Learn The Procedure On How To Take Blood Pressure

I want to share again another nursing procedure that you might be interested to learn.  This is the manual type of taking blood pressure of a person using the sphegmomanometer, though digital is readily avalaible and easy to use but if you have sphegmomanometer at home might as well learn how to use it.  Besides that, it is best to monitor the changes of our  blood pressure especially if we have member/s of the family who is suffering the said illness to undertake necessary measures.  This will also benefit the nursing students who are looking for the the right procedure.

Blood pressure (BP) is the pressure (force per unit area) exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs. The pressure of the circulating blood decreases as it moves away from the heart through arteries and capillaries, and toward the heart through veins. When unqualified, the term blood pressure usually refers to brachial arterial pressure: that is, in the major blood vessel of the upper left or right arm that takes blood away from the heart. Blood pressure may, however, sometimes be measured at other sites in the body, for instance at the ankle.

One measure records the pressure while the heart is in systole (when the heart is ejecting blood into the arteries);this is the higher systolic pressure.  The other measure records the pressure while the heart is in diastrole (when the aortic and pulmonary valves are closed and the heart is relaxed);this is the lower or diastolic pressure.  The range of normal blood pressure recording varies according to age and body size but in the normal young adult is approximately 100-120/70-80 mm Hg. 

Why we should perform the procedure?

1. To provide baseline data 
2. To monitor changes in blood pressure

Procedure
Assessment:

1. Assess client’s general condition.

• Client rest on the bed.
• Avoid strenuous activity.
• To select appropriate cuff size.

     2.  To select appropriate cuff size.

Planning:

1. Prepare the requirements (in a tray)

• Sphygmomanometer
• Stethoscope.
• Alcohol swab in gallipot (to clean stethoscope)
• Receiver
• Observation chart
• Pen (black and red)
• Ruler

     2. Prepare adequate working space.

Implementation:

1.  Greet and inform client about the procedure.
2. Perform hand wash (Prevents cross infection)
3. Provide privacy
4. To obtain accurate reading,  position the sphygmomanometer at heart level and ensure the mercury level at zero.
   
5. Expose the arm above the placement of cuff. 
6. Apply cuff 2.5cm above antecubital fossa.
7. Fold client’s sleeve above the placement of cuff.
8. Apply the cuff smoothly and firmly with the middle of the rubber bladder directly over the artery. (Too tight cuff will impede circulation whereas too loose will lead to false elevation of pressure.)
9. Secure the cuff by fixing the Velcro fastener. (Prevent unwrapping of cuff)
10. Close the valve of the inflation bulb.
11. Palpate the radial pulse.
12. Inflate the cuff until pulse is not palpable. (To estimate how high to pump the mercury)
13. Note the point which pulse disappears. (first reading)
14. Deflate the cuff slowly.
15. Palpate brachial artery and place the diaphragm lightly over the brachial artery.
16. Inflate the cuff further to 20mmHg.
17. Release the valve slowly.
18. First audible sound heard is systolic pressure. (First sound heard when the blood begins to flow through brachial artery)
19. Continue to deflate the cuff. The last sound heard is the diastolic pressure.
20. Deflate the cuff completely
21. Remove the cuff from client's arm.
22. Ensure client is in comfortable. (Advice client to rest if finding show high blood pressure)
23. Clean the stethoscope with alcohol swab
24. Tidy up unit
25. Document the reading in observation chart.

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Giving And Removing Bedpan To A Patient

Here we will learn on how to give and remove a bedpan to a patient.  But first we should know what is bedpan, its importance and why do we need the procedure.

What is bedpan?

Bedpan is an object used for the toileting of a bedridden patient in a health care facility, usually made of a metal, glass, or plastic receptacle. A bed pan can be used for both urinary and fecal discharge

Why they are necessary

1. 
   
    Many diseases can confine a patient to bed, necessitating the use of bedpans.
   
   
   
2. 
   
   Additionally, many patients may be confined to a bed temporarily as a result of a temporary illness, injury, or surgery, thereby necessitating the use of a bed pan.
   
   
   

 Procedure of giving and removing bedpan to a patient.

1.  Wear disposable glove.
2. If the bedpan is metal, warm it by rinsing it with warm water.
3. 
   
   Adjust the bed to a height appropriate to prevent back strain.
   
   
   
4. 
   
   Elevate the side rail on the opposite side to prevent the client from falling out of bed.
   
   
   
5. 
   
