General Nursing Departmental Manual

Republic of
Yemen 48Modern
48
Hospital
Republic of
Yemen 48Modern
Hospital
48
Table of Contents
CHAPTER 1 DEPARTMENTAL PROFILE
Title: Admission
NURSING
SERVICE
DEPARTMENT ORGANIZATIONAL
Procedures
.............................................................................................3
CHART..................................1
Title: Discharge of
NURSING
MISSION-VISION
Client....................................................................................................6
STATEMENT.......................................................................2
Title: Discharge
NURSING
SHARED
Planning..................................................................................................
9
MISSION..........................................................................................
2
Title: Transfer of
NURSING
SHARED
Client.....................................................................................................
13
VISION.............................................................................................
2
CHAPTER
2
POLICIES
AND
PROCEDURES
Title: Answering Telephone
NURSING
DEPARTMENT GOALS AND
Call......................................................................................16
OBJECTIVES..................................................
3
Title: Clients Identification
NURSING
DEPARTMENT'S
SCOPE
OF
NURSING ADMINISTRATIVE POLICIES AND PROCEDURES
Band....................................................................................
18
SERVICE..........................................................4
Title: Code Blue
Procedures............................................................................................ 20
Title: Doctors
Orders.......................................................................................................
24
Title: Informed
Consent.....................................................................................................2
8
Title: Patients
Confidentiality...........................................................................................3
1
Title: Provision of Patients
Privacy................................................................................ 33
Title: Patients and Family Rights and
Responsibilities................................................. 35
Title: Patient
Education....................................................................................................
39
Title: Safety For Patients and
Staff...................................................................................41
Title: Security for Hospital
Equipment.............................................................................45
Title: Standard
Abbreviations..........................................................................................
47
GENERAL WARD INTERNAL POLICIES AND PROCEDURES
Title: Prevention of Medication
Title:
General Wards Staff Competency
Errors............................................................................
53
Assessment...................................................67
Title: Pain
Title:
Scope of Service - In-Patient Nursing
Management................................................................................................
Units........................................................
71
.....57
Title: Isolation
Clients Personal
2
Standards/Precautions..........................................................................
74
Belongings................................................................................ 60
Title: Waived and Point of Care
Testing......................................................................... 62
Title: Absconding of
Clients............................................................................................78
Title: Answering Call
Bells..............................................................................................
80
Republic of
Title:
Yemen 48Modern
48
Kardex.........................................................................................................
Hospital
............. 82
Title: Comprehensive Nursing
Assessment.................................................................. 84
Title: Nursing Care
GENERAL
NURSING INTERNAL POLICIES AND PROCEDURES 87
Plan...................................................................................................
Title: Nursing
Documentations........................................................................................9
0
Title: Nursing
Endorsement.............................................................................................9
4
Title: Assessing Patients Psychological
Needs.......................................................... 96
Title: Unit
Rounds........................................................................................................
.... 99
Title: Calling For a
Physician.......................................................................................... 101
Title: Airway
Management..............................................................................................
104
Title: Applying an External
Catheter...............................................................................107
Title: Assessing the Neurological
System......................................................................110
Title: Application of Skin
Traction...................................................................................117
Title: Back Care / Back
Rub.............................................................................................120
Title:
Bathing.......................................................................................................
..............123
Title: Bed
Making........................................................................................................
......128
Title:
Breastfeeding..............................................................................................
............133
Title: Blood
Extraction....................................................................................................
.137
Title: Blood
Transfusion..................................................................................................
.140
Title: Care of the Unconscious
Client.............................................................................146
Title: Cast
Application..................................................................................................
...150
Title: Cast
Removal......................................................................................................
... 153
Title: Cleaning a Sutured Wound and Applying
a Sterile
3
Dressing ........................... 155
Title: Cold
Compress....................................................................................................
... 160
Title: Instillation of Ear

Drops.........................................................................................239
Title: Instillation of Eye
Drops/Ointment.......................................................................
241
Republic of
Title: Instillation Nasal
Yemen 48Modern
48
Drops/Ointment........................................................................
243
Hospital
Title: Insulin
Therapy......................................................................................................
245
Title: Intravenous Cannula
GENERAL NURSING INTERNAL POLICIES AND PROCEDURES
Insertion.............................................................................
249
Title: Intravenous Fluid
Therapy.................................................................................... 253
Title: Implementing Seizure
Precautions.......................................................................262
Title: Management of
Burns........................................................................................... 264
Title: Management of Client for Electroconvulsive Therapy
(ECT) ............................270
Title: Management of Foreign Body Airway
Obstruction.............................................273
Title: Managing Patient With PCA
Pump...................................................................... 276
Title: Measuring Fluid Intake and
Output..................................................................... 279
Title: Medication Preparation and
Administration....................................................... 281
Title: Mouth/Oral
Care.................................................................................................... 298
Title: Nail Care / Foot
Care............................................................................................. 303
Title: Nasogastric Tube
Feeding....................................................................................306
Insertion...................................................................................310
Removal.................................................................................. 314
Title: Nursing Care of Epileptic
Client...........................................................................317
Title: Obtaining a Wound Drainage
Specimen .............................................................321
Title: Obtaining Specimens for Culture and
Sensitivity.............................................. 324
Title: Offering and Removing Bedpan or
Urinal...........................................................327
Title: Oxygen
Therapy.....................................................................................................3
29
Title: Perineal
Care.........................................................................................................
333
Title: Positioning and Mobilizing The
Client................................................................ 336
Title: Post Mortem
Care................................................................................................. 345
Title: Post-Operative
Care.............................................................................................. 349
Title: Post-Operative Teaching: Moving, Leg Exercises, Deep Breathing and
4
Coughing.....................................................................................................
..............352
Title: Post Thyroidectomy
Care......................................................................................355
Republic of
Yemen 48Modern
Hospital
48
GENERAL NURSING INTERNAL POLICIES AND PROCEDURES

Title: Urinary Catheter (Indwelling)
Care......................................................................
407
Title: Abdominal and Pelvic
Title: Urinary
Ultrasonography.............................................................
472
Catheterization.........................................................................................
Title:
Abdominal
410
Paracentesis...................................................................................... 474
Title: Urine Specimen
Collection................................................................................... 414
Angiography................................................................................................
Title:
Urine Collection for
...........477
24O........................................................................................418
Title:
Barium
Title: Urinary Catheter
Enema........................................................................................................
Removal....................................................................................
420
480
Urine Test
for/ Sugar
Title: Barium
Meal
Bariumand
Ketones.......................................................................
422
Swallow.............................................................................483
Title: Vaginal
Irrigation...................................................................................................
Bronchoscopy..............................................................................................
424
...........486
Title: Vital Signs
Taking..................................................................................................426
Colonoscopy.................................................................................................
Title:
Wound
..........489
Dressing.....................................................................................................
Title:
Endoscopic Retrogade Cholangiopancreatography
DIAGNOSTIC PROCEDURES
436
(ERCP).............................492
Title: Central
Venous
Catheter
Intravenous
Pyelography
Insertion...................................................................... 439
(IVP)..............................................................................495
Central Venous
Title: Kidney,
Ureter, Line
Removal.............................................................................
442
Bladder.........................................................................................
498
Central Venous
Pressure
Title: Lithotripsy
Procedure
Monitoring.................................................................. 444 500
(ESWL)..............................................................................
Title: Chemotherapy:
Implanted Venous Access
Liver
Device........................................... 446
Biopsy.........................................................................................................
Title: Chemotherapy: Management of Cytotoxic
...503
Extravasation
Title: Lumbar ............................... 449
Puncture....................................................................................................5
Spills..............................................
452
05
Title: Chemotherapy: Preparation and Administration of Cytotoxic
Drugs...............454
Myelogram..................................................................................................
Title:
Chest
...........
508 Tube Insertion and
Management...............................................................464
Title:
Pulmonary Function
Title: Chest Tube
Test.....................................................................................
510
Removal.............................................................................................
468
Title: Renal
Biopsy.........................................................................................................
. 513 Anderlift
Title:
Title:
Plus........................................................................................................
MACHINES
Sigmoidoscopy.............................................................................................
526
.........Breast
Title:
516
Title:
Pump.........................................................................................................
Thoracentesis..............................................................................................
529
5
...........519
Title:
Title: Upper GI
Defibrillator.................................................................................................
Endoscopy..............................................................................................522
...........532
Republic of
Yemen 48Modern
48
Hospital
MACHINES
Title: Dinamap Blood Pressure
Monitor.........................................................................536
Title: Electrocardiography
Machine............................................................................... 538
Title: Infusion
Pump........................................................................................................
540
Title: IVAC Temperature
Plus..........................................................................................543
Title: Multiparameter (NELLCOR PURITAN BENNETT4000)...................................... 546
Title: Pulse
Oximeter......................................................................................................
. 550 OTHER DEPARTMENTS POLICIES AND PROCEDURES
Title: Septic AFFECTING
Fluid Aspirator
Medap
NURSING
PRACTICE
P7040.................................................................... 552
Title:
Title:Syringe
Arterial Blood
Pumps.......................................................................................................
Gas.................................................................................................... 568
555
Title: Ultrasonic
Nebulizer.............................................................................................. 559
Title: Suction
Machine .....................................................................................................
561
Title: Optium Xceed
Glucometer.....................................................................................563
Republic of
Yemen 48Modern
48
Hospital
CHAPTER
1
DEPARTMENTA
L
PROFILE
Republicof
of
Republic
Yemen48Modern
48Modern
Yemen
84
84
Hospital
Hospital
48MODERN HOSPITAL
Nursing Services
Organizational Chart
Republic of
Yemen 48Modern
48
Hospital
NURSING MISSION-VISION STATEMENT
NURSING SHARED MISSION
The The Nursing services are committed to

provide
holistic, human, ethically-focused, client-centered
health care
to the diverse population by developing intellectual,
interpersonal and technical competence.
NURSING SHARED VISION

