.

i.

() ( ) You should note the attitude of the

patient to suspect pain, j.

( ) ( )

Frequently it will be necessary for you to ignore a patient's complaints.

2. E.

RATING SCALE:

REFERENCES;

See Chapter 26, D.

Further sources of information on observa­

tion of the patient. 1.

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 219-228; Montag and Filson 143-150 Norlin and Donaldson 191-200; Rothweiler and White 281-359, Very good. 2.

PERIODICALS:

An article to read in the Amorinan

Journal of Nursing. a.

Brim, Katherine, and Chandler, Betty Alice, "Changes in Oral Temperature," 48:772, December, 1948.

3.

FILES:

A movie which will assist you in making

observations. a.

The Vital Signs and Their Interrelation.

59 CHAPTER 10. DIAGNOSIS HOW TO PLAY YOUR PART A.

MOTIVATION:

Advantages to be received by being coopera­

tive. 1.

APPROVAL:

Everyone will appreciate you if you help

to make the schedule run smoothly. 2.

FRIENDLY ATMOSPHERE:

Teamwork takes tensions out

of the air for you. B.

DIRECTIONS:

Helpful hints on how you can aid in making

a diagnosis. 1.

SPECIMEN:

How to collect samples.

a.

Select the appropriate container.

b.

Use the correct implements in handling the sub­ stance.

c.

Enlist the patient's cooperation wherever neces­ sary.

2.

d.

Keep the outside of the container clean.

e.

Label it correctly andcompletely.

f.

Take to the proper place in the laboratory.

g.

Don't forget to record what you did.

LABORATORY:

How to assist the laboratory.

a.

Be prompt.

b.

Be accurate.

c.

Be informative.

d.

Follow directions to the letter.

e.

Plan your nursing care to meet the schedule of the laboratory.

f. 3.

Fill out the label completely and legibly.

X-RAY:

How to work with the roentgen ray staff.

a.

Prepare the patient according to directions.

b.

Plan your schedule so the person is ready at the time specified.

c.

Withhold food and fluids until permission has been granted.

C.

d.

Check when the test is finished.

e.

Use the telephone if in doubt.

ACTIVITY ASSIGNMENTS:

Experiences which will aid in

making tests more meaningful to you. 1.

Take care of patients who are having extensive diagnostic work done.

2.

Instruct out patients in their home preparation for diagnostic procedures which they are to have done.

D.

EVALUATIONS

Samples of ways of checking diagnostic coop­

erative ability. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items.

a* The container used for collecting sputum is ____ . b. Stool specimens are transferred to the container by use of ____ . c. The amount of urine taken to the laboratory in special tests is ____ . d. In a series of laboratory tests, a label is attached to ____ specimens. e. Persons having a basal metabolism test should be taken to ____ depart­ ment. TRUE-FALSE:

Place X in the correct space for true or

false. T a.

F

( ) ()

The sputum specimen of an isolated patient is taken to the laboratory in its original container.

b.

( ) ()

The nurse should plan her schedule to meet that of the department doing the testing.

e.

( ) ()

All diagnostic work is recorded on the chart as it is done.

d.

( ) ()

X-ray department should be informed as to the mode of transportation most suitable for the patient.

62 e.

( ) ( )

You should notify the x-ray department when the fatty meal is served to some­ one having a gall bladder series,

E.

REFERENCES:

Other sources of information on diagnostic

procedures. 1*

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 434-463; Mbntag and Filson 197-229; Tracy 200-220; Wolf 167-180; Young 398407.

63 CHAPTER 11. CHARTING HOW TO KEEP A RECORD A. MOTIVATION:

Rewards to be had bv being a good annalist.

1.

RECOGNITION:

Your good record will always be noticed.

2.

MORE TEAMWORK:

It is easier to work, together when

each person knows the score. 3.

FEWER MISTAKES:

You will have no doubts when accuracy

is the watchword. B. DIRECTIONS:

Practical suggestions on how to make chart­

ing easier. 1.

LEGIBILITY:

How to make it readable.

a.

Practice printing.

b.

Leave a space between words.

c.

Punctuate properly.

d.

Spell correctly.

e.

Use lines, margins, and spaces for the purpose intended.

f. 2.

Be consistant

LEGALITY:

in size and type of print.

How to insure accuracy.

a.

Don’t record anything until you have done it.

b.

Describe but don’t diagnose.

c.

Check the name on the chart.

d.

Record only that which you have observed or indi­ cate your source of information.

e.

Sign the record with your initial and last name in writing.

f. 3.

4.

5.

Correct all errors but don’t erase.

VOCABULARY:

How to express yourself.

a.

Be brief.

b.

Use only accepted abbreviations.

c.

Develop a descriptive vocabulary.

d.

Utilize technical and scientific terms.

e.

Record the patient’s words.

CONTENT:

How to be informative.

a.

Record all treatments given or refused.

b.

Indicate your observations.

c.

Describe all signs and symptoms.

d.

Reduce routine charting.

USABILITY: a.

How to read a chart.

Become acquainted with the various sections and the information given therein.

C.

b.

Determine the diagnosis.

c.

Note what has been done in the past.

d.

Check on the doctor’s orders.

e.

Get information regarding the patient's history.

f.

Evaluate the progress of recovery.

ACTIVITY ASSIGNMENTS: your record work

Projects which will help you in

65 1.

Make a record of your activities in caring for a patient.

Use the chart to get acquainted with the

person. 2.

Help one of your classmates to get information about a patient and assist her in making a record of the necessary data.

D.

EVALUATION; 1.

A sample of testing ability to chart.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F

( ) ( )

The patient is considered the subject of every phrase or sentence of the chart.

b.

( ) ( ) Printing should be done in capital letters.

c.

( ) ( ) Sign the chart with all of your initials.

d.

( ) ( ) You are not permitted to do charting for another person.

e.

( ) ( ) Ink eradicator is the best method of correcting errors.

f.

( ) ( ) Technical terms should be used when quoting the patient.

g.

( ) C ) Indication should be made when a patient refuses a treatment.

66 h.

( )( ) The tentative diagnosis may be found on the history sheet of the record.

i.

C )( ) Social information may be obtained from the admission sheet,

j.

( ) ( ) To insure brevity, abbreviations should be used wherever possible.

E.

REFERENCES:

Other places where you may get help in chart­

ing. 1.

BOOKS:

Pages to read in bibliography listings.

Harmer and Henderson 271-279; Meade; Montag and Filson 128-134; Morris and Adams; Norlin and Donald­ son 201-205; Wolf 181-192; Young 86-91.

6?

68

PART IV.

HOSPITAL ORIENTATION

HOW TO GET ALONG

Much frustration can be avoided by getting your bearings as soon as possible.

Many embarrassing moments can-be pre­

vented by getting acquainted with the hospital personnel. Perhaps a few hints on how to meet the unusual are in order. These are a part of the process of developing the self-con­ fidence which every student nurse is eager to acquire.

69 CHAPTER 12. THE WARD HOW TO GET AROUND A.

MOTIVATION: Advantages to be had by notgetting lost. 1.

SENSE OF BELONGINGS

You will become

a part of the

team as soon as you know your way about. 2.

LESS FRUSTRATIONS

You will find nothing more upset­

ting than not to be able to find something when in a hurry. B.

DIRECTIONS: Some helpful hints on getting acquainted. 1.

2.

MAPs

How to find your way.

a.

Get the basic floor plan.

b.

Locate the boundry lines.

c.

Acquaint yourself with the variations.

d.

Spot the various departments.

LIGHTS:

How to acknowledge signals.

a.

Be prompt.

b.

Respond with courtesy.

c.

Ask what the person wishes.

d.

Turn off the light by pushing in the button or raising the lever to the horizontal position, depending upon the type of signal.

e.

Carry through on the request whenever possible.

f.

Refer the call to someone qualified to answer it if you cannot.

g.

Report your action to the patient if you cannot fulfil the request.

h.

Don't he absent minded.

i.

Use the emergency light if necessary.

TELEPHONE:

How to answer calls.

a.

Be pleasant and courteous.

b.

Identify yourself and your location.

c.

Don't take a message unless qualified to do so.

d.

Carry through on all calls.

e. •Locate someone who can handle the message when you cannot. EQUIPMENT:

How to locate supplies.

a.

Use your spare time by exploring cupboards.

b.

Go to the linen room for bedding.

c.

Get clean utensils from closet off the medicine room.

d.

Find medications and dressing supplies in the medicine room.

e.

Look for dishes and other cooking utensils in the kitchen.

f.

Locate emergency oxygen, paper supplies, etc., on the individual floors.

g.

Search in the utility room for common unsterile treatment equipment and thermometers.

. 71 5*

STORAGE: a.

How to get materials from elsewhere,

Obtain extra or unusual linen from the main linen room,

b.

Get drugs and toilet articles from the pharmacy,

c.

Go to the soda fountain for newspapers, maga­ zines, and cigarettes,

d.

Secure sterile supplies and special equipment from Central Supply.

e.

Procure food from the diet kitchen.

f.

Fill out all interdepartmental requisitions in duplicate.

C.

ACTIVITY ASSIGNMENTS:

Practical suggestions on how to

get your bearings quickly. 1.

Ask to run the errands for one of the wards for several hours.

2.

Take a prospective student or friend on a tour of the hospital.

D.

EVALUATION: 1.

A sample method used to test orientation.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short blanks within the items. ____________

a. Thermometers are obtained from ____ .

____________ b. Denture cups are found in

.

72 c. Central Supply is located on ____ floor. d. The green signal is used for ____ . e. Specimens are taken to the labora­ tory on the

floor.

f. Public telephones are located by the on each floor. g. Dressing trays are found in the ____ , h. You will find a fire extinguisher t^le — — . or* each floor. i. You should place equipment to be returned to Central Supply in the

j. You should get cigarettes from

73 CHAPTER 13. COWORKERS HOW TO COOPERATE A.

MOTIVATION:

Values to be received by maintaining good

rapport. 1.

POPULARITY:

By using tact you will be well liked.

2.

COMPETENCE:

You will learn much by working with and

watching others. B.

DIRECTIONS:

Some practical suggestions on how to work

with others. 1.

WHO'S WHO: How to use the line of authority. a.

Introduce yourself to the head nurse.

b.

Report to the team captain.

c.

Get acquainted with the medicine nurse.

d.

Gradually identify the other people by name and position.

e.

Ask the maids and floorman for their names.

f.

Identify persons with the department in which they work.

2.

ORDERS:

How to respond to requests.

a.

Be humble.

b.

Demonstrate graciousness in your response.

c.

Get instructions straight.

d.

Give a definite answer.

e.

Direct the request elsewhere if unable to take it.

EASE;

How to relax in the presence of superiors.

a.

Remain in the background.

b.

Follow directions if any are given.

c.

Ask questions or keep mum according to the sit uation.

d.

Don't be busy to the point of distraction.

e.

Be professional.

ASSISTANCE;

How to be a helping hand.

a.

Help yourself as much as possible.

b.

Be willing to aid others.

c.

Make yourself available as much aspossible.

d.

Apologize and give your reason when unable to be of help.

e.