   Ask the client to assist by flexing the knees, resting the weight on the back heels, and raising the buttocks, or by using a trapeze bar, if present.
   
   
   
6. 
   
   Help lift the client as needed by placing one hand under the lower back, resting your elbow on the mattress, and using your forearm as a lever.
   
   
   
7. 
   
   Lubricate the back of the bedpan with a small amount of hand lotion or liquid soap to reduce tissue friction and shearing.
   
   
   
8. 
   
   Place a regular bedpan so that the client’s rest on the smooth, rounded rim. place a slipper pan with the flat, low end under the client’s buttocks.
   
   
   
9. 
   
   For the client who cannot assist , obtain the assistance of another nurse to help lift the client onto the bedpan or place the clients on his or her side , place the bedpan against the buttocks and roll the clients onto the bedpan.
   
   
   
10. 
    
    To provide a more normal position for the clients lower back elevates the client’s bed to a semi Fowler’s position. If permitted. If elevation is contraindicated, support the clients back with pillow as needed to prevent hyperextension of the back.
    
    
    
11. 
    
    Cover the clients with bed linen to maintain comfort and dignity.
    
    
    
12. 
    
    Provide toilet tissue, place the call light within reach, lower the bed to the low position, elevate the side rail if indicated and leave the client alone.
    
    
    
13. 
    
    Answer the call bell promptly
    
    
    
14. 
    
    Do not leave anyone on a bedpan longer than 15 minutes unless they are able to remove the pan themselves. Lengthy stays on a bedpan can causes pressure ulcer.
    
    
    
15. 
    
    When removing the bedpan, return the bed to the position used when giving the bedpan, hold the bedpan steady to prevent spillage of its content, cover the bedpan, and place it on the adjacent chair.
    
    
    
16. 
    
    If the client needs assistance, don glove and wipe the patient’s perineal area with several layers of toilet tissue. If a specimen proof is needed place the tissue in a receptacle other than the bedpan.
    
    
    
17. 
    
    Wash the perineal area of dependent patient with soap and water and thoroughly dry the area.
    
    
    
18. 
    
    For all patients, offer warm water soap, a washcloth. and a towel to wash the hands.
    
    
    
19. 
    
    Assist the pateints to a comfortable position, empty and clean the bedpan, and return it to the bedside.
    
    
    
20. 
    
    Remove and discard you gloves and wash your hands.
    
    
    
21. 
    
    Spray the room with air freshener as needed to control odor unless contraindicated because of respiratory problems or allergies.
    
    
    
22. 
    
    Document colour, odour amount and consistency of urine and feces and the condition of the perineal area
    
    
    

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Vacine Recommendations For A(H1N1)

When the vaccine for influenza A(H1N1) becomes available, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends that the following groups be vaccinated:

• pregnant women
• people who live with or care for children less than 6 months old
• health care and emergency services personnel
• people between the ages of 6 months through 24 years of age
• people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems

In the event of a vaccine shortage, the ACIP recommends that the following groups receive the vaccine before others:

• pregnant women
• people who live with or care for children less than 6 months of age
• health care and emergency services personnel with direct patient contact
• children between 6 months and 4 years of age
• children ages 5 through 18 years of age who have chronic medical conditions

To decrease the incidence of secondary pneumococcal pneumonia, the CDC is also recommending prophylactic administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) during the outbreak of novel influenza A(H1N1). The recommendations of the CDC's Advisory Committee on Immunization Practices (ACIP) are as follows:

• Vaccination for all persons over 65 years of age
• Vaccination for persons 2 to 64 years with the following medical conditions:
  
  
  • Chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
  • Chronic pulmonary disease, including COPD and emphysema
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease, including cirrhosis
  • Cerebrospinal fluid leaks
  • Functional or anatomical asplenia, including sickle cell disease and splenectomy
  • Immunocompromised conditions, including HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant
  
  
  
  
• Vaccinations for persons 19 to 64 years who have asthma or smoke.

*Note: A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS or malignancy.

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Learn How To Treat And Prevent A(H1N1)

The CDC has outlined specific antiviral guidelines for prevention and treatment of confirmed, probable, and suspected cases of patients with influenza A(H1N1) and their close contacts.

Current antiviral dosing recommendations are as follows:

oseltamivir (Tamiflu)

To prevent influenza A(H1N1).
 