The Nursing shared vision is to provide reliable
nursing services based on international standard that
exceeds
patients and doctors expectations.
Republic of
Yemen 48Modern
Hospital
48
NURSING DEPARTMENT GOALS AND

OBJECTIVES
1 To deliver quality health care services to the
patients.
1.1 To utilize the nursing

anning and implementation of the
interventions, and the
pltion of the outcomes to determine
the level of the achieved
wellness.
1.2 To utilize the quality evaluaprocess - assessing the
patients,
identification of the needs, improvement scheme through
planning, continuous monitoring and evaluation to ensure
that
1.3
To provide
motivations
patients
received
the bestamong
quality of care nursing
personnel to
encourage them to render optim evel al contributions in
2
To provide the optimum lof nursing cares and
the
services
2.1 of
To
to
treat
meet
patient
the health
with
dignity
care and
demands
respectof
advocating
the
the
delivery
quality
patient
care.
health rights of individual patient and family.
patients
who entrusted their lives to our care.
2.2 To make use of appropriate hospital facilities in meeting

the
patients health care needs.
2.3 To develop competent nurses capable to provide quality
nursing cares and services to the patients.
2.4 To provide skilled nurses through education, trainings
and
workshops, seminars, and scientific activities.
2.5 To have a continuous in-service training program to
update
10
nurses with the latest trend in nursing
care delivery.
Republic of
Yemen 48Modern
Hospital
48
NURSING DEPARTMENT'S SCOPE OF

SERVICE
1 SGHG NURSING DEPARTMENTS SCOPE OF SERVICE:
1.1 The 48 MODERN HOSPITAL Nursing Departments aim to provide the highest
quality of service to all its client-population on various range of services Pediatrics
(Newborn, NICU, PICU) OB-Gyne, Internal Medicine, Cardiology, Hemodialysis,
Oncology, Intensive Care, Psychiatry, Surgery (Open Heart and General),
Orthopedics,
1.2
The
hospitals services.
offer quality care through competent and reliable provision of
and
Outpatient
care,
observing ethical standards and respecting patients rights in the
performance of
functions and responsibilities and to maintain a high standard of the services
provided by
1.3
48Nursing
MODERN
HOSPITAL Nursing
Departments
believe
that
nursing, in
the
Departments
in orderService
to improve
delivery of
patient
care.
its broadest meaning, is a science and art that involves patient as a whole
body, mind,
and spirit, and contributes to the social, mental, and physical health by
caring, teaching,
and examples. The knowledge and skills of nurses should help people to care
for
1.4
The nursingservice
serviceindepartment
themselves at home, and maintain
a continuous
preventive,in
general:
curative, and
restorative program.
1.4.1 Participates with the organizational leaders in resource allocation
activities
relative to providing a sufficient number of appropriately qualified nursing
staff to
care for
the
patients.
1.4.2
Ensures
the continuous and timely available nursing services
to patients.
1.4.3 Develops, presents, and manages the nursing services portion of the
organizations
budget.
1.4.4 Implements the findings of current research from nursing and other
literature into
the policies and procedures governing the provision of nursing care.
1.4.5 Measures, assesses, and improves patient outcomes achieved through
the
development and implementation of nursing standards of patient care and
nursing
standards
of practice.
1.4.6
Assigns
responsibility to individual or groups of nursing staff members
to take
action to improve the nursing service performance.
1.5 As SGHG nursing service personnel, it is our aim to provide the best quality
and
quantity of nursing care for each patient. And through this, SGHG nursing
service
11
believes that:
Republic of
Yemen 48Modern
48
Hospital
1.5.1 The patient is the corner stone for nursing services. So all planning and
administration should be directed to meet his/her needs and contribute to
his/her best
outcome, rehabilitation, and to add to his knowledge about maintaining
his/her
health.
1.5.2
The plan for nursing service personnel should be on a continuous basis,
24-hoursa-day, seven days a week, and serving the out patient 10 hours per day.
Nursing
personnel need to consider long and short-term planning with the medical
staffThe
andnursing department has a major responsibility to maintain an
1.5.3
patients for
most effective health care delivery.
environment
that
is clean and conducive to recovery and safety. Each nursing personnel
makes a
contribution to the disease prevention by the way she carries her works
with patients
1.5.4
to assess
and study
and Nurses
family. are
Theexpected
work of the
nurse begins
withthe
thesocio-economic,
diagnosis of the patient,
psychological,
conditions ofand
illness, prescribed treatment and home long-term care.
emotional needs of people and to take steps to consider his/her needs
according to
these
facts.must
Then,
the plan
care
should
beprocedures
made.
1.5.5
Nurses
abide
withof
the
policies
and
to be the bases for
the
standards of services.
1.5.6 Appropriate supervision will increase or promote the fulfillment of the
purpose of
the individual and the group.
1.5.7 The total environment in the hospital should be conducive to teaching
and learning
for patients, visitors, and staff in the unit.
2 THE SGHG NURSING SERVICE PROFESSIONAL STAFFS MUST:
2.1 Go through the hiring processes, procedures, and credential
verifications by:
2.1.1 Checking the staffs educational work experience
backgrounds.
2.2 Consider the worth and dignity of
mankind.
2.3 Be aware of the basic needs of the
people.
2.4 Apply principles to promote feeling of mental and physical comfort, safety,
and respect.
2.5 Assist people to get the best results in sickness and
in health.
2.6 Have the attitude, knowledge, and skills to do quality
nursing care.
2.7 Develop plans to meet the needs of the
people.
2.8 Understand her role in the preventive, restorative, and curative program in
comprehensive health services.
12
Republic of
Yemen 48Modern
48
Hospital
2.9 Take responsibility for own personal and professional

growth.
2.10 Encourage others to take interest to learn and to maintain the social and
ethical values
in thinking and behavior.
2.11 Have the responsibility to delegate work to others that they can do safely.
She must
give necessary instructions and supervision of the work.
2.12 Supervision is necessary
for:
2.12.1 Evaluating the effectiveness of the nursing service
personnel;
2.12.2 The interim and annual evaluation to serve as
guidance;
2.12.3 Supervision to increase or promote the fulfillment of the purpose of
individual
and group;
2.13 In all the works that are done, we must learn to teach the patients,
visitors, and staff in
the unit. Good practices by the nursing personnel and staff development
programs affect
the morale and encourage on-going study. And also, it will improve the
attitudes and 3 SGHG NURSING SERVICE DEPARTMENT ORGANIZATION:
skills of nursing personnel.
3.1 There is an over-all Group Nursing Director who looks over the nursing
departments
of all Saudi German Hospitals in Jeddah, Aseer, Riyadh, and Madinah. The
Group
Nursing Director coordinates and provides consultative functions with all
nursing
3.2
There isof
a the
designated
Nursing
in every
Saudi
German aspects.
Hospital
directors
branches
on the Director
administrative
and
operational
branch who is
responsible for the over-all functions and professional operations of the
department. She
actively participates in an organizations leadership functions and
collaborates with other
leaders in the provision of care and services. The nursing director ensures
that
allNursing Director in every hospital branch has the authority and
3.3 The
nursing
service
staffs participate in the implementation of applicable
responsibility
to
processes
in
patient
ensure that the following functions are addressed and done:
care. Developing organizational patient care programs, policies, and
3.3.1
procedures that
describe how patients nursing care needs are assessed, evaluated, and
3.3.2 Developing and implementing the organizations plan for providing
met.
patient care.
3.3.3 Participating with leaders from the governing body and the
management in the
organizations decision-making structures and processes.
3.3.4 Responsibility for implementing effective ongoing programs to
measure, assess,
and improve the quality of nursing care delivered to the patients.
13
Republic of
Yemen 48Modern
48
Hospital
3.4 There is an Assistant Nursing Director, in collaboration with the nursing

director,
facilitates the smooth performance and provision of service by the
department. She takes
over
theis
responsibility
of the director of
nursing
on her
absence.
3.5
There
an assigned Nurse-Educator
and
a Clinical
Instructor
who are
responsible in
the orientation functions of the staff and in the administration of regular inservice
educations. Also they are responsible in the initiation of competency
assessment during
3.6
The
Quality Improvement
Nurse is responsible in the quality-related
the
orientation
period.
activities in the
department. She conducts periodic performance assessment and reviews
functions
performed by staffs in carrying-out nursing care procedures. Identified areas
of
deficiencies are studied and solutions are planned using the approved
scientific
methodologies
and effects
implementation
in coordination
with
the Director
3.7
There are Nursing
Supervisors
who work on
shifts, and are
responsible
in of
Nursing
the day-toand
hospital-wide
TQM.
day operation
of the
entire nursing population 24-hours a day. She performs
clinical and
administrative function from the level of head nurses down to the lowest
level.
3.8 The Head Nurses are the managers of the units. They are responsible in the
maintenance of the unit and in the direct care provision of patients admitted
in the unit.
She assigns patient responsibility among the staff in the unit and checks
individualized
plan of care formulated by the staff on their assigned patient.
3.9 There are Charge Nurses that act as pseudo-unit managers and take over
the
responsibilities of the head nurses on their absences.
3.10 The Staff Nurses are responsible in the provision of direct patient cares.
They perform
nursing processes and formulates plan of care specific to patient needs. Staff
nurses are
totally responsible for the outcome of care and services provided to patients
assigned to
3.11
Collaborating with the staff in patient care are the Nurse Aides, Porters,
them.
Receptionists, and Ward Secretaries who provides assistance in the
accomplishment of
the patients day-to-day needs.
3.12 The Nursing Department supports the Saudizaton of various healthcare
roles through
training of the young females Saudis and hiring them later as nurse aides,
porters, and
ward receptionists.
14
Republic of
Yemen 48Modern
48
Hospital
4 STRATEGIC PLAN FOR PROVIDING NURSING CARE:

4.1 Definition of Nursing Practice:
4.1.1 The 48 MODERN HOSPITAL Nursing Service Department employ nurses
according to the level of responsibilities and accountabilities. Positions are
according
to the staffs years of experience, skill levels, and educational attainment.
Applicants
are subjected through strict credentialing and privileging procedures. All
nursing
department staffs are required to undergo examination given by the Saudi
Council
Specialties and licensing by the Saudi Arabian Ministry of Health before
being
assigned with the technical nursing works. Inability to secure professional
licenses
prohibits the staff to perform technical works. The practice of
4.2 Standards of Nursing Practice
professional nursing
means the performance of acts requiring substantial specialized
knowledge,
4.2.1 The Nursing Service Department has developed written standards of
judgment, and skill based on the biological, physiological, behavioral, or
nursing
socio
practice that describe utilization of the nursing process to assess, plan,
cultural sciences as the basis for assessment, planning, implementation,
implement
andand evaluate patient care expected within the department. These
evaluationprovide
of the practice of nursing in order to maintain health and
standards
prevent
the basis by which the practice of nursing can be judged and measured.
complications.
The
standards are integrated into the departments
improvement
4.3quality
Standards
of Performance
program. The
Standards
of Nursing
Practice
are consistent
with thewritten
mission,
vision,
4.3.1
The Nursing
Service
Department
has developed
Scope
of and
values
of
Practice that
the
institution.
describes
levels of competencies for the various staff nurses roles.
Competencies are
measured upon joining and yearly thereafter. Combined with the Standards
of Care,
they provide the basis by which the quality of nursing practice can be
4.3.2
We assure
all our clients that nurses working at 48 MODERN HOSPITAL
monitored
and
areevaluated.
competentBased
to practice
intensive credentialing
and privileging
on thethrough
job descriptions,
Scope of Practice
has been
processes
developed that
andare
through
validation
of their competency
skills
by means
of orientation
specific
and measurable
and match the
expected
patient
outcomes.
and yearly
performance appraisal. Regular in-service education sessions are designed
where
5 SCOPESatisfactory
OF PRACTICE
OF A REGISTERED
NURSE:
staffs are scheduled to attend.
competency
assessment
results are
5.1
Care-givingassume
responsibility
for administer
helping clients
promote,
assurances
that nurses
staffs are
capable
to handle and
cares
to the
restore, and
patients.
maintain health wellness. Each client is viewed as unique entity and provides
holistic
care provision. Nurses address not only physiologic concerns but also
spiritual,
emotional, and social needs of the client. 15
Republic of
Yemen 48Modern
Hospital
48
5.2 Decision-making nurses identify obstacles in the promotion, restoration,

and
maintenance of health by choosing the best approaches to client care. They
are also
responsible in involving other members of the healthcare team and the
clients
5.3 Client-advocacy nurses are responsible in client protection by promoting
significant others in decision-making to ensure that sound choices are made.
safe
environments that facilitate the restoration of health. They are responsible
for thoroughly
understanding their clients health problems, histories, and potential
problems. They
5.4 consistently
Managing and
coordinating
nurses
are responsible
coordinating
all
take
responsibility
for protecting
clients in
and
helping them
activities
and legal
asserts their
treatments
that involve the clients. Their aim is to complete clients care
rights.
effectively and
efficiently
in a way
that is are
beneficial
to thefor
client
5.5
Communicator
nurses
responsible
communicating findings with the
healthcare
team in oral and written form critical in helping clients meet their healthcare
needs.
Nurses must be knowledgeable, articulate, and capable of effective written
and
5.6verbal
Educator Nurses educate clients about diseases, prevention, nutrition and
expressions.
healthy
behaviors by explaining treatments and procedures for which they are
responsible,
answers questions clients have,
and evaluates
the OF
progress
of CARE
clients towards
6 MODE
OF DELIVERY
PATIENT
health.
6.1 The mode of the delivery of patient care that is currently advocated is
Total Client
Care Delivery System. The nurse takes the patient as a person and aims to
meet his
individual needs by a plan that provide physical, psychosocial, and economical
care
6.1.1 With this model, each nurse is given the full responsibility for a client
according
or
group ofto the needs, that assists him, and rehabilitate him.
clients (3-5) depending on the acuteness of the condition. Assignments of
nurses are
based on patients acuity, number and type of patients, skills and
competency of the
6.1.2
However,
on cases
where
staffingand
status
low in relation
to patient
nurse.
The assigned
nurse
performs
fullyisresponsible
for all
aspects of
ratio,
care. nursing
unit utilizes Functional Method of Patient Care wherein specific nursing
function is delegated to a specific staff.
6.2 The unit managers plan the staffing pattern and the model of nursing care
delivery
system. Reports of the unit situation are given to the Director of Nursing who,
in turn,
studies the model of care delivery in the facility. This study is documented
and review of
the type of patient care is done at least on a yearly basis and adjusted
accordingly
depending on the patients care needs. Use of records related to
comprehensive nursing
16
care includes:
Republic of
Yemen 48Modern
48
Hospital
6.2.1 Nursing care plan

6.2.2 Day and night report
6.2.3 Kardex
6.2.4 Nurses notes
6.2.5 Nursing personnel
assignments
6.2.6 Comprehensive patient
assessment
6.2.7 Doctors orders
6.2.8 Discharge plan
6.3 The Nursing Director conducts periodical evaluation on the manner and
method of
patient assignments among nurses working in the unit. She ensures that such
assignment
is based according to his/her skill level and appropriate qualifications
consistent
with the
6.3.1 All nurses
should take examinations given by Saudi Council for Health
laws, regulations, and nursing licensing boards and considers the following:
Specialty
in order to qualify for MOH licensure.
6.3.2 Patient assignment should be based on the following
factors:
6.3.2.1 number of patients on the
unit
6.3.2.2 types of patient on the
unit
6.3.2.3 acuity (degree of sickness and the complexity of care) of
the patients
6.3.2.4 skill level of the nurse and his/her scope of current
practice
6.3.3 The Nursing Director maintains an adequate staffing level and
considers the
participation of the nursing staff on assigned committees and quality
improvement
projects
when assignments
are made.
6.3.4
The Nursing
Director ensures
that assignments of nurses working
outside his/her
usual work area is done safely on the following premises:
6.3.4.1 Skills and knowledge required in the assumption of the new
responsibilities
are taken into considerations.
6.3.4.2 A list of cross-trained staffs is posted in the nursing office for
reference.
17
Republic of
Yemen 48Modern
48
Hospital
CHAPTER
POLICIES
2
AND
PROCEDURE
S
18
Republic of
Yemen 48Modern
48
Hospital
NURSING
ADMINISTRATIV
E
POLICIES AND
PROCEDURES
19
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Manual: General Nursing Departmental Manual
Issued Effective: Replaces:
Title: Admission ProceduresDue for Review: Page 1 of 3
CONTENTS: This General Ward Internal Policy and Procedure (IPP) discusses about the
procedure of
admitting patients in the ward units.
1 DEFINITION:
1.1 Admission - a means of accepting patient in the hospital unit/area for observation,
treatment or
management of patients illness/disease condition.
1.2 Types of Admission:
1.2.1 Routine Admission the patient admission that may start from the Outpatient
clinic or
Emergency room, passing through the Admission and Discharge Office.
1.2.2 Emergency Admission - the admission of a client on an emergency basis. These
clients
present a condition which unless promptly treated on an inpatient basis would
cause the
following condition:
1.2.2.1 put clients life in danger
1.2.2.2 can cause serious damage to bodily function
2 PURPOSES:
2.1 To provide healthcare services that is not possible to be rendered at home or as an
outpatient.
2.2 For further observation, treatment or management of the patients presented
condition.
3 POLICIES:
3.1 Patient is admitted at anytime of the day passing through Admission/Discharge
Office.
3.2 Admission Advice Sheet is generated from Admission Office as a proof of acceptance.
3.3 Admission/Discharge Officer on duty informs the area where the patient will be
admitted.
3.4 Preventive isolation cases should be admitted in a single room.
3.5 On cases where patients cannot afford a first class rooms the following should be
observed:
3.5.1 ENT cases should not be placed in a room with febrile patients.
3.5.2 Pediatrics, obstetrics and gynecology cases should not be mixed with oncology
patients
or those undergoing chemotherapy treatments.
3.6 Every patient should have an individual medical file and PIN card.
3.7 Follow standard file arrangement.
20
Republic of
Yemen 48Modern
48
Hospital
PROCEDURES:
4.1 Check for Admission Advice Sheet, admitting documents, and PIN card.
4.2 Ensure proper identity of patient.
4.3 Accompany to the room assigned and make patient comfortable.
4.4 Provide hospital gown and assist patient in wearing it.
4.5 Orient the patient on the following:
4.5.1 how to access assistance such as call bell signal, telephone number, or other
electronic
alerting
4.5.2 physical environment and healthcare arrangements
4.5.3 basic care equipment
4.5.4 frequency of contact with care provider
4.6 Enforce hospital policy on valuables.
4.7 Obtain vital signs, height and weight as baseline information.
4.8 Identify the right patient:
4.8.1 Apply ID band on patients right wrist, unless contraindicated.
4.8.2 Put patients name on bed and outside room door.
21
Republic of
Yemen 48Modern
48
Hospital
4.9 Inform admitting/treating physician or his/her resident.