Indicate your limitations.

f.

Keep your eyes and ears open when working with others.

CRITICISM;

How to accept judgments.

a.

Be honest.

b.

Don't alibi.

c.

Avoid superfluous questions.

d.

Admit your errors or misjudgments.

e.

Accept responsibility.

f.

Use tact in correcting the errors or criticiz­ ing of others.

6.

g.

Watch your tongue and tone of voice*

h*

Ask for constructive suggestions.

SELF CONFIDENCE:

How to adjust to situations.

a.

Help yourself and others as much as possible.

b.

Don't be afraid.

c.

Control yourself if you intend to control the situation at hand. •

7.

d.

Seek new situations and experiences.

e.

Ask for suggestions and moral support.

TRUTH:

How to deal with errors.

a.

Ask for advice.

b.

Don't bluff or try to be showy.

c.

Request checking, especially when tired, hurried, or nervous.

C.

d.

Admit your mistakes.

e.

Be tactful in correcting the errors of others.

ACTIVITY ASSIGNMENTS:

Pro.iects to help you to adjust to

the personnel. 1,

Work on the wards for one day and apply the principles mentioned in this chapter.

2.

Attend a meeting of ward personnel.

Evaluate the

working relationships. D.

EVALUATION: 1.

A sample method of testing staff adjustment

COMPLETION:

Write in the long blanks ahead of the

76 items the answers that should go in the short token blanks within the items. ;_______ a. You should report on duty to ____ . ___________

You are expected to _____ when a doc­ tor enters the room.

____________ c. When answering the telephone, you should introduce yourself by ____ • ____________ d. If a patient asks you for a med­ ication, you report it to ____ . ______________ e. You can avoid doing things for which you are not qualified by ____. _f. It is a good policy to ________________ when you have finished your assignment. __________ g. As soon as you realize that you have made an error you should ____ . _________ _____ h. If you are to be in control of a situation, you must be _ _ _ • ____________ i. You can correct someone else's mistake by ____. ____________ j. It is best to ____ when a doctor gives you a list of orders.

77 CHAPTER 14. ORGANIZATION HOW TO PLAN YOUR WORK A.

MOTIVATION:

Advantages you will receive by being on

schedule. 1.

COMPLETE PICTURE:

Your learning is complete only as

you carry through to the end. 2.

CONVENIENCE:

You will be able t o ‘make better "off

duty” plans if you also plan while "on duty'*. B.

DIRECTIONS:

Some helpful clues toward the enlighten­

ment of ward experience. 1.

2.

START:

How to begin your assignment.

a.

Appear on time.

b.

Read the assignment sheet.

c.

Listen to morning report.

d.

Report to the team captain.

e.

Check the Kardex.

f.

Refer to the chart to clarify any points.

g.

Make your notes.

h.

Study the chart in detail later.

TIME: a.

How to make minutes count.

Dovetail your work by arranging routine care around special treatments.

b.

Do small tasks during "waiting" time.

c.

Plan to care for patients not receiving food

during the meal hour. d.

Don’t dawdle or fritter away time.

e.

Anticipate needs, the patients' and yours.

f.

Tell patients when you plan to care for them.

g.

Make each trip in or out of a room count.

h.

Allow for interruptions and delays.

i.

Refrain from petty conversation.

SPACE:

How to work within a given area.

a.

Put away all unnecessary supplies and equipment.

b.

Move furniture out of your way.

c.

Discard magazines, newspapers, and waste before starting.

d.

Arrange your materials for convenience of work­ ing and safety.

e.

Stack materials in order to be used.

PROGRESS:

How to proceed with procedures.

a.

Check the order.

b.

Arrange for supervision if necessary.

c.

Read the procedure.

d.

Inform the patient what you are going to do.

e.

Assemble and test equipment and supplies.

f.

Do the treatment.

g.

Make the patient comfortable.

h.

Clean the equipment and return to proper place

i.

Record the treatment in detail.

5.

SEQUENCE:

How to plan the order of succession.

a.

Evaluate importance.

b.

Care for the sickest patient first.

c.

Complete dressing patients for the operating room before their basal anesthetic.

d. 6.

Perform other treatments before giving the bath.

EVALUATION: a.

How to analyze your results.

Check with each patient regarding comfort and further requests.

b.

Ask someone to check your work.

e.

Use the guide designed for checking a unit.

7. FINISH:

How to report off duty.

a.

Recheek all orders.

b.

Bring the record up to date.

c.

Inform the team captain of the condition of the patients and the status of your assignment.

C.

d.

Give a summarizing report to the head nurse.

e.

Don't be a clock watcher.

ACTIVITY ASSIGNMENTS:

Projects to assist you in gaining

experience in organization of duties. 1. Arrange to take care of at least two patients for one half day.

Apply the principles of this chap­

ter. 2.

Observe how someone else has planned an assignment

and analyze it for improvement. 3.

Assist a classmate in making a plan for her morning work.

D.

EVALUATION;

Evaluate the results together. A sample of a device used to test ability

to plan a work assignment. 1.

BEST ANSWER;

Put in parenthesis the numbers of the

correct answers. a. ( ) The first thing to do when is to: (2)

(1)

coming on duty

Report to the team captain.

Check the assignment sheet.

(3)

swer any lights which may be on.

An­

(4) Lis­

ten to morning report. b.

( ) A good time to care for an patient is: (2)

(1)

unconscious

Before any other patients.

Late in the forenoon.

(3)

patients are eating breakfast.

While other (4)

After

the doctor has made his visit. c.

( ) Patients receiving special have their baths (2)

(1)

treatments should

Before breakfast.

Immediately after breakfast.

fore the treatment.

(4)

(3)

Be­

After the treat­

ment. d.

( ) While waiting for a patient you could: (1)

Answer someone else’s light.

(2)

Run

errands,

(3)

Chart,

(4)

Put away unused

supplies. The patient will not have to put on his light if you: do so.

(2)

(1)

Request that he not

Ask before leaving if there

is anything else which you can do for him. (3)

Tell him when you will be back.

(4)

Place everything within the person's reach before leaving. You can evaluate your work most conveniently if you:

(1)

Check the chart.

the instructor. criticisms.

(3)

(4)

(2)

Call

Ask the patient for

Have the team captain

check your work. More working space can be had by:

(1)

Put­

ting away all unnecessary supplies before starting. equipment. you.

(4)

(2)

Working with a minimum of

(3)

Have the patient assist

Use the bed as a working area.

When preparing to do a procedure, begin by:

(1)

Calling the instructor.

the procedure manual.

(3)

what you are going to do. orders in detail.

(2)

Read

Tell the patient (4)

Check the

8 2

OPERATjMG(3.00 ps\ .

I

83

PART V.

INFECTION

HOW TO PROTECT EVERYONE

In the field of health we are continually fighting a battle with germs.

Operations and communicable diseases

are frightening to the lay people. ferent set of rules.

Each calls for a dif­

Therefore, technic has been divided

into two categories, medical and surgical.

In this part

we have a chapter dealing with each type of defense against bacterial action.

To learn this section well is your pass­

port to better health.

84 CHAPTER 15. SURGICAL ASEPSIS .HOW TO KEEP AWAY BACTERIA A.

MOTIVATION:

Compensations to be derived from maintaining

aseotic technic* 1.

GOOD POSITION:

As a good surgical nurse, you will

always be in demand. 2.

SURENESS:

You will acquire security in your move­

ments as you practice and use good safe procedures, B.

DIRECTIONS:

Some suggestions to make the application of

aseptic technic easier. 1.

STERILIZATIONS a.

How to get rid of germs.

Coagulate bacterial protoplasm by heat or chemical.

b.

Destroy spores.

c.

Regulate the time of exposure according to size of pack and type of material.

d.

Pack the autoclave so the folds of cloth are verticle.

e.

Clean all materials before sterilizing them.

f.

Check the results by use of gauges or bacter­ iological cultures.

g. 2.

Resterilize materials at definite intervals.

MANIPULATION: a.

How to handle sterile supplies,

Store it in a clean dry place.

b.

Do not open until ready to use.

c.

Keep supplies covered if delayed in use.

d.

Never put unused supplies back in original container.

e.

Don't let sterile goods touch anything unsterile.

f.

Pass unsterile articles around, not over, the sterile field.

g.

Handle sterile instruments away from the end to be used.

h.

Take care not to contaminate the inner side of the wrapper.

i.

Wear sterile gloves or use a forcep when transfering sterile equipment or supplies.

HANDSs a.

How to put on sterile gloves.

Check position of gloves regarding the direction of the thumbs.

b.

Wash and dry hands thoroughly.

c.

Powder hands over wastebasket, not over gloves.

d.

With left hand, pick up right glove by fold of cuff and slip right hand into glove, being care­ ful not to touch outer part of glove with any­ thing .

e.

Slip gloved finger under cuff of left glove and put onto left hand using same precautions as

before, as well as protecting right hand. 4.

IRRIGATIONS:

How to cleanse injuries.

a.

Wash surrounding area with soap and water.

b.

Flush wound with sterile water or saline solu­ tion.

c.

Work from site of wound outward in most instan­ ces.

d.

If dressings are on the area, apply solution with an asepto syringe.

e.

Use sterile supplies, regardless of condition of wound.

5.

DRESSINGS: a.

How to cover wounds.

Cover the area with sterile gauze of desired size and thickness.

b.

Place larger sterile abdominal pads over gauze.

c.

Secure in place by use of adhesive tape or binders.

C.

ACTIVITY ASSIGNMENTS:

Pro.iects to assist in the

mastery of aseptic technic. 1.

Arrange to assist a doctor with the changing of several types of dressings.

2.

Visit the surgical clinic at the Dispensary and assist the doctor with treatments.

3.

Arrange with the Visiting Nurse Association to

87 give home care to a patient needing dressings. D.

EVALUATION:

Samples of testing device to measure ability

to use sterile technic. 1.

COMPLETIONS

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. __________ a* The period of exposure begins at the time when the thermometer reaches a temperature of ___

degrees.

________________ b. Corks, when not in use, should be placed with the part that goes into the bottle ____. ____________

c. All materials which come in contact with the sterile field must be ____ .

____________ d. When using transfer forceps, the business end should always be direct­ ed ____ . ____________

e. Sterile non-disinfectant solutions should be kept in bottles with ____ tops.

________________ f. The sterilizing process is determined by ____ • _______

.

g._____ may be used to secure dressings when the individual cannot tolerate adhesive tape.

88 .

h. Only ____ solutions should be used for irrigating wounds.

2. E.

RATING SCALES

REFERENCES:

1.

BOOKSs

See Chapter 26, D.

Other sources of assistance on asepsis. Pages to read from frequently cited texts.

Harmer and Henderson 193-218, 765-777; Montag and Filson 95-115.

89 CHAPTER 16. PRECAUTION CARE HOW TO CARRY OUT MEDICAL ASEPSIS A.

MOTIVATION:

Benefits to be received by knowing how to

work around dangerous bacteria. 1.

LESS ILLNESS;

If you kdll the bugs, they won’t get

you. 2.

LOVLIER HANDS;

You will not have to scrub as often

if you use good technic. B.