Adults: 75 mg capsule by mouth (P.O.) once daily for 10 days
Children 12 months and older weighing greater than 40 kg: 75 mg P.O. once daily for 10 days
Children 12 months and older weighing 24 kg to 40 kg: 60 mg P.O. once daily for 10 days
Children 12 months and older weighing 16 kg to 23 kg: 45 mg P.O. once daily for 10 days
Children 12 months and older weighing 15 kg or less: 30 mg P.O. once daily for 10 days
Infants 6 to 11 months: 25 mg P.O. once daily for 10 days
Infants 3 to 5 months: 20 mg P.O. once daily for 10 days
Infants less than 3 months: Not recommended unless situation judged critical due to limited data on use in this age group.

To treat influenza A(H1N1).
 
Adults: 75 mg capsule P.O. twice daily for 5 days
Children 12 months and older weighing greater than 40 kg: 150 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 24 kg to 40 kg: 120 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 16 kg to 23 kg: 90 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 15 kg or less: 60 mg P.O. per day divided into two doses for 5 days
Infants 6 to 11 months: 25 mg P.O. twice daily for 5 days
Infants 3 to 5 months: 20 mg P.O. twice daily for 5 days
Infants less than 3 months: 12 mg P.O. twice daily for 5 days

Click here for complete prescribing information for oseltamivir (Tamiflu).
Click here for drug information from NDH2009

zanamivir (Relenza)

To prevent influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) once per day for 10 days
Children 5 years and older: Two 5 mg inhalations (10 mg total) once per day for 10 days

To treat influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) twice per day for 5 days
Children 7 years and older: Two 5 mg inhalations (10 mg total) twice per day for 5 days

Click here for complete prescribing information for zanamivir (Relenza).
Click here for drug information from NDH2009.

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How To Administer An Enema To A Patient

The other day was the presentation day for all the nursing procedure that Miss Tracey has given us. Each group presented their respective nursing procedure. so in few days i will be posting here some of the the different nursing procedure that we are going to undertake during our clinical posting.

The first nursing procedure i will give you is how to administer an enema to a patient.

An enema is a solution introduced into the large intestine. The action of an enema is to distend the intestine and sometime to irritate the intestinal mucosa , thereby increasing peristalsis and the excretion of feces and flatus.

Enema are classified into 4 groups: 

• Cleansing - Cleansing enemas are intended and remove feces.
• Carminative - A carminative enema is given primarily to expel flatus.
• Retention - A retention enema introduces oil or medication into the rectum and sigmoid colon
• Return- flow enema - A return- flow enema is used occasionally to expel flatus. 

Why You Should Perform The Procedure?
Purpose

• To achieve one or more of following actions; cleansing, carminative, retention or return-flow.

Assessment 

• When the client last had a bowel movement and the amount, color and consistency of the feces.
• Presence of abdominal distention ( the distended abdomen appears swollen and feels firm rather than soft when palpated)
• Whether the client has sphincter.
• Whether the client can use a toilet or must remain in bed and use a bedpan. 

Steps Of The Procedure?

• Introduce yourself and verify the client’s identity using agency protocol. Explain to the client what you are going to do.
• Perform hand hygiene, apply clean gloves, and observe appropriate infection control procedure.
• Provide for client privacy.
• Assist the adult client to a left lateral position, with the right leg as acutely flexed as possible and the linen-saver pad under the buttock
• Insert the enema tube. 

Insert the tube smoothly and slowly into the rectum, directing it towards the umbilicus.

If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube to relax the internal anal sphincter.

never force the tube or solution entry.

•  Slowly administer the enema solution.

Compress a pliable container by hand.

During most low enemas hold or hang the solution than 30 cm (12 in) above the rectum.

Administer the fluid slowly.

Using the plastic commercial container, roll it up as the fluid is instilled. This prevent subsequent suctioning of the solution.

After the solution , close the clamp and remove the enema tube from the anus.

Place the enema tube in a disposable towel as you withdraw it.

• Encourage the client to retain the enema.
  

Request that the client retain the solution.

ask the client to remain lying down

• Assist the client to defecate.  

• Assist the client to a sitting position on the bedpan or toilet. A sitting position facilitates the act of defecation.
• Ask the client to using the toilet but not to flush because needs to observe the feces.

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Some Acronyms That Nursing Students May Encounter During Clinical Practice

Last Tuesday our clinical instructors have given us an assignment to look for the meaning of the acronyms that doctors often use. Nursing students should be able to identify and know these acronyms, in relation to patient's case, especially doctor's hand writings are sometimes unreadable.