4.10Check and carry/out doctors order.
4.11Transcribe doctors order/treatment.
4.12Decrease the clients fear or anxiety through:
4.12.1 Establishing report and showing a willingness to listen.
4.12.2 Clearly defining the purpose and expectations of the admission.
4.12.3 Assisting the client to understand fully as possible in care-related decisions.
4.13Formulate Nursing Care Plan.
4.14Order diet through computer according to diet prescribed.
4.15Request medicines, laboratory or X-ray investigations through computer online (if
applicable).
4.16Inform Nursing Supervisor on duty. (If patient is critical, from OHU/ICU,
Septic/Isolation Case)
4.17Document properly:
4.17.1 Nursing Notes
4.17.2 Admission Assessment
4.17.3 Kardex
4.17.4 Medication
4.17.5 Record and Medication Card
4.17.6 Other Nursing Forms, as needed.
4.18Initiate discharge planning using the Patient Discharge Planning Assessment Tool.
REFERENCES:
5
5.1 LD Policy # 41.12
5.2 Fundamentals of Nursing, Ruth F. Craven, Constance J. Hirnle,
pp. 28
22
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Issued Effective:Replaces:
Title: Discharge of ClientDue for Review:Page 1 of 3
CONTENTS: This General Ward policy and procedure serves as a guideline in discharging
client.
1 DEFINITION:
1.1 Discharge refers to the process of activities that involve the patient and a team of
individuals
from various disciplines working together to facilitate the transition of that client
from one level
of care to another.
1.2 Types of Discharge:
1.2.1 Medically Advised (Routine) when the attending clinician considers that the
client no
longer requires in-patient care. The client may be transferred to another facility
for
ongoing care, or in most cases, discharged home.
1.2.2 Against Medical Advice (AMA) when the client / relatives request and insists
on
discharge and refuses further in-patient care despite clear explanation by the
attending
POLICIES:
clinician
the client
is for
notdischarge
ready for from
discharge.
3
3.1.There should
bethat
a written
order
the Attending Physician.
23.2.
PURPOSES:
A Discharge Form should be filled up completely by the nurse taking care of the
2.1 Encourage the patient/relative to participate actively in the nursing/medical treatment
patient
at home.
indicating all necessary information reflected in the form.
2.23.2.1.
To foster
a senseplanning
of belongingness
among
family
members.
Discharge
should start
from
the first
day of patients admission.
2.3 To ensure safety and continuity of care at all times.
3.2.2. A copy of the discharge form should be given to the patient/relative upon
discharge.
3.2.3. A patient/relative level of understanding on health education provided
should be reevaluated on their level of understanding.
3.2.3.1.Necessary information should be provided to the patient regarding
his/her
medication; safe use of medical equipment and self-care methods for
activities of daily living. All of these should be documented.
3.3.All necessary documents must be completed before discharge.
3.3.1. For discharge against medical advice:
3.3.1.1.Waiver for Discharge Against Medical Advice (Form M1019) should be
signed by the patient/relative witnessed by the attending physician or
resident on duty.
3.3.1.1.1. If patient is a minor and his relative still insist on DAMA, the
matter shall be referred to the following services: Clinician,
Social Worker and Medical Director to make reasonable attempt
to dissuade the patient / relative from DAMA or refusal of care.
3.3.1.2.The Chief of the Medical Operations (CMO) and the Nurse Supervisor
should be informed regarding patients desire to be discharged against
medical advice.
3.3.1.3.The treating doctor must fill up
23the dama form on the same day to be
submitted to the executive medical director by the nursing supervisor.
3.4.Remaining medicines of patient discontinued for use should be returned back to
Pharmacy.
Republic of
Yemen 48Modern
Hospital
48
3.5.No discharge should be done without Notification of Payment (Attached Form 4

M0027)
from
PROCEDURES:
Admission
& Discharge
Office.
5.1 Medically
Advised Discharge
3.6.for
infected
cases,
room
shouldregarding
be disinfected
as per infection control policies.
5.1.1 Inform client / relatives
discharge.
5.1.1.1 Carryout doctors order for medically

advise discharge.
EQUIPMENTS:
5
5.1.1.1.1 Once the Admission/Discharge
Office isor
informed
of the discharge, a
4.1 wheelchair
stretcher
4.2isconveyor
or trolley
patients
family member or the client
accompanied
by afor
nurse
aide/porter to
belonging.
the
Admission/Discharge Office to settle the payment and collect valuables
deposited, if any.
5.1.1.2 Request for clients take home medicines, when necessary.
5.1.1.2.1 Record in the discharge summary (Form M1193) and inform the ward
secretary to order take home medicines online, update charges, and
discharge from the computer.
5.1.1.3 Fill up Patient Appointment (Form 1103) and enter in the computer the
follow up
date and time of revisit in the Outpatient clinic and verified in the computer
under
doctors code.
5.1.1.4 Instructions regarding further care, medication and treatment, and follow
up revisit
should be clearly explained to the client / relatives as stated in the clients
discharge
form.
5.1.1.4.1 Hand over to client / relative the following :
5.1.1.4.1.1 Take home medicines
5.1.1.4.1.2 PIN card
5.1.1.4.1.3 Appointment slip
5.1.1.4.1.4 Discharge instructions
5.1.1.4.2 Let the client sign the filled up Release Claim for Indemnity (Form
M0191)
witnessed by the nurse.
5.1.1.4.3 Remove ID band before client leaves the room.
5.1.1.4.4 Arrange for porter, nurse aide, or a doorman to accompany the client
to the
hospital exit door via wheelchair or stretcher according to clients
condition.
5.1.1.5 Strip off used linen. Notify housekeeper to clean the room and record in
the
Discharge/Housekeeping record (Form M0134).
5.1.1.6 Prepare bedding and keep the room locked (for first class) to be ready for
next
admission.
5.1.1.7 Document in nurses notes the following observations.
5.1.1.7.1 Condition of client upon discharge.
5.1.1.7.2 Date, time and mode of discharge.
5.1.1.7.3 Accompanying person.
5.1.1.8 A copy of the discharge summary should be given to the client.
5.1.1.9 Discharge files will be double checked by the Head Nurse or Charge Nurse
and
returned by the Ward Secretary to Medical Records Department.
5.2 Discharged AMA / Refusal to Accept Care
5.2.1 Attending Clinician, Social Worker, CMO/Night Medical Director on duty shall :
5.2.1.1 make reasonable attempts to dissuade
the client / relatives from ama
24
discharge or
refusal to accept care.
5.2.1.2 explain the risks involved.
Republic of
Yemen 48Modern
48
Hospital
5.2.1.3 provide related education, as appropriate to the situation.