DIRECTIONS:

Some helpful hints on how to simplify med­

ical asepsis. 1.

THE BEGINNING;

How to set up the area.

a.

Please the esthetic sense.

b.

Arrange the furniture for working convenience.

c.

Place the special supplies where they are to be used.

2.

d.

Protect the patient.

e.

Guard the clean area.

f.

Check on completeness.

ENTRANCE AND EXIT;

How to come and go.

a.

Assemble all supplies before getting into gown.

b.

Wear a gown whenever there is danger of your uniform coming in contact with the patient or other contaminated articles.

c.

Check gown for ties and proper sleeves.

d.

Be sure you are clean before putting on or taking off the gown.

e.

Take care not to contaminate your cap or hair when tying the strings.

f.

Remain within the unit when contaminated or wearing a gown.

g.

Rinse and dry your hands thoroughly after scrub­ bing.

h.

Follow the directions in the procedure manual.

EQUIPMENT: a.

How to care for contaminated supplies.

Keep the first food tray and condiments in the room.

b.

Soak all dishes which become contaminated, being sure that they are covered with the solution.

c.

Keep the outside and cuff of laundry bag clean and dry.

d.

Soak all articles in a container of suitable size.

e.

Disassemble equipment whenever possible for better cleaning.

f.

Wash with solution those articles which cannot be soaked.

TREATMENTS: unit.

How to do procedures in an isolated

a.

Work with a minimum of supplies,

b.

Avoid taking into the unit anything whieh can­ not be soaked.

c.

Prevent accumulation of excess supplies.

d.

Consider the cleaning of the equipment before contaminating it.

e.

Arrange for a clean working area when it is nec­ essary to take into the unit something which cannot be soaked.

f.

Keep watches and sphygmomonometers clean.

EXCEPTIONS:

How to handle special cases. *

a.

Cover the nose and mouth with a mask when caring for tuberculosis patients.

b.

Give special care to syringes used for persons having infectious hepatitis.

c.

Disinfect the stool in cases of typhoid fever and dysentery, being sure to give your hands proper care and also considering the esthetic sense.

d.

Use hand and mask technic in cases of pneumonia and undiagnosed coughs.

THE END:

How to terminate precaution care.

a.

Assemble adequate supplies before starting.

b.

Wear the glasses which are provided whenever work­ ing around the Safe-T-aire lamp.

e.

Wrap all waste in a double thickness of news­ paper.

d.

Make several small bundles rather than one large package of waste.

C.

e.

Don't forget the dresser drawers.

f.

Discard light cords.

ACTIVITY ASSIGNMENTS:

Projects to aid in applying the

principles of medical asepsis. 1.

Give nursing care to a patient who is on precaution care.

2.

Arrange with

a nurse from the city health depart­

ment to care for a patient with a communicable disease in the home. D.

EVALUATION:

A sample device for testing medical asepsis

ability. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. a. At this institution the gown is hung on the ______ side of the screen. ____________ b. An area of ____ inches around the neck of the gown is kept clean. ____________ c. The faucets are considered ____ .

93

____________ d. A mask should cover ____ . e. The food tray should he set ____ while it is being cleared. _____________ f. Semisolid foods are disposed of by ____ ____________

.

g. The frequency of changing the solu­ tion for sterilizing dishes is ____ .

____________ h. Small articles of waste are disposed of in ____ . ____________ i. Daily dusting of the room is done by ____ . _____________

When giving an enema, the equipment is carried into the room in a ____ .

2. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Sources of obtaining further help on med­

ical asepsis. 1.

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 149-192; Mbntag and Filson 74-94* Norlin and Donaldson 277-280; Wolf 308-325.

94

95

PART VI.

MEDICATIONS

HOW TO ADMINISTER DRUGS

An error in giving a medication may be very serious. It may cost the life of a patient. takes are very uncommon.

Fortunately, these mis­

You have heard about the nfive rights”

of administering medications:

the right patient, the right

drug, and the right dose, the right time, and method.

These are your protection.

the right

Know them well and never

cease in their application. It is the method with which we are most concerned here. Each type of administration requires the use of specific technics.

Lay persons, some of them with a minimum of instruc­

tion, have done these same procedures. can you.

If they can do it, so

96 CHAPTER 17. ORAL HOW TO GIVE. MEDICINES BY MOUTH A.

MOTIVATION;

Rewards to be obtained by serving

medica­

tions in as pleasant a way as possible. 1.

APPRECIATION:

Patients will be grateful to you

for disguising the unpleasant. 2.

FEWER ERRORS:

You will be safe if you carry out

all therules and regulations. B.

DIRECTIONS:

Some pointers to assist you inadministering

drugs orally. 1.

LABELS:

How to insure the correct drug.

a.

Read at least three times in a good light.

b.

Compare the name and strength with the order.

c.

Look for specifications as to method of giving.

d.

Check for a poison label.

e.

Watch for a sign which may indicate for external use only.

2.

QUANTITY:

How to measure medicines.

a.

Pour at eye level.

b.

Read at the bottom of theminiseus.

c.

Check for errors in symbols, abbreviations, or decimal points.

d.

Use a very sharp knife when necessary to cut a tablet in half.

97 3.

VARIATIONS: a.

How to give in the right manner.

Give cough medications as sips in concentrated form.

b.

Dilute the drugs as indicated.

c.

Insist upon a straw when giving acids or iron preparations.

d.

Place certain drugs under the tongue for quick absorption.

e.

Disguise unpleasant tastes whenever you can.

f.

Crush tablets for persons who cannot swallow them whole.

g.

Prick capsules for quicker effect.

h.

Refrain from using nutritious food to conceal medications being given to children.

i.

Never give a drug orally to an unconscious patient.

C.

ACTIVITY ASSIGNMENTS:

Pro.iects to aid you to develop

self-confidence in the giving of oral medications. 1.

Arrange to give oral medications on one of the wards.

2.

Teach a young mother how to administer medicines to her sick child.

3.

Assist a visiting nurse in teaching a family member how to give medicines to an invalid in the home.

98 D.

EVALUATION:

A sample form of examination which can be

used for checking ability to give medicines by mouth. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F

( ) ()

Nitroglycerine is administered by being placed under the tongue.

b.

( ) ()

The contents of capsules are frequently emptied for easier swallowing.

c.

C ) ()

You should give two tablets if the order reads to give one gram and the label reads seven and one half grains each.

d.

( ) ( )

It is safe to give a hypodermic prepara­ tion of a drug by mouth.

e,

()()

When pouring a liquid medication, you should read at the middle of the miniscus.

f. ( ) ( ) Medications to stimulate the appetite are given very dilute. g.

()()

The symbols for an ounce and a dram should be watched carefully.

h. i.

()() ()()

It is not a good policy to crush tablets. Milk is a good mask when giving drugs to children.

( ) ( ) Cough medicines should be given in sips.

99 2. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Other places to look for clues on the

administration of medications by mouth. 1*

BOOKS:

Pages to read in texts listed in the biblio

graphy. Harmer and Henderson 551-564; Montag and Filson 482-490; Norlin and Donaldson 238-246; Trott 311-314; Wolf 342-346, 354-358; Young 212-225.

100 CHAPTER 18. PARENTERAL HOW TO INJECT MEDICINES A.

MOTIVATION:

Benefits to be gained by being able to give

an excellent hypodermic. 1. FEWER COMPLAINTS:

Patients will be veryquick

express their opinions to you on themanner

to

in which

you give an injection. 2.

FREEDOM FROM FEAR:

You need have no qualms if you

can do the procedure properly. B.

DIRECTIONS:

Some pointers to help you when giving or

assisting with in.iections. 1. INTRADERMAL:

2.

Howto do a skin test.

a.

Select a very small needle.

b.

Be sure the needle is in the skin.

c.

Use the specified minute quantity of solution.

d.

Don't rub the area.

SUBCUTANEOUS:

How to instill solutions under the

skin. a.

Inject small quantities of solution as a simple hypodermic.

b.

Insert the needle at a 45° angle.

c.

Expect resistance on the part of the skin.

d.

Avoid striking the bone in very thin persons.

e.

Massage the area for more rapid absorption.

f.

Give larger amounts of fluid as a hypodermoclysis.

g.

Use a large syringe when giving a subcutaneous infusion to a child.

h.

Follow the procedure manual for the adminis­ tration of a hypodermoclysis to an adult,

i.

Watch the rate of absorption.

INTRAMUSCULAR;

How to introduce medications into the

muscle. a.

Expect it to cause more discomfort than a sub­ cutaneous hypodermic.

b.

Select a safe location to insert the needle,

c.

Place

d.

Stretch the skin and insert needle at a 90°

the patient in a relaxed position.

angle. e.

Check for blood.

f.

Don't try

throwing the needle until accustomed

to giving this type of injection. g.

Inject the solution at the speed of the patient's preference unless directed otherwise.

h.

Follow directions when using expendable equip­ ment.

INTRAVENOUS;

How to assist in giving fluids by

vein. a.

Double- check the label and purity of the drug or solution.

102 b.

Prepare the equipment but do not administer unless qualified to do so under the circum­ stances.

c.

Restrain the extremity of all persons receiving solutions in the vein.

d.

Regulate the speed with which the solution enters *the vein.

e.

Watch for untoward reactions.

f.

Keep the patient comfortable.

g.

Discard expendable tubing but save the needle.

h.

Be prepared to meet varying situations as a cut-down or continuous infusion.

i.

Follow directions carefully so as not to lose vacuum in preparing plasma.

j.

Take added precautions when assisting with blood transfusions.

C.

ACTIVITY ASSIGNMENTS:

Projects which will assist in

easier administration of drugs by in.iection, 1.

Spend a day assisting the medicine nurse giving and preparing the various types of parenteral med­ ications.

2.

Assume responsibility for the drugs and solutions to be administered to a group of patients for one half day.

103 D.

EVALUATIONS

A method suitable for use in testing

ability in administration of parenteral medications. 1.

BEST ANSWER:

Place in the parenthesis the number

of the best answer. a.

( )

The most suitable needle for an intradermal injection is: i".

b.

(4)

(1)

.

(2)

(3)

3/4".

( ) For a subcutaneous injection the needle is inserted at an angle of: (2)

c.

1'*.

45°.

(3)

60°.

(4)

(1)

90°.

100°.

( ) The most suitable location for an intramus­ cular injection is in the : (1)

Thigh.

(2)

(4)

Shoulder,

(3)

Upper arm.

But­

tocks. d.

C ) The method most suitable for regulating the speed at which a solution runs into the vein is to;

(1)

Use a clamp.

or lower the bottle. of the needle.

(4)

(3)

(2)

Raise

Change the size

Insert the needle into

another vein. e.

( ) The usual speed at which a glucose solution should enter the vein is: minute.

(2)

60 drops per

30 drops per minute.

drops per minute. ute.

(1)

(4)

(3)

120

100 drops per min­

104 f.

C )

Used intravenous equipment is cared for by:

(1)

Discarding everything.

(2)

Re­

turning everything to Central Supply. (3)

Discarding the tubing and placing

everything else to be returned to Central Supply.