So here are some of them that you should know:

Hb (Haemoglobin) - the iron-containing respiratory pigment in red blood cells of vertebrates, consisting of about 6% heme and 94% globin.

MRSA (Methicillin-Resistant Staphylococcus Aureus) - a strain of Staphylococcus aureus that is resistant to a large group of antibiotics called the beta-lactams, which include the penicillins and the cephalosporins.

IHD (Ischemic Heart Disease) - is also callled myocardial ischaemia, a disease characterized by reduced blood supply to the heart muscle, usually due to coronary artery disease (atherosclerosis of the coronary arteries). Its risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, hypertension (high blood pressure) and is more common in men and those who have close relatives with ischaemic heart disease. In simple term it is a heart problem caused by narrowed heart arteries and is also called coronary artery disease or coronary heart disease.

SOB (Shortness Of Breath) - is also called Dyspnea, is characterized by a feeling that you are unable to breathe enough air, which lead to hurried, franctic breathing or heaving. This can lead to suffocation.

CBI (Continuous Bladder Irrigation) - a continuous infusion of a sterile solution into the bladder, usually by using a three-way irrigation closed system with a triple-lumen catheter. One lumen is used to drain urine; another is used to inflate the catheter balloon, and the final lumen carries the irrigation solution. CBI is primarily used following genitourinary surgery to keep the bladder clear and free of blood clots or sediment.

CBD (Common Bile Duct) - the duct formed by the union of the cyctic duct and the hepatic duct that carries bile from the liver and the gallbladder to the duodenum.

BP (Blood Pressure) - the pressure of the blood against the inner walls of the blood vessels, varying in the different parts of the body during different phases of contraction of the heart and under different conditions, exertions, etc.

CCF (Congestive Cardiac Failure) - is also called congestive heart failure, is a disorder where the heart loses its ability to pump blood efficiently. The result is that the body doesn't get as much oxygen and nutrients as it needs, leading to problems like fatigue and shortness of breath.

IV (Intravenous) - a drug, nutrient solution, o other substances administered into a vein.

NPC (Nasopharyngeal Carcinoma) - is a cancer originating in the nasopharynx, the uppermost region of the pharynx or "throat", where the nasal passages and auditory tubes join the remainder of the upper respiratory tract.

CPOD (Chronic Obstructive Pulmonary Disease) - refers to chronic bronchitis and emphysema, a pair of two commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath.

IO Chart (Intake and Output Chart) - a record of your food and liquid intake and output.

GIT (Gastrointestinal Tract) - the stomach and intestine - the system of organs within multicellular organisms that takes in food, digests it to extract energy and nutrients, and expels the remaining matter. The major functions of the gastrointestinal tract are ingestion, digestion, absorption, and defecation.

I & D (Incision and Drainage) - are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area with an antiseptic, such as iodine based solution, and then making a small incision to puncture the skin using a sterile instrument such as a sharp needle, a pointed scalpel or a lancet. This allows the pus fluid to escape by draining out through the incision.

TURP (Transurethral Resection of Prostate) - also known as TURP, plural TURPs and as a transurethral prostatic resection TUPR - is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). It is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.

PO (Per Orally or by Mouth)

GA (General Anaesthesia) - is a state of total unconsciousness resulting from general anaesthetic drugs

LA (Local Anaesthesia) - is any technique to render part of the body insensitive to pain without affecting consciousness. It allows patients to undergo surgical and dental procedures with reduced pain and distress.

ESRF (End Stage Renal Failure) - also known as chronic renal disease, is a progressive loss of renal function over a period of months or years.

PRN ( Pre Re Nata) - as the situation arises or take as needed or whenever necessary.

DM (Diabetes Mellitus) - often referred to simply as diabetes—is a condition in which the body does not produce enough, or properly respond to, insulin, a hormone produced in the pancreas. Insulin enables cells to absorb glucose in order to turn it into energy. In diabetes, the body either fails to properly respond to its own insulin, does not make enough insulin, or both. This causes glucose to accumulate in the blood, often leading to various complications.

ECG (Electrocardiogram) - or EKG is a transthoracic interpretation of the electrical activity of the heart over time captured and externally recorded by skin electrodes.

MI (Myocardial Infarction) - or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium).

Urine FEME ( Urine Full Microscopic Examination) - is a valuable diagnostic tool for the detection and evaluation of renal and urinary tract disorders and other systemic diseases.

T & S (Toilet and Suture) - the cleaning and stitching of the wound.

TWDC (Total White Differential Count)

C & S (Cultural and Sensitivity)

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