5.2.1.4 sign as witness if asked to do so.
5.2.1.5 if a client is a minor, incapable of giving informed consent, or in special
circumstances, suspicious situations.
5.2.1.6 attending clinician, social worker, cmo/night medical director on duty,
shall make
reasonable attempts to dissuade the relatives from ama discharge or
refusal to accept
care.
REVISIONS:
6
6.1 Discharge Form is utilized for the purpose of this policy and
procedure.
25
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Discharge PlanningDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure deals with the guidelines procedure
planning
patients discharge.
1.0 DEFINITION:
1.1 Discharge Planning - is the process of activities that involve the client and a team
of
individuals from various disciplines working together to facilitate the transition of
that client
from one environment to another. It includes a systematic process of assessing the
assets and
limitations of the client during hospitalization, planning for continuity in his/her
health care
upon discharge from the hospital, and coordinating needed individual, family,
hospital and
community resources to implement the discharge plan.
1.2 Extended Medical Care Level I are those services provided to clients who require
maintenance, medications, minimal laboratory/radiological support, rehabilitative
services,
nutritional support (e.g. oral, intravenous, or enteral feeds), continuous skilled
nursing care and
infrequent clinician intervention. This level of care is usually the after effect of
disease or
injury, or any medical condition requiring ongoing chronic care interventions.
1.3 Extended Medical Care Level II are those services provided to clients who have
unexpected acute care requirements (excluding mechanical ventilation) beyond the
parameters
stated in paragraph 1.2.
1.4 High Risk Discharge Clients comprise of those diagnosed with CVA, neurological
deficit,
3.0 POLICIES:
carcinoma or other debilitative, terminal or respiratory condition, dementia and
3.1 Discharge planning should start prior to admission (for planned admissions), or at
Alzheimers
the time
of
disease
and orthopedic cases with limited activities of daily living.
admission (for unplanned admissions).
2.0 PURPOSES:
3.2
patientstandards
and his/her
shall be planning
included which
in identifying
realistic
goalsand
and all
2.1The
To define
forfamily
collaborative
prepares
the patient
efforts
his/her family for
shall
be directed
towards and
helping
patient to achieve these goals.
discharge
from hospital
carethe
at home.
3.3
plan for patients
discharge
shall
be discharge
reassessed
at appropriate
intervals and shall be
2.2The
To identify
for
whom
planning
is critical.
documented
and unplanned re-admissions due to incomplete course of treatment or
2.3 To reduce
updated
in the clients medical record.
recourse
gaps and
3.4 prevent
Discharge
planning isadmissions.
critical when patient or his/her significant others are assessed
unnecessary
to have
2.4 To plan for better quality of life and health outcomes.
knowledge
deficit
regarding
the
condition,
and treatment needs.
2.5
To promote
integration
and
continuity
of prognosis,
care.
Conditions may
include:
3.4.1 Patients having deviations in growth
26 pattern.
3.4.2 Child with special needs.
3.4.3 Patients who have undergone surgical interventions.
3.4.4 Patients undergoing organ transplantation.
Republic of
Yemen 48Modern
Hospital
48
3.4.5 Psychiatric conditions.

3.5 Discharge planning shall be a multi-disciplinary and inter-disciplinary team
function.
3.6 The plan shall be a part of the patients medical record and shall be updated as
changes, due to
the patients condition, as indicated.
3.7 The process includes mechanics to foster continuity of medical and/or dental
aftercare to meet
patients needs and to initiate discharge planning on a timely basis.
4.0 RESPONSIBILITIES:
The discharge
of clients should be based on the client needs for continuity of care
4.13.8
Nursing
Unit staff:
wherein
the
4.1.1 Determine
the discharge needs of the client as part of the admission
family needs to be involved in the discharge planning process as appropriate to the
assessment
client needs.
using the Patient Discharge Planning Assessment Tool.
3.9
The Determine
client and the
family
are
with
clear follow
up
instructions
4.1.2
if the
client
is provided
high risk for
discharge,
and
then
initiate aat
Social
discharge
including
Worker
whenconsultation
to obtain urgent
care. patients home situation and the available support
to evaluate
services.
4.1.3 Plan for client and family education and ensure that they are able to assume
responsibility for self-care prior to discharge.
4.1.4 Obtain or coordinate necessary supplies/equipment that the client may need
at home
to do self-care.
4.1.5 Plans for patient and family education in preparation for discharge.
4.2 Attending Physician:
4.2.1 Conducts ward rounds to review client records.
4.2.2 Checks on discharge plans and appropriate attention to actual and potential
discharge problems.
4.2.3 Discuss with client sponsor or family the discharge plan.
4.2.4 Write order for either discharge home or transfer to other facilities.
4.2.5 A comprehensive discharge summary should be made that include the
following :
4.2.5.1 Reason for admission
4.2.5.2 Significant findings
4.2.5.3 Diagnosis
4.2.5.4 Procedure performed
4.2.5.5 Medications and other treatments
4.2.5.6 Client condition on discharge
4.2.5.7 Discharge medication and follow up instructions
4.3 Social Worker:
4.3.1 Interview the client/family to evaluate the home situation in preparation for
discharge and communicate with rehabilitation services, as necessary, for
information regarding the patients functional status and equipment
recommendations.
4.3.2 Counsel the family and prepare them to accept the patient upon returning
home.
4.3.3 Assist in making appropriate education of discharge instruction for the family
with
the help of the healthcare team.
4.3.4 Complete the social work service intervention in the interdisciplinary form.
4.4 Dietitian:
4.4.1 Make nutritional assessment using the nutritional scoring system and report
on
clients nutritional status, form of feeding, method of feeding, nutritional
intake,
nutritional requirements and any problem
with feeding.
27
4.4.2 Instruct and educate the client and/or family in therapeutic dietary needs
ordered by
the clinician.
Republic of
Yemen 48Modern
48
Hospital
Assists the client in planning for his/her diet so that cultural and religious
4.4.3
customs
can be maintained.
4.4.4 Interprets how and when the client can substitute cultural foods in
therapeutic diets.
4.4.5 Documents in the clients file and diet instructions given to the client on the
order of
the attending clinician.
4.4.6 Anticipate and recommend what diet and tests will be needed after
discharge/transfer as part of the follow up nutrition reassessment plan.
4.5 Nursing Administration:
4.5.1
Ensures
that discharge planning is a part of everyday care given by nursing
4.6
Physical
Therapist:
staff. 4.6.1 Evaluate clients needs for rehabilitation related special medical item such
as
wheelchairs, splints, pressure garments or adaptive equipment in order to
maximize
client function.
4.6.2 Teach client and their families the exercise / activities of daily living and
skills
needed to function effectively and independently within the limitations of
their
disability.
28
Age
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Circle all that apply and total the score. Refer to the Risk Factor Index at the
bottom.
Name of Patient:__________________________ ____Age:__________ Attending Physician:___________________
Chief Complaint/s:________________________ Diagnosis:_____________________ Room No.:________________
0=55 years or less
1=56 to 64 years
2= 65 to 79 years
3= 80+ years
Living Situation/Social Support
0 =lives only with spouse
1 = Lives with family
2 = Lives alone with family support
3 = Lives alone with friends support
4 = Lives alone with no support
5 = Nursing home or residential care
Functional Status
0 = Independent in activities of daily living and
Instrumental activities of daily living
Dependent in:
1 = Eating/feeding
1 = Bathing/grooming
1 = Toileting
1 = Transferring
1 = Incontinent of bowel function
1 = Incontinent of bladder function
1 = Meal preparation
1 = Responsible for own medication
administration
1 = Handling own finances
1 = Grocery shopping
1 = Transportation
Cognition
0 = Oriented
1 = Disoriented to some spheres, some of the
time
2 = Disoriented to some spheres all of the time
3 = Disoriented to all spheres some of the time
4 = Disoriented to all spheres all of the time
5 = Comatose
Behavior Pattern
0 = Appropriate
1 = Wandering
1 = Agitated
1 = Confused
1 = Other
Mobility
0 = Ambulatory
1 = Ambulatory with mechanical assistance
2 = Ambulatory with human assistance
3 = Nonambulatory
Sensory Deficit
0 = None
29
Republic of
Yemen
1 = Visual or hearing deficit

48Modern
48
2 = Visual and hearing
deficit
Number of Previous
Admissions/Emergency
Room
Hospital
Visits
0 = None in the last 3 months
1 = One in the last 3 months
2 = Two in the last 3 months
3 = More than two in the last 3 months
Number of Active Medical Problems
0 = Three medical problems
1 = Three to five medical problems
2 = More than five medical problems
Number of Drugs
0 = Fewer than three drugs
1 = Three to five drugs
2 = More than five drugs
TOTAL SCORE:__________
Risk Factor Index:
Score of 10 = at risk for home care resources; score of 11 to 19 = at risk for extended discharge
planning; score
grater than 20 = at risk for placement other than home. For score 10 or greater, refer the patient to the
discharge
planning team.
30
Republic of
Yemen 48Modern
4. PROCEDURES:
48
Hospital
48 MODERN HOSPITAL
Title: Transfer of ClientDue for Review:Page 1 of 3
CONTENTS: this general ward policy and procedure discusses about the system
implemented in
transferring of p patient from one unit to another or from SGH to other hospital.
1DEFINITION:
1.1 Transfer - a systematic process of handing over patient from one unit/hospital
to
another for continuity of medical/nursing care management.
1.2 Types:
1.2.1 Within the Hospital:
1.2.1.1. Transfer Out - transfer of patient from one unit to another.
1.2.1.2.Transfer In - transfer of patient to the unit from another.
1.2.2 Hospital to Hospital:
1.2.2.1. Transfer From - transfer of patient coming from another health care
facility
to SGH, considered as admission (to follow admission process).
1.2.2.2. Transfer To - transfer of patient to another health care facility, this
follows
the discharge process.
2. PURPOSES:
2.1For continuity of care.
2.2 To support patients treatment that needs life-saving equipment/machines.
2.3 For further medical/nursing observation and management.
2.4 For patient convenience (proximity of the residence).
3. POLICIES:
3.1 Transfer order should be documented.
3.2 Prior information to the receiving unit/hospital should be provided. Doctor to
doctor for
hospital to hospital transfer and nurse to nurse communication is needed for
patient transfer
within the hospital.
3.3 Proper endorsement of patients condition is given to the receiving nurse.
3.4 Discharge and Transfer Form (Form M1196) should be properly accomplished
filling up
all necessary documents.
3.5 For Hospital Transfer:
3.5.1 Original copy of Discharge/Transfer Summary (Form M1196) should be
signed
and handed over to the receiving nurse and a copy should be kept to clients
file in our
Hospital.
3.5.2 Client is escorted by a nurse via SGH ambulance.
3.5.3 For critical case, a nurse and doctor shall accompany the client.
3.5.4 Safety measures should be followed.
4.1 Obtain a written order prior to transfer. In emergency situation, documentation could be
31
Republic of
done later.
Yemen
48Modern
48
4.2 Explain
to client/relatives
regarding the transfer and prepare client physically.
4.3 For Hospital
to Hospital Transfer :
Hospital
4.3.1 Obtain a written acceptance from the receiving hospital.