(4)

Saving the needle and discard­

ing the remainder of the equipment. 2. E.

RATING SCALE:

REFERENCES;

See Chapter 26, D.

Other sources of help on giving and

assisting with parenteral medications. 1.

BOOKS;

Pages to read in various texts.

Harmer and Henderson 565-595; Montag and Filson 490-499; Wolf 358-371; Young 227-262.

105 CHAPTER 19. MISCELLANEOUS HOW TO ADMINISTER DRUGS BY OTHER METHODS A.

MOTIVATION:

Goals to be achieved by being able to

apply the how, when, and where. 1,

SELF SERVICE:

You will be using some of these

methods yourself. 2.

HAPPY PATIENTS:

Your ability to relieve discom­

fort will be a joy to everyone whether it be a patient or you. B.

DIRECTIONS:

Some suggestions to help in various sit­

uations . 1.

CAVITIES:

How to instill medications.

a.

Remove paper covering from suppositories.

b.

Prick holes into capsules.

c.

Wear gloves when inserting anything into vagina or rectum.

d.

Prepare drug in a soothing solution for rectal instillation.

e. 2.

Give not more than 60 c.c. medication per rectum.

SKIN:

How to apply medications to the epidermis.

a.

Apply a thin layer of ointment.

b.

Warm some oils before applying.

c.

Wear gloves if applying mercurial drugs for absorption.

d.

Use cotton or gauze when applying antiseptics

106 or lotions, C.

ACTIVITY ASSIGNMENTS;

Projects to assist in application

of various forms of drugs. 1.

Assist the medicine nurse in administering drugs by less common methods.

2.

Arrange with the Dispensary to assist in the giving of treatments which involve the use of drugs,

3.

Teach a patient or his family how to use the medica­ tion prescribed,

D.

EVALUATION;

Sample of a testing device which can be

used to test the ability to apply medications by mis­ cellaneous routes. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. a. Lotions are applied by use of ____ , _________ b. Suppositories of cocoa butter base are kept in ____ , ____________ c. Irritating substances should be mixed with ____ for rectal instill­ ation. ____________ d. Oil applied to soften the skin or crusts will be more effective if it is ____ .

107 ___________

e.

Capsules inserted into the rectum

are effective more quickly if

. __

before insertion, _

f • Ointments are applied in a _________________ layer.

__________ ___ g. Ointments are removed from the stock container by use of

.

____________ h. A spray may be used to apply ____. 2. E.

BATING SCALES

REFERENCES:

See Chapter 26, D.

Other places to find information on various

methods of administering drugs. 1.

BOOKS:

Pages to read from frequently cited texts.

Harmer and Henderson 670; Montag and Filson 505; Wolf 383-385; Young 225-227.

503-

1 0 8

PART VII.

MEDICAL-SURGICAL

HOW TO TREAT INDIVIDUAL SYSTEMS

Difficulties arise when we try to draw a line between medical and surgical nursing care.

Many of the same proce­

dures are used in caring for both groups of patients.

In

this part, the procedures have been classified according to the systems to which they apply.

True, there is a certain

amount of over-lapping but we hope the result will be better integration of your various nursing subjects.

Studying

should be easier and more meaningful by this plan.

110 CHAPTER 20. ALIMENTARY TRACT HOW TO ATTEND TO THE INTESTINAL MACHINERY A.

MOTIVATION;

Goals to be reached bv good maintenance of

intestinal functions. 1.

PLEASANTER LABORS:

Prevention is better than cure

and you can prevent many of your patient’s troubles. 2.

MORE FUN:

You will be able to apply to your own

health much of what is contained in this chapter. B.

DIRECTIONS:

Some helpful suggestions on how to meet the

various situations of the intestinal tract. 1.

GAVAGE: How to feed the patient through a tube. a.

Warm the formula.

b.

Assist with passing the tube nasally or orally as indicated.

c.

Lubricate the tube for nasal passage and wet it for passing orally.

d.

Tape the tube if it is to remain in place.

e.

Check to be sure the tube is in the stomach before injecting any of the formula.

2.

LAVAGE: How to wash the stomach. a.

Restrain small children and uncooperative adults.

b.

Enlist the patient's cooperation when possible.

c.

Protect yourself and surroundings.

d.

Assist but do not pass the tube yourself.

TESTS; a.

How to aid in making the diagnosis.

Observe all emesis and check regarding labor­ atory examination before discarding anything unusual.

b.

Watch for abnormal stool and cooperate in collect­ ing specimen.

c.

Cooperate with x-ray department when doing par­ tial or complete series of gastro-intestinal pictures.

d.

Do gastric aspirations according to directions.

e.

Remove dentures before passing a tube.

f.

Elevate the head when you ask a patient to swal­ low a tube.

g.

Have the person hold his tongue and keep swallow­ ing as the tube is passed.

h.

Ask the individual to expectorate all saliva during the series of aspirations.

i.

Collect the correct number of specimens before and after the stimulation has been given.

j.

Label all specimens completely.

k.

Test each sample for acid.

1.

Follow the procedure manual for detailed direc­ tions regarding various types of aspirations.

m.

Work so that the patient cannot watch you aspirate the gastric contents.

DECOMPRESSION; a.

How to deflate the alimentary tract,

UPPER INTESTINES;

How to operate suctions.

(1)

Select the correct type of tube.

(2)

Set up the equipment correctly with all clamps closed.

(3)

Fill upper bottle with water.

(4)

Open one clamp at a time starting with the clamp farthest away from and proceeding toward the patient.

(5)

Prevent kinks in tubing.

(6)

Assist the interne in preparing the MillerAbbott and Harris tubes.

(7)

Follow specific directions for advancing spec­ ial tubes.

(8)

Place patient on the right side if tube is to go beyond the stomach.

(9)

Save mercury when removing and cleaning tubes.

(10)

Set the electric suction for low speed.

(11)

Don't fool with the gauges of electric machines.

(12)

Keep stoppers tight in all suctions.

(13)

Check the equipment frequently by giving the individual a drink of water.

(14)

Irrigate the tube if water does not return.

(15)

Fill or empty bottles as necessary.

b.

LOWER INTESTINES:

How to relieve discomfort

from flatus. (1) Lubricate and insert a rectal tube. (2)

Place the distal end of the rectal tube in a bottle of water tied on the edge of the bed.

(3)

Tape the tube in place if necessary.

(4)

Apply stupes but don't burn the patient.

(5)

Do a tidal drip irrigation according to the procedure manual.

OBSTRUCTION:

How to deal with intestinal stoppages.

a.

Utilize suctions according to directions.

b.

Cooperate with x-ray in determining the location of obstruction.

c.

Suspect a fecal impaction if the patient is having frequent small loose stool.

d.

Soften impactions with oil retention enemas.

e.

Put on a glove and break up impaction manually if it does not respond to oil.

f.

Prevent impactions.

ENEMAS: a.

How to irrigate the rectum.

Use an irrigating can and rectal tube for hrge amounts of solution.

b.

When a small amount of solution is injected, use a funnel and small rectal tube.

Give not more than 150 c.c. of solution if it is to be retained. Mix medications for retention in a starch solu­ tion. After rectal or vaginal surgery use a small rubber catheter and insert gently directing it toward the umbilicus. Place the patient in the correct anatomical position whenever possible. If you have difficulty in locating the rectum ask the patient to bear down. Do not hurry or use force in inserting a rectal tube. Allow the solution to run in slowly by not hold­ ing the solution more than 18 inches above the patient. Shut off the flow for a short time if the patient complains of pain. Siphon off the solution of the patient cannot expell it. Make the patient as comfortable as possible while expelling the solution. Observe the results before discarding. Apply slight pressure to the rectum if the solu­ tion is to be retained.

o.

Instruct the patient as to how he can best cooperate for best results,

p. 7.

Use whatever formula has been ordered.

COLONIC: a.

How to wash the colon.

Prepare according to the purpose for which the treatment is being done.

b.

Be sure you have an order.

c.

Mark the tubings with adhesive tape in order to maintain proper distance of insertion.

d. 8.

Irrigate until the solution returns clear.

PROCTOCLYSIS:

How to administer nourishment via

the rectum. a.

Unless contraindicated, give an enema at least one hour before starting the treatment.

b.

Place the person in a comfortable position.

c.

Protect the bed.

d.

Fasten the rectal tube in place.

e.

Avoid any weight on the tubing.

f.

Regulate the speed according to the individual’s ability to absorb or retain the solution.

g. 9.

Measure the amount of fluid given.

COMPRESSES:

How to put packs to the rectum.

a.

Use clean but not sterile technic.

b.

Moisten gauze with the solution to be used.

c.

Cover compress with perineal pad.

116 d.

Hold pad and compress in place with a T binder.

e.

Follow directions for frequency and duration of treatment.

10.

COLOSTOMY:

How to manage an artificial opening.

a.

Regulate elimination by diet.

b.

Change dressings as necessary.

c.

Adjust the size and type of dressing

according

to the individual’s needs. d.

Teach the patient to care for the opening.

e.

Use clean but not aseptic technic.

f.

Cleanse the intestines by irrigating as ordered or indicated.

g.

Use a large emesis basin to collect the irrigating solution.

h.

Insert the tube according to the anatomical location of the opening.

i.

Place the patient on a bed pan if irrigating the lower loop of intestines.

11.

PARACENTESIS:

How to assist with an abdominal

aspiration. a.

Be sure to have the patient’s bladder empty.

b.

Maintain strict aseptic technic.

c.

Assemble all materials for the doctor and assist him in the procedure.

d.

Know where you can find a stimulant in case of

emergency. e.

Place the person in as upright a position as possible.

f.

Watch for reactions of any kind.

g.

Apply seultitus binder after procedure.

h.

Leave patient comfortable and check at intervals regarding condition.

C.

ACTIVITY ASSIGNMENTS:

Pro.iects to assist you in doing

gastro-intestinal treatments. 1.

Assume responsibility for the care of a patient who is presenting a diagnostic problem of the alimentary tract.

2.

Take care of a patient who has had intestinal sur­ gery.

D.

EVALUATION:Sample

methods which can be used in testing

the ability to care for patients with intestinal difficulty. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. ____________ a. The direction in which to insert a rectal tube is toward ____ . b. The speed at which a proctoclysis should be given is ____.

____________c. _____

technic is used for colostomy

dressings and care. ____________ d. The enema solution is held ____ inches above the patient. BEST ANSWERS

Place in the parentheses the numbers

for the best answers. a.

( )

The most suitable temperature for a formula being given by gavage is: (2)

b.

( )

Gold.

(3)

Tepid.

(1) Warm. (4)

Hot.

The easiest way to determine if a gastric suction is working is to;

(1) Give the

patient a drink of water.

(2) Irrigate

the tube.

(3)

Close all the clamps and

open them one at a time.

(4)

Change the

solutions in the bottles. c.

( )

When passing a Miller-Abbott tube the mer­ cury is placed into the bag; insertion.

(2)

(1)

Before

Just after insertion.

(3)

When the tube reaches the stomach.

(4)

After the tube has entered the duo­

denum. d.

( )

When irrigating a colostomy which has been done on the transverse colon, the direction in which the tube should be inserted is:

119 (1)

Up.

right. 3. E.

RATING SCALE:

REFERENCES:

(2)

(4)

Down.

(3)

To the patient's

To the patient's left.

See Chapter 26, D.

Other places where you can get help in

eastro-intestinal treatments and nursing care. 1.

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 330-333* 445-450, 632-634, 637-671, 857-868; Montag and Filson 221-224,

-

434-451, 528-533; Norlin and Donaldson 218-224; Trott 321-324; Wolf 272-278, 382, 439-441, 442452; 476-486; Young 277-300. 2.

PERIODICALS:

Articles to read in the American

Journal of Nursing. a.

Blodgett, James B., and Sheldon, Nola Smith, "Intestinal Suction,"

b.

Frey, Mary, "A New and Safe Method of Gastric Suction,"

c.

46:237-38, April, 1946.

Haviland, Barbara, "An Effective Colostomy Dres­ sing,"

d.

46: 90-92, February, 1946.

49:153-154, March, 1949.

Waples, Genevieve, and Thompson, Bernice, "Colostomy Care,"

48:233-37, April, 1948.

120 CHAPTER 21. CARDIOVASCULAR CIRCUIT HOW TO MINISTER TO THE CIRCULATORY APPARATUS A.

MOTIVATION:

Values to be had by keeping the blood flow­

ing,.proper^* 1.

FEWER WORRIES:

You will have mental ease only as

you know the invalid’s condition. 2.

SAVE LIVES:

Proper watching and interpretation of

heart function may mean life or death to your patient. B.

DIRECTIONS:

Some guiding principles to help you care

for the cardiovascular patient. BLOOD PRESSURE:

How to measure arterial pressure.

a.

First, practice listening with a stethescope.

b.

Set the equipment where the patient cannot see it.

c.

Always take the pulse before inflating the cuff.

d.

Get an estimate before taking the exact reading.

e.

Do not keep the cuff inflated too long.

f.

Check your readings.

g.

Detach the apparatus if the cuff is

left on the

arm. 2.

CIRCULATION:

How to regulate the blood supply.

a.

Elevate an extremity for drainage.

b.

Raise the temperature of

a part toincrease

121 the blood supply. c.

Relieve pressure by drawing blood elsewhere.

d.

Check bleeding by the use of cold.

e.

Vary the degree of heat according to the effect desired.

f.

Decrease pain by the use of cold.

g.

Watch the tolerance and reaction of the patient for cold as well as for heat.

h.

Never apply heat to an unconscious or diabetic patient without specific orders.

i.

Retain heat in compresses by using moist flannel.

j.

Apply counterirritants with caution.

k.

Use radiation or hot water bottles for dry heat.

1.

Never fill a hot water bottle directly from the tap and never hotter than 120°F.

m.

Assist with a sitz bath to increase blood supply to the pelvic region.

n.

Increase elimination of the skin by use of a hot pack.

o.

Reduce temperature by use of a cold, tepid, or alcohol sponge.

p.

Stimulate circulation by use of saline, mustard, or temperature baths.

q.

Refer to the procedure manual for specific direc­ tions on the application of heat, cold, and

122 counterirritants * 3.

ASPIRATION:

How to assist in removing fluid from

the pericardial sac. a. Use the same set up as for a thoracentesis. b.

Prepare the patient and equipment.

c. Try to have the patient's head turned so as not to be able to watch the procedure. d.

Assist the doctor as much as possible.

e.

Watch the patient very closely for untoward symptoms.

C.

ACTIVITY ASSIGNMENTS:

Pro.iects to assist you in caring

for the cardiovascular patient. 1.

Care for patients in the hospital who are having cardiovascular therapy.

2.

Assist at the Dispensary with the treatments designed to treat the circulatory system.

D.

EVALUATION:

A testing device which can be used in

testing ability to care for patients with cardiovascular conditions, 1.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F

( ) ( )

When taking a blood pressure, the cuff should be deflated very slowly.

123 b.

( ) ( ) At no time should the patient be in­ formed of the exact blood pressure . reading*

c.

( ) ( ) The pulse should be taken after each blood pressure reading.

d.

( ) () Cold should be used whenever constric­ tion of the blood vessels is desired.

e.

( ) () It is possible to use the patient's tolerance as a guide for safety when making applications of heat or cold.

f.

( ) ( ) Heat should not be applied to an uncon­ scious patient without a specific order.

g.

( ) ( ) Counterirritants should remain in place long enough to cause an erythema.

h.

( ) () Saline or mustard baths may be used to stimulate the circulation.

i.

( ) ( ) The hot water bottle is a form of dry heat.

j.

C ) () Flannel is the most satisfactory material to use for moist hot compresses.

2. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Sources of information which will be help­

ful in caring for the patient with circulatory disturbances.

124 1.

BOOKS:

Pages to read from frequently cited texts.

Harmer and Henderson 260-269, 471-550, 631-632; H.M.H. Procedure Manual; Montag and Filson 172-180, 411, 433j Norlin and Donaldson 224-238; Trott 324336; Wolf 225-229, 387-426, 433-434;

Young 74-78,

187-211, 374-375. 2.

FILMS:

Movies which are listed in the bibliography

that will help you master the nursing care of cardiac and vascular conditions. a.

Therapeutic Uses of Heat and Cold.

b.

The Vital Signs and Their Interrelation.

125 CHAPTER 22. RESPIRATORY ORGANS HOW TO RELIEVE DIFFICULTIES OF THE BRONCHIAL TREE A.

MOTIVATION:

Goals to be achieved by promoting the Intake

of adequate air. 1.

BETTER HEALTHS

You are running fewer risks by short­

ening the contagious period of your patient's illness. 2.

SAFE FUTURE:

You will be using this information to

treat yourself frequently in the time to come. B.

DIRECTIONS:

Some suggestions to make nursing the respir­

atory patient easier. 1.

RESPIRATIONS:

How to stimulate breathing.

a.

Increase the carbon dioxide intake.

b.

Administer whiffs of carbogen.

c.

Encourage coughing and deep breathing.

d.

Insist upon moving if permitted to do so.

e.

Give artificial respiration if necessary.

f.

Utilize the Bennet machine only if you know how to operate it.

2.

INHALATIONS:

How to alter the air for therapy.

a.

Increase the humidity by use of steam.

b.

Give penicillin inhalations by use of nebulizer.

c.

Administer helium to make breathing easier and more effective.

d.

Supplement the oxygen intake to meet the individ­ ual's needs.

e.

Select the most suitable oxygen equipment to meet the situation.

f. 3*

Observe all safety rules when working with oxygen.

DRAINAGE: a.

How to free the chest of excess secretions.

Plan for a thoracentesis if the fluid is in the pleural space.

b.

Operate the equipment properly if suction is used.

c.

Maintain a vacuum if closed drainage is desired.

d.

Change or reinforce dressings if a wound is the source of drainage.

e.

Use postural drainage for emptying bronchial tree of fluids.

C.

ACTIVITY ASSIGNMENTS:

Pro.iects to assist you in caring

for patients with respiratory difficulties. 1.

Make arrangements to care for a patient who is receiv­ ing therapy for chest conditions.

2.

Assist the doctor in treating an invalid who has had chest surgery.

D.

EVALUATION:

A sample form of examination to test the

ability to care for respiratory conditions. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. _____________ a. Humidity is increased by use of ____ .

127 b.

gas is used to stimulate deep breathing.

____________ c. The oxygen tank should be turned on . the mask is applied to the face. ____________ d. The usual quantity of oxygen to give a patient is ____ per cent. ____________ e. A ____ is used when a high concen­ tration of oxygen is desired. , ______ f . Positive pressure is obatined by using ____. ____________ g. You ean assist the bronchiectasis patient to get relief by ____ drain­ age. ____________ h. When preparing an invalid for a thor­ acentesis, you should have him sitting up or lying on ____ side. _____________i. When giving penicillin inhalation, you should instruct the patient to the end of the Y tube as he exhales. ____________ j.

When caring for someone who has oxygen in the room, be sure there is a ____ sign on the door.

2.

RATING SCALE:

See Chapter 26, D.

128 E.

REFERENCES:

Places to go for further help on respiratory

conditions. 1. -BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 599-617, 621-624; H.M.H. Pro­ cedure Manual; Montag and Filson 533-54-1, 551-565; Norlin and Donaldson 233-234; Trott 317-319; Wolf 429-433; Young 268-275, 367-374. 2.

PERIODICALS:

Articles to read in the American

Journal of Nursing. a.

Johnson, Artell Egbert, "Penicillin Therapy," 48:780-82, December, 1948.

b.

Livingston, Huberta M., "Administration of Oxy­ gen Therapy," 48:88-91, February, 1948.

3.

FILMS:

Movies listed in the bibliography which will

assist in oxygen therapy. a.

Oxygen Therapy.

b.

Oxygen Therapy Procedures.

129 CHAPTER 23* GENITO-URINARY MACHINERY HOW TO NURSE THE PELVIC REGION A.

MOTIVATION:

Outcomes to be reached by providing comfort

and cleanliness. 1.

GRATITUDE:

These patients are always very uncomfort­

able and, therefore, very appreciative of what you do for them. 2.

FREEDOM FROM FEAR:

Much energy is used in worry

when you are not confident of what you are doing. B.

DIRECTIONS: Some practical suggestions to help you when you are caring for the genito-urinary patient. 1.

BLADDER:

How to execute treatments of the urinary

tract. a.

CATHETERIZATION: (1)

How to drain the bladder.

First try to induce voiding.

(2) Wash the perineal area with soap and water. (3) Prepare the patient and supplies. (4) Use strict aseptic technic. (5) Prepare to collect a sterile specimen. (6) Clean the vulva from front to back using a cotton ball for only one stroke. (7) Select the most suitable catheter. (8) Lubricate the catheter with a water soluble preparation.

(9)

Keep the labia separated and the meatus in view until the urine is running from the catheter,

(10)

Rotate the catheter as you insert it.

(11)

Apply principles of good body mechanics.

(12)

Always have a good light.

(13)

Assemble the extra equipment before starting if the catheter is to remain in the patient.

INSTILLATION':

How to inject medicines into the

bladder. (1)

Double check the solution to be instilled.

(2)

Prepare medication before starting the cathe­ terization.

(3)

Attach an asepto syringe to the catheter and inject the medicine.

(4)

Pinch catheter upon withdrawal and leave solution in bladder.

IRRIGATION:

How to wash the bladder.

*

(1)

Unless an irrigation set up is being used, use an asepto syringe and a basin.

(2)

Be sure that everything is kept sterile.

(3)

Don't force solution into the bladder.

(4)

Keep the can in the Connell Suction filled with water at all times and keep the Y connector in a verticle position.

(5)

When using a Murphy Drip set, use measured sterile solution in the can and do not let it become empty.

(6)

Using the Two-way Irrigation set, wash the bladder as frequently as ordered or indicated, being sure that the solution returns.

(7)

Always measure the solution used for bladder irrigations.

(8)

Always use sterile solution.

GENITALIA: a.