4.3.2 Arrange for ambulance conduction through Emergency Room.
32
Republic of
Yemen 48Modern
48
Hospital
4.3.3 Ask client or relative to settle account in Admission/Discharge Office

after
charges are updated by Units Ward Secretary.

4.3.4 Inform the Nursing Supervisor and Medical Director on duty about the
transfer.
4.4 For Internal Hospital Transfer:
4.4.1 Inform verbally the following areas:
4.4.2 Admission & Discharge Office to change room in the directory and
update
record.
4.4.3 Telephone Operator to close telephone line of the previous room and
open the
line of the room where client is transferred.
4.4.4 Receiving area to prepare the room for transfer.
4.4.5 Fill up and distribute copies of Transfer of Client Form M1090
(excluding
special areas).
4.5 Inform Ward Secretary to update charges.
4.6 Assist in collecting clients belongings. If client is unconscious and without
any relative,
No Valuables Received, should be filled up and endorsed to the receiving nurse.
4.7 Assemble the file and other pertinent records.
4.8 Transport client by wheelchair, stretcher or bed, according to his/her
condition.
4.9 Proper
documentation should be followed. Complete and accurate
5.0 SPECIAL
CONSIDERATIONS:
endorsement
to the
5.1. Transfer of client
from isolation area to general ward.
receiving
nurses
should
done.
5.1.1 Give the client
a fullbe
bath.
4.10
Receiving
nurse
should
for complete documents, physical condition of
5.1.2 Gown and linens should check
be changed.
the
client,
5.1.3 Dressing (if there is) should be done.
and personal
belongings
(if to
client
is the
unaccompanied
by relative).
must
5.1.4
Instruct the
floor staff
bring
bed to transfer
the client He/she
from isolation
clarify from
bed.
endorsing
nurse if in doubt of anything related to the client management.
5.1.5
For procedure
5.1.5.1 Client with airborne/droplet infection should wear mask
5.1.5.2 Instruct the housekeeper to clean the bed or prepare a clean bed to
transfer the
client
5.1.5.3 Change the linens/gown if soiled
5.1. Ensure that the staff who are transferring client from isolation area should wear
protective
apparel according to type of infection the client is suffering from.
5.2. Transfer of client with specific precautions.
5.3. The movements of clients under isolation should be limited, and when transported
appropriate
barriers should be used.
5.4. The personnel in the receiving unit should be informed and of the precautions to be
taken.
5.5. Educate the client in which ways she/he can help in preventing the spread of
infectious
microorganism while she/he is out of the room.
6.0 REVISIONS:
6.1 Previous policy title Transfer of Patient is changed to Transfer of Client.
6.2 Revised Transfer Form Policy (M1196).
33
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Answering Telephone CallDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure deals with the procedure of answering
telephone
calls.
1.0 DFEINITION:
1.1 Answering of Telephone Calls- the professional manner/conduct of receiving
incoming
telephone calls observing the hospital telephone protocol
2.0 PURPOSES:
2.1 To facilitate ease of communication.
2.2 To receive inter/intra department/unit call.
3.0 POLICIES:
3.1 Telephone call should be answered after 2 rings.
3.2 Telephone protocol should be followed. See attach telephone protocol.
4.0 PROCEDURES:
4.1 Answer the telephone after 2 rings.
4.2 Greet by saying hello, tell your department, introduce yourself and say may I
help you.
4.3 Speak in a clear, well-modulated voice.
4.4 Listen attentively on the messages that are being delivered by the sender, jot
down notes if
needed.
4.4.1 Confirm the correctness of the message received by repeating the
information given.
4.4.2 Identify name of the calling party.
4.5 After the conversation is over, end by saying Goodbye or Bye.
4.6 Put the telephone down properly, making sure you dont bang it.
5.0 SPECIAL CONSIDERATIONS:
5.1 If the message is to be relayed to another person, ensure that communication is
passed on
correctly to the proper person.
5.2 Secrecy or confidentiality of the issue is observed when needed.
34
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Clients Identification BandDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure deals with the guidelines on the use
and
application of waterproof ID band to all admitted patients in the unit.
1.0 DFEINITION:
1.1 Identification band - a waterproof material applied on the patients wrist for
proper
identification.
1.2 ID band for the NewBorn bears the mothers name and PIN, with the date, time,
and sex
of the baby immediately after birth.
1.3 Pediatric ID band - contains the patients correct name and identification number.
2.0 PURPOSES:
2.1 For safety of patient at all times.
2.2 For proper identification.
3.0 POLICIES:
3.1 Every admitted patient should have an ID band applied.
3.2 ID band is applied securely (neither tight nor lose):
3.2.1 Adult - right wrist, unless contraindicated. (as long as it is not
interfering in
the gadgets or treatment)
3.2.2 Pediatric - right wrist or right lower leg with the use of Pediatric size
ID band.
3.2.3 Newborn - 2 ID bands are applied on both legs immediately after birth
in the
delivery room with corresponding mothers name and PIN and one (1) ID
band
applied in the newborn department at the right wrist bearing the mothers
name and
PIN of the baby.
3.3 In case of multiple births, a corresponding number should be written in the ID band
according
to their sequence of delivery.
3.4 ID band should be applied in the Delivery Room immediately after neonatal
resuscitation.
4.0 PROCEDURES:
3.5 ID band should bear the complete name and PIN of patient that should be clear and
4.1 Upon admission collect patients PIN card and prepare the ID band.
readable.
4.2 Write patients PIN card on paper tab provided inside the ID band. (Paper tab is
3.6 Gender, date and time of delivery are identified on the ID band, which is applicable
secured
to
with plastic included in ID band.)
newborns only.
4.3 Insert back the paper tab inside the plastic and seal to prevent spoilage and
3.7 Every staff should check and counter-check patients ID band before doing any
tampering.
procedure or
4.4 Identify the right patient. Confirm patients full name and compare with records
bedside care.
before
3.8 It is removed by the Nursing staff upon discharge only upon confirmation of the
applying ID band on the wrist.
correct
4.5 Apply ID band as per the policy. Do not fasten too tight or too loose.
identity of the mother.
4.6 When administering medication, procedures and other related nursing care,
identify
35
correctly the clients name against the ID band.
Republic of
Yemen 48Modern
48
Hospital
4.7 For newborn, check the ID band attached on the right arm where babys
permanent PIN is
written against the file and/or medication card embossed with the PIN.
4.8 Upon discharge, remove patients ID band before leaving the room.
4.8.1 For post partum mother:
4.8.2 ID band is retained with the mother and to be removed only by the
Newborn Unit
staff upon claiming the baby.
4.8.3 If the mother is discharged without the baby, instruct the mother to
keep her ID
band and present it to the NewBorn Unit staff when she will claim the baby.
4.9 For newborn, upon discharge remove the 2 ID bands attached to both legs
simultaneously
with the mothers ID band on her wrist. Correctly identify the mothers name and
PIN printed
5.0
CONSIDERATIONS:
onSPECIAL
the tag against
the tag of the newborn. Both ID bands should match the
5.1
For
patient
mothers name
and treated in Emergency Room staying 1-4 hours for ER-OR or; for
observation,
PIN.
should have ID band applied, plus a bed tag with proper identification.
5.2 Never let discharged client go home with ID band still attached to the wrist or leg
except
for identical twins where one (1) ID band will be retained on the leg until the parents
can
identify the twins properly.
36
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Code Blue ProceduresDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure deals with the guidelines during Code
Blue
procedures.
1.0 DEFINITION:
1.1 Code Blue the term used over the public address system to summon assistance
for
patients with impending or in cardiorespiratory arrest.
2.0 PURPOSES:
2.1 To ensure that the patient receives optimum emergency care.
2.2 To effectively manage the flow of team members and intervention in an
emergency
situation.
2.3 To prevent irreversible brain damage by restoring effective circulation within 4
minutes.
3.0 INDICATION:
3.1 For all patients who have cardiorespiratory arrest.
4.0 EQUIPMENTS/SUPPLIES:
4.1 Crash cart with:
4.1.1.Defibrillator
4.1.2 Emergency medicines
4.1.3 Oxygen with O2 devices
4.1.4 Suction machine with suction tube
4.1.5 Cardiac board
5.0 POLICIES:
5.1 All staff must be aware regarding the assigned number for code blue.
5.2 Crash cart items and medicines should be kept in each respective drawer. (Refer
for
Standard Crash Cart Checklist) Ensure completeness.
5.3 Crash cart should be checked every shift.
5.4 Crash cart items and medicines should be replaced immediately after each use.
5.5 Assigned nurse for the crash cart checking should be the one responsible to bring
the crash
cart to the site of the code blue.
5.6 Hospital infection control policy should be followed.
6.0 PROCEDURES:
5.7.All members of the Code Blue Team should have ACLS training.
6.1 Assigned Nurse
5.8 Code blue should not be initiated for patients with DNR (Do Not Resuscitate)
6.1.1 Nurse who discovers should ensure that the client is
order.
6.1.1 Unresponsive
5.9 Each member of the Code Blue Team should be aware of their responsibilities.
6.1.2 No breathing
5.10 Patients safety should be observed during the procedure and transfer.
6.1.3 No pulse in carotid or femoral artery
6.1.2 Call for help either:
6.1.2.1 Dial 12, identify yourself and state the exact location of code
blue.
6.1.2.2 Press the emergency call bell.
6.1.2.3 Tell the relative (if there is) to summon for help.
6.1.3 Position the client in supine, remove pillows and headboard.
37
6.1.4
Republic
Initiate 1 rescuer
of CPR while waiting for the code blue team to arrive.
6.1.5 Open airway (head tilt chin lift maneuver).
Yemen 48Modern
48
6.1.6 Assess for breathing (look, listen & feel) 10 seconds.
Hospital
6.1.6.1
Give 2 initial ventilation (1second each) with the aid of an ambu
bag
6.1.6.2 Attach connecting tubing from flow meter and nipple adapter to
resuscitation bag.
6.1.6.3 Turn oxygen flow meter to 8L/min. Attach reservoir bag to
resuscitation
bag.
6.1.6.4 If not contraindicated, tilt back patients head or raise on a pillow to
better
achieve a sniffing position.
6.1.6.5 Insert an oropharyngeal airway to keep clients mouth open and
prevent
airway obstruction that maybe caused when the tongue falls back.
6.1.6.6 Use proper size oxygen mask and apply it over the clients mouth
and nose.
6.1.6.7 Support the mask with your left hand and compress the bag with
your right
hand.
6.1.6.8 Check carotid pulse (10 seconds).
6.1.6.9 Locate the area (lower half of the sternum) and start giving
compression and
ventilation at 30:2 ratio.
6.1.6.10 Check pulse after 2 minutes, if no pulse continue CPR until the
help arrive.
6.2 Nurse assigned for crash cart
6.2.1 As soon as the code blue is announced by the operator, crash cart
should be
brought to the location of the code blue.
6.2.2 Put the cardiac board at the back of the client.
6.2.3 Connect ambu bag to oxygen and apply to the client.
6.2.4 Assist in 2 rescuer CPR with 30 : 2 ratio until the Code Blue Team arrive.
6.2.5 Connect client to cardiac monitor.
6.2.6 CPR will be continued by the Code Blue Team as soon as they arrive.
6.3 Assigned Nurse
6.3.1 Will give a brief information to the Code Blue Team regarding the
diagnosis and
the condition of the client prior to code blue.
6.3.2 Keep vein open by starting IVF according to clients condition.
6.3.3 Take blood pressure and do suction as needed.
6.4 Code Blue Team function as follows:
6.4.1 Cardiologist
6.4.1.1 Continue with chest compression
6.4.1.2 Order emergency medicines
6.4.1.3 Monitor cardiac status of the client
6.4.1.4 Apply external defibrillator if indicated with specified number of
joules.
6.4.2 Anesthesiologist
6.4.2.1 Continue ventilation (ambu bag)
6.4.2.2 Intubate if needed and maintain client airway
6.4.2.3 Establish and maintain IV access if none
6.4.3 ICU Nurse
6.4.3.1 Assist the anesthesiologist in intubation
6.4.3.2 Administer emergency medicines as prescribed.
6.4.4 Nursing Supervisor
6.4.4.1 Document in Mock/Real Code and Cardiopulmonary Evaluation
form.
6.4.4.2 Obtain additional equipment and help as necessary.
6.4.4.3 Clear the room of all personnel who are not involve in the Code
Blue
38
Team.
6.4.4.4 Communication with clients family.
6.4.5 Head Nurse/Charge Nurse
Republic of
Yemen 48Modern
48
Hospital
6.4.5.1 Assist the Code Blue Team

6.4.5.2 Observe the performance of nursing staff
6.4.5.3 Control the flow of work in the unit
6.4.5.4 Inform and facilitate transfer of client to ICU or OHU (if needed)
6.4.6 Assigned Nurse
6.4.6.1 Assist in the transfer of client
6.4.6.2 Documents all event accurately in the nurses notes
6.4.6.3 Endorse client to receiving nurse
6.4.7 Biomed Engineer
6.4.7.1 Standby for any malfunction of the machine.
6.4.8 X-Ray Technician will be called if needed.
6.4.9 Respiratory Therapist
6.4.10 Pharmacist should be ACLS certified
6.4.11 Security Guard
6.5 As soon as the client is stabilized, client is transferred to ICU/OHU per order of
cardiologist/anesthesiologist accompanied by the Code Blue Team.
6.6 Document the following
6.7 Time when and person who discovered code blue.
6.8 Time CPR was initiated.
6.9 Time of arrival of the Code Blue Team and management done.
6.10 Medications given.
6.11 Observations made.
6.12 Time of transfer and condition of client upon transfer.
6.13 Charge the medicines and supplies used.
39
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Doctors OrdersDue for Review:Page 1 of 4
CONTENTS:This General Ward policy and procedure of 48 MODERN HOSPITAL serves as
guidelines in receiving doctors orders in whatever forms.
1 DEFINITION:
1.1 Doctors Orders - Are prescribed treatments/procedures given by the Attending
Physician
according to the patients condition.
1.1.1 Mode:
1.1.1.1 Written Order - treatments/Procedure documented in the Doctors Order
Sheet
(Form M1043).
1.1.1.2 Verbal Order - treatments/Procedure verbally stated or instructed on
emergency
cases only.
1.1.1.3 Telephone Orders - treatments/Procedure being conveyed by the Attending
Physician over the phone (in emergency situation).
1.1.2 Types:
1.1.2.1 Standing - an order that is carried out as specified until it is discontinued
or
cancelled by another order.
1.1.2.2 Single - an order that is carried out only once, at a time specified needed
by the
patient.
1.1.2.3 Stat (Latin word statim meaning immediately) a single order but one
that is
carried out at once.
1.1.2.4 prn (Latin word pro re nata) an order, which is carried out when patient
requires it. It does not indicate a specific time of administration of
medication.
2 PURPOSES:
2.1 To serve as legal document to support clients health treatment during his/her
hospitalization and
to protect the health personnel.
2.2 To provide guidelines in treatment or management of client.
2.3 To provide validation for clinicians order given verbally or by telephone.
40
Republic of
Yemen 48Modern
Hospital
48
POLICIES:
3.5 All doctors order should be documented in the patients file.
3.5.1 Written order should:
3.5.1.1 bear the date and time
3.5.1.2 include complete description or instruction
3.5.1.3 be clear and legible
3.5.1.4 duly signed by the attending physician
3.5.2 Verbal/telephone order is given and received only during emergency situation.
3.5.3 Telephone order is given and received only when the doctor is unable to come
and assess
the client.
3.5.3.1 Telephone orders should be received by two (2) RNs. A verification readback of the
entire order to the physician is done by the person/s receiving the order.
3.5.3.2 To exclude telephone order on radiology, laboratory investigations and
procedures.
3.6 The physician should sign verbal/telephone orders within 24 hours.
3.7 When receiving doctors orders, nurses accept only approved list of abbreviations
and
41
standardized approved drip preparation for parenteral medications such as heparin,
etc.
3.8 Nurses check with the physicians for any medication orders that are not clear.
Republic of
Yemen 48Modern
Hospital
48
3.9 In addition to the standard abbreviations approved for use in the hospital
prescribing doctors
should be prompted when using the following abbreviations in order to avoid error in
Resolutions
the
Rationale
transcription. Write unit
Abbreviations
Mistaken
Write international unitas 0 or cc
U
Mistaken as IV or 10
Write daily
IU
(International
Unit)
Mistaken
Write every other
day for QOD
QD
Mistaken
QD
Do not write zero
by itselffor
after
QOD
Decimal
point
is
decimal point.
Trailing zero (X.0mg)
Decimal point is missedAlways writemissed
a zero before a
decimal point
Lack of leading zero (.Xmg)
Confusion between Morphine Write morphine
sulfate
and Magnesium
MS
Confusion between Morphine Write morphine
MSO4
sulfate
MgSO4
and Magnesium
Confusion between Morphine Write magnesium
Ug
sulfate
Cc
and Magnesium
OD
Mistaken for mgWrite mcg
Mistaken for UWrite ml
Mistaken for each other: daily Write daily or
3.10When dealing with medication dosages, a zero should always precede a decimal
right eye
point right
(0.5mg)
for
versus
eye
clarity.
3.11Doctors orders should be read and reviewed by a registered nurse.
3.12Orders that are not clear or doubtful should be clarified before carrying out.
3.13The assigned registered nurse should carry out every order immediately;
checks/counterchecks
and draws a line on the space after the last order and sign as the order is carried out
on the space
PROCEDURES:
4
provided.
4.1 On Routine Orders (written)
4.1.1 Treating physician writes the order on the doctors order sheet Form M1043
with date and
time. Ordering doctor duly signs the order.
4.1.2 Nurse reads and interprets immediately the doctors order and clarifies if
needed.
4.1.3 Nurse carries out and processes the order as required.
4.1.3.1 Tick () every order to ensure that it is done and nothing is left unnoticed.
4.1.3.2 Transcribe or update orders to kardex, treatment sheet and medication
card.
4.1.4 Ensure that orders are implemented as:
4.1.4.1 Medication and treatment (Refer to policy of Medication Preparation and
Administration)
4.1.4.2 Procedure order process should be entered in the computer (X-ray, lab)
4.1.4.3 Diet entered to computer
4.1.4.4 Nurse executing the order should affix his/her name legibly with date and
time
carried out
4.2 Verbal Order:
4.2.1 Registered nurse transcribes the order directly in the doctors order sheet by
indicating the
42
date, time, and complete order and writing V.O. (verbal order) and writes the
name of the
ordering doctor countersigned by the receiving nurse.
Republic of
Yemen 48Modern
48
Hospital
Receiving nurse confirms that the order is taken correctly by repeating,