How to cleanse the perineal area.

VAGINA: (1)

How to give an internal douche.

Give a vaginal douche only upon a written order.

(2)

Use sterile technic if following surgery or during puerperium.

(3)

Select a catheter instead of the usual nozzle if sutures are painful.

(4)

Protect yourself if there is a discharge.

(5)

Insert the nozzle downward and backward.

(6)

Hold the irrigating can so that the fluid level is never more than 18 inches above the level of the nozzle.

(7)

Avoid causing embarrassment to the patient at any time.

b.

PERINEUM:

How to give an external douche.

(1) Use the solution indicated for the purpose. (2)

Assemble supplies at the foot of the bed.

(3)

Don’t let the equipment tip over onto the bed or the floor.

(4)

Use as much solution as is necessary.

(5)

Dry the vulva thoroughly working from front to back and using a cotton ball for one stroke only.

C.

ACTIVITY ASSIGNMENTS>

Projects which will assist you in

caring for patients with difficulty in the pelvic region. 1.

Arrange to care for a patient who has had pelvic surgery.

2.

Secure permission to assist in the genito-urinary and gynecological clinics at the Dispensary.

D.

EVALUATION;

A sample of a testing device suitable for

use in checking ability to do genito-urinary nursing. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. ____________

a. When cleaning the perineum,

the di­

rection of the stroke should be from _____ •

____________

b. A

catheter is frequently used

as a retention catheter and may be

inserted by you. . ______c.

A catheter should be inserted with the eye ____ .

d. An _____ preparation of medication should never be instilled into the bladder. ____________ e. When using the Two-way Irrigation, the solution in the can should be kept ____. _

f . When using the Murphy Drip, the speed should be regulated according to

____________ g. When giving

.

a vaginal douche, the

fluid level should be no higher than ______ inches above the nozzle. ____________ h. In cases of discharge or drainage the nurse should protect herself by use of ____ . ____________ i. The douche nozzle should be inserted in a _____ direction. ____________ j. A

may be substituted for a nozzle

in cases where sutures may be painful. 2. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Places to get further information about

genito-urinary nursing.

BOOKS:

Pages to read in frequently cited texts

Harmer and Henderson 673-699; H.M.H. Procedure Manual; Montag and Filson 460-481; Wolf 452-464 486-492; Young 302-316.

135 CHAPTER 24. MUSCULO-SKELETAL SYSTEM HOW TO HANDLE BONES AND MUSCLES A.

MOTIVATIONS

Compensations to be gained by being a

good mechanic. 1.

CLEAR CONSCIENCE!

Unless you manage the situation

properly, much damage can be done. 2.

EASIER WORK:

You will be better able to obtain

the patient’s cooperation by preventing undue pain. B.

DIRECTIONS;

Some practical suggestions in caring for the

orthopedic patient. 1.

BEDS:

How to make orthopedic beds.

a.

Keep the bed firm and pillows fluffed.

b.

Pull all wrinkles out of sheets.

c.

Secure help if the task will be difficult.

d.

Put bottom sheet on from top to foot if easier that way.

e.

Fold sheets to fit the Bradford frame.

f.

Keep linen away from traction.

g.

Place the linen securely over cradles and foot boards.

h.

Make the polio bed according to the directions published by Joint Orthopedic Advisory Service.

2.

APPLIANCES; a.

How to manipulate special equipment.

Place the over head bar at the extreme upper end of the bed.

136 b.

Keep the traction pulling straight.

c.

Have the air circulating around thecast

when

using the cast dryer. d.

Raise the Bradford frame when placing a patient on a bed pan.

e.

Turn the patient by moving the Bradford frame from side to side.

3.

ADAPTATIONSs

How to alter procedures to meet the

special needs of the orthopedic patient. a.

Work on the side away from the injury.

b.

Keep individual in good body alignment.

c.

Teach the patient to help you.

d.

Push down on the mattress when slidinganything under the patient.

e.

Do some of the procedures piece meal.

f.

Clean well under the cast.

g.

Prevent the cast from becoming soiled.

h.

Give special attention to feet, toes, and pres­ sure areas.

i.

Turn the patient in one piece.

j.

Apply manual traction to an extremity if nec­ essary to move an untreated fracture.

C.

ACTIVITY ASSIGNMENTS;

Projects to assist you in caring

for the orthopedic patient.

1.

Make arrangements for you and a classmate to assume responsibility for an orthopedic patient requiring the use of a special bed and appliances.

2.

Assist in the orthopedic clinic at the Dispensary.

3-

Assist the physical therapist in giving treatments to orthopedic patients.

D.

EVALUATION;

A sample device to test the ability to care

for patients with conditions of the musculo-skeletal system. 1.

COMPLETION:

Write in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. ____________a. When caring for a fracture patient, preferably do the procedure from the side. ____________ b. The overhead bar should be located to be of most help to the nurse. ____________ c. You can keep the skin under the cast clean by use of ____ . ____________ d . _____ the bed pan to make it slide under the patient easier. ____________ e. ____ the cast when turning the pat­ ient. ____________ f. Patients on Bradford frames are put on the bed pan by ____ .

g. When using the east dryer, the heat should be turned on ____. h. The east should be covered with a ____ when using the cast dryer. 2. E.

RATING SCALES

REFERENCES;

See Chapter 26, D.

Other sources of information on orthopedic

nursing. 1.

BOOKS:

Pages to read in text.

Harmer and Henderson 945-972.

139 CHAPTER 2?. NEURAL CONDITIONS HOW TO HELP WITH THE NEUROLOGICAL PATIENT A. MOTIVATION:

Goals to be achieved by a display of tran­

quillity. 1.

TOLERANCE:

By knowing the causes of peculiar beha­

vior, it will be easier for you to be sympathetic with the victim. 2.

STATUS:

You will rank high because the nurses who

are able to care for this type of patient effective­ ly are limited in number. B. DIRECTIONS:

Practical suggestions to help you in caring

for the neurological patient. 1.

SPINAL PUNCTURE:

How to aid in aspirating spinal

fluid.

2.

a.

Prepare equipment.

b.

Assist the doctor in every way possible.

c.

Hold the patient in position.

d.

Watch for untoward effects.

SEDATIVE:

How to quiet the excited patient.

a.

Arrange for a non-stimulating environment.

b.

Restrict visitors.

c.

Be calm.

d.

Administer an alkaline bath to sooth the nerves.

e.

Give a continuous bath at 92°-97°F.

140 C.

ACTIVITY ASSIGNMENTS:

Projects which will put you at

ease when caring for the person with nervous conditions. 1.

Secure permission to care for a neurological patient receiving therapy.

2.

Contact the Visiting Nurse Association and make arrangements to assist a family caring for a neuro­ logical patient in the home.

D.

EVALUATION:

A sample method of testing ability to care

for patients with neurological conditions. 1.

COMPLETION:

Write, in the long blanks ahead of the

items the answers that should go in the short token blanks within the items. ____________ a. A sedative bath should be given at a temperature of ____ . ___________b. ______ is the most satisfactory color to create a soothing environment. ____________

c. The spinal column should be in ____ position while the doctor does a spinal tap.

____________ d. The position of the back should be to the bed during a lumbar puncture. ____________

e. Following a spinal puncture, the patient’s head should be kept ____ .

1 4 1

____

f. For a cisternal puncture, an area at should be shaved.

2. E.

RATING SCALE:

REFERENCES:

See Chapter 26, D.

Places to go for information regarding nurs­

ing the neurological patient. 1.

BOOKS:

Pages to read in frequently cited texts.

Harmer and Henderson 471-488, 625-631; H.M.H. Pro­ cedure Manual; Montag and Filson 541-547; Wolf 434439; Young 36O-367.

CHAPTER 26. EYE, EAR, NOSE, AND THROAT HOW TO APPLY REMEDIES TO THE ORBIT AND UPPER RESPIRATORY AREA A.

MOTIVATION;

Outcomes to be derived by keeping the senses

sensitive. 1.

COOPERATION:

It is much easier for the patient to

follow your directions if he can hear and see. 2.

PREPARATION FOR FUTURE:

This field receives much

home doctoring which you will be able to do with greater advantage and safety to your family and you. B.

DIRECTIONS:

Some guiding principles to be followed for

the sake of safety and convenience. 1.

EYE: a.

How to nurse the visual apparatus. DROPS:

How to instill medications.

(1)

Check solution carefully.

(2)

Use sterile supplies.

(3)

Steady your hand by bracing it against the face.

(4)

Don’t let the solution touch the rubber of the eye dropper.

(5)

Instruct the patient to look up.

(6)

Drop the solution into the lower lid as you pull it downward to form a cup.

b.

IRRIGATIONS: (1)

How to bathe the eye.

Use all sterile supplies.

(2) Cleanse the lid before starting. (3) Turn the patient's head to the side with the side to be treated turned downward. (4) Protect the other eye. (5)

Select the most appropriate equipment, such as a syringe, dropper, or cotton pledget.

(6)

Treat the least affected eye first.

(7)

Protect your own eyes if indicated.

HEAT: (1)

How to apply warmth.

Check the orders carefully for the time, frequency, and solution to be used.

(2)

Use a temperature about 120°F. unless ordered otherwise.

(3)

Have the compresses thick enough to retain heat.

(4)

Apply

vaseline to the lids before heat.

(5)

Place the compress over the lid and brow if treating the orbit and over the lid and cheek if treating the lids only.

(6)

Avoid using a, hot water bottle as it is too heavy.

(7)

If sterile procedure, do not reuse a com­ press.

COLD:

How to treat with ice.

144 (1)

Apply vaseline before putting cold to the lids.

(2)

Use wet dressings which have been cooled on a cake of ice or ice chips.

(3) e.

Avoid using an ice bag as it istoo heavy,

DRESSINGS: (1)

How to bandage the

eye.

Be sure you have doctor's order and under no circumstances cover an

infected eye

without a specific order to do so. (2)

Use sterile dressings.

(3)

Cover the first dressing with an eye shield.

(4)

Do not apply pressure unless indicated.

(5)

Usually bandage both eyes by using a mask, with or without a window on the good side,

(6)

Hold dressings in place with adhesive, scotch tape, or bandage.

2.

EAR: a.

How to doctor the aural equipment. DROPS: (1)

How to put drugs into the canal.

Know why the medication is being given so you can observe the effects.

(2)

Check and warm the solution.

(3)

Hold the ear down and back for a child and up and back for an adult.

(4)

Hold the hand steady by bracing it if nec­ essary.

(5)

Restrain children.

(6)

Permit the solution to run in slowly and on one side of the canal.

b.

IRRIGATIONS: (1)

How to wash the auditory mechanism.

Find out why the irrigation is being done, so that you can observe the results intell­ igently.

(2)

Use a small pointed syringe so as not to obstruct the canal.

(3)

Soften wax before irrigating.

(4)

Pull the ear into the correct position.

(5)

Tell the patient what you are going to do.

(6)

Check the solution for correct drug and temperature.

(7)

Use special precautions for furuncles or bony prominences.

(8)

Protect the patient and use his help when­ ever possible.

(9) NOSE:

Be sure the solution returns. How to give treatments to the breathing appa­

ratus . a.

DROPS: (1)

How to introduce nasal medications.

Obtain a doctor's order because this treat­ ment can be overdone.

(2)

Avoid use of oily preparations, especially in children.

(3)

Place the person in the position of doctor’s choice.

(4)

Steady your hand by bracing it.

(5)

Use a rubber tipped or blunt medicine dropper.

b.

IRRIGATIONS; (1)

How to cleanse the nasal passages.

Determine the reason for the treatment so you may use special precautions indi­ cated.

(2)

Check the solution for temperature and type.

(3)

Secure the patient’s cooperation by explain­ ing the procedure to him.

(4)

Tip the head forward.

(5)

Instruct the patient to hold his breath or to say ”kay, kay, kay” throughout the pro­ cedure.

(6) THROAT; a.

Note the solution as it returns. How to minister to the pharynx.

IRRIGATIONS; (1)

How to flush the tonsillar region.

Prepare a gargle of correct solution and temperature, or

(2)

Assemble equipment for a throat irrigation.

(3)

Place the patient in a suitable position.

(4)

Protect the bed.

(5)

Instruct the patient to breathe through his nose during the procedure.

b.

(6)

Direct the flow from side to side.

(7)

Observe the solution returned.

TRACHEOTOMY: (1)

How to attend to the life saver.

Remove the inner cannula and clean as often as necessary.

(2)

Use suction into the trachea and tube as or­ dered or indicated.

(3)

Boil the inner cannula daily.

(4)

Provide adequate moisture in the air.

(5)

Protect the opening from foreign bodies.

(6)

Warm the atmosphere.

(7)

Avoid using cotton in the area.

(8)

Teach the patient to clean his own tube.

(9)

Be sure the tube is secure.

(10) C.

Change gauze and tape strings as necessary.

ACTIVITY ASSIGNMENTS:

Performances which will aid in

nursing the eye, ear, nose, and throat. 1.

Find a person who is receiving eye treatments. Arrange to do the treatments according to the doc­ tor's directions.

2.

Go to the First Aid Department and assist with

148 dressing of injuries about the head. 3.

Visit the Dispensary and assist in the Ear, Nose and Throat Clinic.

4.

Take care of a patient who has recently had a trache­ otomy.

Teach the person to assume responsibility

for his own care. D.

EVALUATION:

Sample of a device used to check the ability

to nurse the eye, ear, nose, and throat. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. T a.

F

( ) ( ) Eye medications should be dropped onto the cornea.

b.

( ) ( ) The patient should be instructed to look up when drugs are being placed in the eye.

c.

( ) ( ) When irrigating the eye, the head should be turned with the side to be treated turned down.

d.

( ) ( ) You should always use a syringe to irri­ gate the conjunctival sac.

e.

( ) ( ) The most infected eye should be treated first.

f.

( ) ( ) Vaseline should be applied to the eye­ lid before treating with heat or cold.

149 g.

() ( ) A compress should be applied over the lid and upper cheek when treating the orbit.

h.

( ) C ) Cold dressings should be applied dry.

i.

() ( ) Ear wax should be softened before irrigating the canal,

j.

() ( ) The patient should be instructed to hold his breath during a nasal irri­ gation.

2. E.

RATING SCALE:

REFERENCES: 1.

BOOKS:

See next page.

Further aids suggested for clarification. Pages to read from frequently cited texts.

Harmer and Henderson 701-716, 852-855, 935-937; H.M.H. Procedure Manual; Montag and Filson 455-460, 504, 549, 581-583; Trott 316; Wolf 381-382, 469-476; Young 263-268, 318-325. 2.

FILMS:

Movies listed in bibliography.

a.

Eyes and Their Care.

b.

Eyes for Tomorrow.

c.

Nose . Throat and Ears

d.

Your Children’s Ears.

e.

Your Children’s Eyes.

f.

Your Ears.

g.

Your Eyes.

2.50

Name Procedure PROCEDURE RATING SCALE Place X in the space most nearly descriptive of the student’s performance. Leave blank those spaces which do not pertain to the particular procedure being rated. Excel­ Unsatis­ Satis­ factory Good lent factory Preparation of self . . . Mental preparation of patient . . . . . . . Physical preparation of patient ............ Preparation for procedure Simplicity and adaptability Economy of time . . . . . Economy of effort . . . . Economy of materials. . . Safety of the patient , . Comfort of the patient Application of principles Observance of technic . . A c c u r a c y ........ .. Neatness .............. Care of equipment . . . . Charting Poise .................. Manual dexterity. . . . , Comments:

Signature of instructor

BIBLIOGRAPHY FOR TEACHERS A.

BOOKS

Brown, Esther Lucile, Nursing as a Profession. New York: Russell Sage Foundation, 1940. 152 pp. Brown, Esther Lucile, Nursing for the Future. New York: Russell Sage Foundation, 1948. 198 pp. Chayer, Mary Ella, Nursing in Modern Society. New York: G. P. Putnam's Sons, 1947. 279 pp. Committee on Curriculum of the National League of Nursing Education, A Curriculum Guide for Schools of Nursing. New York: National League of Nursing Ed­ ucation, 1937. 678 pp. Committee on the Function of Nursing, A Program for the Nursing Profession. New York: The Macmillan Company, 1948. 108 pp. Committee on Standards, Essentials of a Good School of Nursing. New York: National League of Nursing Ed­ ucation, 1945. 75 PP. Gelinas, Agnes, Nursing and Nursing Education. York: The Commonwealth Fund, 1946. 67 pp.

New

Heidgerken, Loretta E., Teaching in Schools of Nursing. Philadelphia: J. B. Lippencott Company, 1946. 460 pp. Muse, Maude B., Guiding Learning Experience. The Macmillan Company, 1950. 600 pp.

New York:

Stewart, Isabel Maitland, The Education of Nurses. York: The Macmillan Company, 1945. 387 pp. B.

New

PERIODICAL ARTICLES

Abbott, W . , and others, "Anecdotal Behavior Record Im­ plications for Nursing Education, "American Journal of Nursing. 43:928-33, October, 1943. Aird, Ellen L., "Training Within. Hospitals," American Journal of Nursing. 43:633-4, June, 1943.

152 3.

Barrett, Jean, “Simplifying Nursing Procedures," American Journal of Nursing. 43:713-16, August, 1943.

4.

Berg, I. A., “Study of Success and Failure Among Student Nurses," Journal of Applied Psychology. 31? 389-96, August, 1947.

5.

Bernays, E. L., "Educators Appraise Nursing," Journal of Nursing. 46:372-75* January 194o.

6.

Bixler, J. K., and others, "Research and Nursing Ed­ ucation," American Journal of Nursing, 48:45-8, January, 1948.

7.

Brody, J., "How to Teach Home Nursing," American Journal of Nursing, 42:619-22, June, 1942.

8.

Brown, Esther Lucile, "Professional Education for the Nursing of the Future," American Journal of Nursing. 47:820-25, December, 1947.

9.

Brunner, Ellen J., and Frances McKenna, "Flexibility in Nursing Arts Procedures," American Journal of Nursing. 49:386-87, June, 1949.

American

10.

Brunstetter, M. R., and M. E. Kakosh, "Audio-Visual Materials for Nursing Education," American Journal of Nursing. 46:693-95, October, 1946.

11.

Connor, M. C., "Supervised Student Practice; expanding demands and decreasing opportunities," Public Health Nursing. 39:288. July, 1947.

12.

Dennison, Clare, "Nursing Procedures and Treatments in the Strong Memorial Hospital," American Journal of Nursing^ 42:776-83, July, 1942.

13.

Dickerman, W . , and M. Davis, "San Francisco Nursing Education Conference," Adult Education Bulletin. 12:82-7, February, 1948.

14.

Dodo, L. S., and L. K. Wolf, "New Approach to the Teach­ ing of Nursing Arts," American Journal of Nursing. 46: 404-8, June, 1946.

15*

Dunbar, V. M., "How to Teach Home Nursing," Journal of Home Economics. 37?580-81, November, 1945.

153

16. Feider, Ruth E., "Nursing in Junior and State Colleges," American Journal of Nursing. 508236-238, April, 1950. 17.

Gelinas, Agnes, "Bill of Rights for all Clinical Teachers," American Journal of Nursing. 47:287, May, 1947.

18.

Gelinas, Agnes, "Our Basic Educational Programs," American Journal of Nursing, 49:47-50, January, 1949.

19.

Gelinas, Agnes, "The Pressure, Problems, and Programs of Nursing Education," American Journal of Nursing. 49: 307-10, May, 1949.

.

Glasoe, D. I., "Students Learn by Experimenting," American Journal of Nursing. 41:1157-58. October, 1941.

21

.

Goff, H. A., and M. W. Hall, "Alternating Theory and Practice," American Journal of Nursing, 46:189-91, March, 1946.

22

.

. "Guarding Student’s Experience and Keeping Them Happy," American Journal of Nursing. 45:464-66, June, 1945.

20

23.

Heidgerken, L. E., "Experimental Study to Measure the Contributions of Motion Pictures and Slide-films to Learn Certain Units in the Course Introduction to Nursing Arts," Journal of Experimental Education. 17:261-93) December, 194b.

24.

. "Hospital Needs and Nursing Education," School and Society. 67:332-33, May, 1948.

25.

Hunsicker, M. M., "Nurse as a Teacher; Information on Nursing Training and Service for Teachers Giving Vocational Guidance to Pupils," Ohio Schools. 25:334, October, 1947.

26.

Ingram, M. E., "Teaching Students to Teach," American Journal of Nursing. 41:1189-92, October, 1941.

27.

Johansen, Dorothy, "The Integrative Method of Teaching," American Journal of Nursing. 50:117-19. February, 1950.

28 .

Kelso, M. M., "Preparation for Living," Hygeia. 20: 912-13, December, 1942.

154 29.

Kemble, Elizabeth L., and Emma Spaney, “Studying Students or Testing Teachers?*’, American Journal of Nursing. 47:481-83, July, 1947.

30.

Leader, H. J., ’’Centralized Preclinical Teaching,*1 American Journal of Nursing. 43:26-8. January, 1943.

31.

McCoy, E. G., "Improved Method of Teaching Skills; Red Cross adapts training within industry pattern in teaching home nursing," American Journal of Nursing. 45:115-18, February, 1945.

32.

McLean, B., "Students Reaction to Evaluation Reports," American Journal of Nursing. 47:123-24. February, 1947.

33.

McManus, R. L.,"Suggested Plan for Acceleration of Clinical Learning," American Journal of Nursing, 43:706, January, 1943.

34.

. "New.Ways of Teaching Health in Nursing," American Journal of Nursing. 34:458-61, August, 1942.

35.

Nicholson, H. F., "Education Through Clinical Assign­ ments," American Journal of Nursing. 45:1055-57? December, 1945.

36.

, "Nursing and Nursing Education," American Journal of Public Health. 38:1574-76, November, 194-8.

37.

, "Nursing School, a Disillusioning Experience," American Journal of Nursing. 47:292. May, 1947.

38.

"Nursing School, a Satisfying Experience," American Journal of Nursing. 47:293? May, 1947.

39.

Petry, Lucile, "Community Nursing— The Challenge of Nurse Education," American Journal of Nursing. 46:75759? November, 1946.

40.

Reiter, M., "Educating Adolescents to Become Nurses," American Journal of Nursing. 47:117-20, February, 1947.

41.

Sanger, W. T., "Making Nurse Education Dynamic," American Journal of Nursing. 45:472-76, June, 1945.

42.

Shepard, M. E., "Block Plan of Instruction; Report of Four Years’ Experience With a Block Plan of Alternating Classwork and Practice," American Journal of Nursing. 46:856-59, December, 1946.

155 43.

Toy, M. T., "Observation Study; Method of Teaching in Nursing Arts," American Journal of Nursing. 47;120-22, February, 1947.

44.

Walker, J. F., f,A Cooperative Venture in Planning for "Integration" and Better Care for Patients," Indiana State Board of Health Monthly Bulletin, 5l:7«, August, 1948.

45-

Wetzel, Sylvia, "Wartime Nursing Procedures," American Journal of Nursing. 45.;443-44, June, 1945.

156 BIBLIOGRAPHY FOR STUDENTS A.

BOOKS

1. Carlson, Anton J., and Victor Johnson, The Machinery of the Body, Chicago: University of Chicago Press, 1 9 4 1 . 6 6 6 pp. 2.

Committee on Nursing Standards, Division of Nursing, Department of Hospitals, Standard Nursing Procedures. New York: The Macmillan Company, 1943. 420 pp.

3.

Day, Sister Mary Agnita Claire, Principles and Tech­ niques of Nursing Procedures. St. Louis: The C. V. Mosby Company, 1943. 564 pp.

4.

Fash, Bernice, Body Mechanics in Nursing Arts. McGraw-Hill Book Company, Inc., 1946.

5.

Goodnow, Minnie, The Technic of Nursing. W. B. Saunders Company, 193!?. 4^7 pp.

New York:

Philadelphia:

6. Harmer, Bertha, and Virginia Henderson, The Principles and Practice of Nursing. 4th edition. New York: The Macmillan Company, 1939. i008 pp. 7.

Huntington Memorial Hospital Procedure Manual. California: Huntington Memorial Hospital.

Pasadena,

8.

Kelly, Irene V., Textbook of Nursing Technique. Phila­ delphia: W. B. Saunders Company, 1940. 404 pp.

9.

Kimber, Diana Clifford, Carolyn E. Gray, and Caroline E. Stackpole, Textbook of Anatomy and Physiology. New York: The Macmillan Company, 1937. 740 pp.

10. Lewis, Warren H., Gray's Anatomy of the Human Body. Philadelphia:_ Lea & Febriger, 1942. 1380 pp. 11.

McClain, M. Esther, Student's Guide in Nursing Arts. St. Louis: The C. V. Mosby Company, 1945. 407 pp.

12.

Meade, Agnes Barrie, Manual of Clinical Charting. Philadelphia: J. B. Lippencott Co., 1935. 93 PP.

13.

Montag, Mildred, and Margaret Filson, Nursing Arts. Philadelphia: W. B. Saunders Company, 1948. 5^5 PP.

157 14.

Morris, Ernestine, and Roma D. Adams, Manuscript Writing for Nurses. Philadelphia: F. A. Davis Company, 1940. Bo pp.

15.

Norlin, Elinor E., and Bessie M. Donaldson, Everyday Nursing for the Every Day Home. New York: The Mac­ millan Company, 1945. 296. pp.

16.

Olson, Lyla M., Improvised Equipment. Philadelphia: W. B. Saunders Company, 1940. 197 PP»

17.

Pope, Amy Elizabeth, and Virna N. Young, The Art and Principles of Nursing. New York: G. P. Putnam’s Sons, 1934. 820 pp.

18.

Rothweiler, Ella L., John S. Coulter, and Felix Jansey, The Science and Art of Nursing. Philadelphia: F. A. Davis Company, 1936. 1172 pp.

19.

Rothweiler, Ella L., and Jean Martin White, The Art and Science of Nursing. Philadelphia: F. A. Davis Com­ pany, 1949. 905 pp.

20.

Shepard, Katharine, and Charles H. Lawrence, Textbook of Attendant Nursing. New York: The Macmillan Company, 1942. 412 pp.

21.

Smith, Martha Ruth, Principles of Nursing Care. York: J. B. Lippencdtt Company, 1939. o40 pp.

22.

Tracy, Margaret A., Nursing an Art and a Science. St. Louis: The C. V. Mosby Company, 1938. 5 3 3 PP.

23.

Wolf, Lulu K., Nursing. New York: tury Company, 1 9 4 7 . 5 0 5 pp.

24.

Young, Helen, and Eleanor Lee, Essentials of Nursing. New York: G. P. Putnam’s Sons, 1948. 530 pp. B.

New

D. Appleton-Cen-

PERIODICAL ARTICLES

1.

Bishopp, F. C., ’’Insect Control in Hospitals and Home,” American Journal of Nursing. 47:613-17, September, 1947.

2.

Blodgett, James B., and Nola Smith Sheldon, "Intestinal Suction," American Journal of Nursing. 46:90-92, February, 1946.

158 3.

Brim, Katherine, and Betty Alice Chandler, "Changes in Oral Temperature," American Journal of Nursing. 48;772, December, 1948.

4.

Collins, Elizabeth M., and Helen Solowinski, "Bedsores— Their Prevention and Treatment," American Journal of Nursing, 49:688-690, November, 1949.

5.

Dade, Lucy, "Diversional Activities for Patients," American Journal of Nursing. 47:384-87, June, 1947.

6.

Davis, Bernard D., "A Patient's View of Backrubs," American Journal of Nursing. 47:112, February, 1947.

7.

Dericks, Virginia C., "Measuring and Recording Oral Fluid Intake," American Journal of Nursing. 47:319-20, May, 1947.

8.

Elman, Robert, "Fluid Balance from the Nurse's Point of View," American Journal of Nursing. 49:222-23, April, 1949.

9.

Feamon, Geneva, "Better Care for Older Patients," American Journal of Nursing, 48:702-5, November, 1948.

10.

"Foot Care for You and Your Patient," jQ-UEaal flCJtoaJLmu 47:322, May, 1947.

American

11.

Frey, Mary, "A New and Safe Method of Gastric Suction," American Journal of Nursing. 46:237-38, April, 1946.

12.

Hargiss, Clarice Osterud, "When Nurses Know the Patient," American Journal of Nursing. 47:831-32, December, 1947.

13.

Haviland, Barbara, "An Effective Colostomy Dressing," American Journal of Nursing. 49:153-54, March, 1949.

14.

Hollander, Lester, "Care of the Skin in Older People," American Journal of Nursing. 47:219-22, April, 1947.

15.

Irene, Bernice Wunderlick, "Foot Supports in Polio," American Journal of Nursing, 47:323-24, May, 1947.

16.

Johnson, Artell Egbert, "Penicillin Therapy," American Journal of Nursing. 48:780-82, December, 1948."”

17.

Livingston, Huberta M., "Administration of Oxygen Therapy," American Journal of Nursing. 48:88-91* February, 19481. “

159

.

18

Morrissey, Alice B., “The Nursing Technics in Rehabilitation,n American Journal of Nursing. 49:545551, September, 1949.

19.

Parfitt, R. Eunice, "Proper Instillation of Eye Med­ ications," American Journal of Nursing. 49:91-92,

20.

, "Patients Are People," American Journal of Nurs­ ing. 49:199, April, 1949.

21

.

22

, "Posture Fundamentals Illustrated: The Patient," . American Journal of Nursing. 46:20-1, January, 1946.

"Posture Fundamentals Illustrated: The Nurse," American Journal of Nursing. 46:122-23, February, 1946.

23.

Schwartz, Doris R., "Assisting Helpless Patients to a Chair," American Journal of Nursing. 47:10-11, January, 1947.

24.

Troy, Crescentia J., "Tender Loving Care," American Journal of Nursing. 48:748-50, December, 1948.

25.

Waples, Genevieve, and Bernice Thompson, "Colostomy Care," American Journal of Nursing. 48:233-37, April, 1948.

26.

Weiss, Mary M. A., "Who Said "lice"?," American Journal of Nursing, 46:225, April, 1946.

160 LIST OF FILMS 1.

Bathing the Patient (Home Care). 16 mm., sound, black and white, 24 minutes. Available from Bureau of Health Education, California State Department of Public Health, 760 Market Street, San Francisco 2, California. Free.

2.

Eyes and Their Care. 16.mm., sound, black and white, 10 minutes. Available from Pasadena City Schools and from Bureau of Health Education, California State Depart­ ment of Public Health, 760 Market Street, San Francisco 2, California. Free.

3.

E.yes for Tomorrow. 16 mm., sound, black and white, 22 minutes. Available from National Society for the Pre­ vention of Blindness, 1790 Broadway, New York 19, New York, for rental fee of $2.00 per snowing day. Also available from Bureau of Health Education, California Department of Public Health, 7&0 Market Street, San Fran­ cisco 2, California. Free.

4.

Feeding the Patient. 16 mm., sound, black and white, 14 minutes. Available from Boston University, Division of Motion Pictures and Visual Aids, 84 Exeter Street, Boston, Massachusetts. Rental $2.00 per day.

5.

Nose. Throat, and Ears. 16 mm., sound, black and white, 10 minutes. Available from Bureau of Health Education, California State Department of Public Health, 760 Market Street, San Francisco 2, California, Free.

6.

Oxygen TherapyT 16 mm., silent, color, 10 minutes. Made by the Edgar Bergen Foundation and available from local hospitals.

7.

Oxygen Therapy Procedures. 16 mm., sound, black and white, 30 minutes. Available from The Linde Air Products Co., Oxygen Therapy Department, 20 East 42nd Street, New York 17, New York, or their local representative.

8 . Therapeutic Uses of Heat and Cold. 16 mm., sound, black and white, 20 minutes. Available from Boston University, Division of Motion Pictures and Visual Aids, 84 Exeter Street, Boston, Massachusetts. Rental $2.00 per day. 9. The Vital Signs and Their Interrelation. 16 mm., sound, black and white, 32 minutes. Available from Pasadena City Schools. Free.

161 10

.

Your Childrens Ears. 16 mm., sound, black and white, 15 minutes. Available from Bureau of Health Education, California State Department of Public Health, 760 Market Street, San Frandsco 2, California. Free.

11 . Your Children’s Eyes. 16 mm., sound, black and white, 20 minutes. Available from National Society for the Prevention of Blindness, 1790 Broadway, New York 19, New York. Rental $2.50 per shomdng day. 12

.

13.

Your Ears. 16 mm., sound, black and white, 10minutes. Available from Bureau of Health Education, California State Department of Public Health, 760 Market Street, San Francisco 2, California. Free. Your Eves. 16 mm., sound, black and white, 10minutes. Available from National Society for the Prevention of Blindness, 1790 Broadway, New York 19, New York. Rental $2.50 per showing day.

O n iv u r*u y or iio u tta e rn

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