reading again the
4.2.2
order to the clinician.
4.2.3 The nurse makes a follow up with the clinician to countersign the order in the
file within
24 hours.
4.2.4 Any verbal order not signed by the clinician within 24 hours should be
informed to the
nursing supervisor.
4.2.5 For any dubious order (eg. Medication dose wrongly ordered), nurse verifies it
to the
ordering clinician.
4.2.5.1 If the clinician insists to administer the dubious medication order, the
nurse should
refer the case to the nursing supervisor and/or to the CMO, when necessary.
4.2.5.2 The nurse should not administer unclear or doubtful medication order.
4.3 Telephone Order:
4.3.1 Two (2) registered nurses should receive telephone order, with one to serve as
a witness
to the veracity of the order.
4.3.1.1 When there are no available 2 nurses to take the telephone order, the
nurse will
inform the prescribing clinician to call back again to give the order. The
nurse will
call for the nursing supervisor or another nurse to witness the order.
REFERENCES:
4.3.2 Like in receiving verbal order, the registered nurse transcribes the order 5
5.1directly
Fundamentals
in the of Nursing, Human Health and Function, Ruth F. Craven, Constance J.
Hirnle, pp. doctors order sheet by indicating the date, time, and complete order and
518-520.
writing T.O.
(telephone order) and writes the name of the ordering doctor countersigned by
the
receiving nurses.
43
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Manual: General Wards Policies and Procedures

Title: Informed ConsentDue for Review:Page 1 of 3
CONTENTS: This General Ward Internal Policy and Procedure discusses about one way of
supporting
patients rights through informed consent.
1 DEFINITION:
1.1 Informed Consent - an individuals freely given agreement to examination, treatment,
procedure or an act of care based on information about, and an understanding of what
is proposed.
1.2 Types:
1.2.1 General Consent a general consultation and treatment not covered by consents
under
1.2.2. to 1.2.4
1.2.2 Surgical Consent (Form M1025) for surgical procedure.
1.2.3 Therapeutic/Diagnostic Procedures (Form M1141) for hazardous invasive
treatment or
diagnostic procedure.
1.2.4 High Risk Consent (Form M0102) for cases that is done as life-saving treatment
and there is
a great chance of loss or complication.
2 PURPOSES:
2.1 To protect patient against unsanctioned practice.
2.2 To protect hospital against claim.
2.3 To respect patients autonomy.
POLICIES:
3
2.4 To
act in patients best interest.
Every
patient
should have
an informed
the following
2.5 To3.1
serve
as legal
document
on patients
claimconsent
againstunder
the hospital
or its practitioner
guidelines:
especially
on
3.1.1 General
medico-legal
cases. Admission
3.1.2 Surgical Consent
3.1.2.1 Surgical cases requiring simple anesthetic intervention
3.1.2.2 Incision
3.1.2.3 Cystoscopy
3.1.2.4 Paracentesis
3.1.2.5 True Cut Biopsy
3.1.3 High Risk Consent
3.1.3.1 Major Surgery under general anesthetic
3.1.3.2 Arteriogram
3.1.3.3 Angiogram without or with using dilators or catheters
3.1.3.4 Bone marrow aspiration
3.1.3.5 Insertion of central lines
3.1.3.6 Hemodialysis
3.1.4 Therapeutic/Diagnostic Procedures (Form M1141) such as:
3.1.4.1 Blood and blood products infusion
3.1.4.2 Fine Needle Aspiration (FNA)
3.1.4.3 Interventional X-Ray procedure, e.g. draining an abscess under CT
Guidance
3.1.4.4 CT examination with or without contrast
3.1.4.5 Epidural injections and anesthesia
44
Republic of
Yemen 48Modern
Hospital
48
3.1.4.6 Receiving Hemotherapeutic and radio-active material including radiation

and cobalt
therapy
3.1.4.7 Blood Transfusion
3.1.4.8 Other diagnostic and therapeutic interventions
3.2 The informed consent form which is written in English/Arabic shall be used with the
required
procedure written on it by the treating doctor in a language understand by the
patient with
translation in English for other healthcare providers to know what is the procedure to
be done.
3.3 It is primary responsibility of the Treating Doctor to explain according to patients
and relatives
level of understanding the contents of consent and procedure to be done before
signature is
obtained.
3.4 Patient must sign on the consent together with the accompanying relative and
treating doctor (as
witnesses).
3.4.1 Patients signature indicates understanding and agreement to its contents.
3.4.2 It is a must for two (2) witnesses to sign in which one of them should be the
Treating
RESPONSIBILITY:
Doctor
for reference
to a legal documentation.
4.1 Treating
Doctor
shall be responsible
to:
4
3.4.3
If
patient
is
a
minor,
illiterate
unconscious
(thus unable
to sign), the
4.1.1 Write on the Consent form andorexplain
the procedure
in a language
understood
available
relative
by
the
or
designee shall sign on his/her behalf specifying the relation to the patient
patient.
after
4.1.2 Translate the procedure to be done in English, if it is written in different
his/her identification documentation such as iqama.
language presenting
so that
3.4.4
If
no
relative
is available
of patients
condition),for
he/she
shall put
other healthcare
providers (regardless
will understand
as it is necessary
patients
his/her
preparations.
right/left
thumb-mark
onpatient
the space
for signature
assisted by the
nurse
4.1.3 Get
the signature
of the
andprovided
one witness
i.e. the accompanying
relative
taking
care
and to sign
of consent
the patient.
the
form as the other witness.
4.2 The Nurse assisting the doctor in the clinic or in-charge of the patient in the ward
shall be
PROCEDURES:
responsible to:
5.14.2.1
Emboss
patients
PINcard
cardisfor
identification
on the
consent
Ensure
the PIN
embossed
on space
provided
onform.
the Consent form.
5.24.2.2
Fill-up
the required
data patient
i.e. the date
andthe
room
number
(if inpatient).
Identify
the correct
against
Consent
Form.
5.34.2.1
AfterDouble-checking
the doctor fill upall
his/her
part, patients
signature
is obtained
with relative
5and
information
on the consent
form
and to remind
the doctor,
treating
doctor
if
signing
on the consent:
information
provided is deficient.
5.3.1 If patient uses thumb-mark, identify which hand-side (left or right thumb).
5.3.2 If a relative sign on behalf of the patient, identify relation to the patient
according to the
identification documentation presented.
5.3.3 Female above 18 years of age may sign her consent in accordance with Saudi
Law.
5.3.1 In case of a male designee signing the consent for a female patient, the female
patient
should sign also or put her thumb-mark.
5.4 Double-check accuracy of all information on the consent form including translation
into English,
if the language is written in other language.
5.5 Include the completed consent form in the patients file to be endorsed to the area
of service where
45
the intervention is to be done i.e. Operating Room or X-Ray Department.
5.5.1 If consent is executed from OPD or ER (depending on who admitted the
patient), the
Republic of
Yemen 48Modern
48
Hospital
Consent should be included in the admission file of patient to be endorsed to the

ward.
5.5.2 If consent is executed in the ward itself, it should be automatically included in
the
patients chart.
5.6 In the service area where the procedure should be done, the receiving staff should
countercheck
the informed consent for accuracy and completeness on:
5.6.1 Pertinent information needed.
5.6.2 All signatories as required
SPECIAL CONSIDERATIONS:
6
6.1 Nurse in charge of patient is responsible to check patients consent and to follow up
completion if
not properly filled up with correct data including English translation and signatures.
6.2 The procedure stated in the consent form shall be checked by receiving staff against
the requested
procedure to verify correct procedure.
6.2.1 Receiving staff i.e. in Operation Room shall notify the area of concern for any
discrepancy on the consent form before proceeding.
7
REFERENCES:
7.1 Informed Consent, p. 109-110
The Lippincott Manual of Nursing Practice 7 th Edition
7.2 LD.16 Informed Consent
46
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Patients ConfidentialityDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure discuss the guidelines and practices in
the
protection of confidentiality and all accompanying information concerning the patient and
his/her health,
social and psychological conditions.
1 DEFINITIONS:
1.1 Patients Information information contained in the medical records, or being given
verbally. It
includes related information of the patient, diagnosis, management and interventions,
diagnostic
examinations done, treatment prognosis, and other relevant data.
1.2 Patients Confidentiality protection of patients information given either written or
verbally.
2 PURPOSES:
2.1 To provide security for all information concerning patient and his/her family.
2.2 To maintain anonymity of the patient.
2.3 To serve as guidelines that ensures confidentiality of patients information.
2.4 To protect patients records from any possibility of loss or misuse.
3 POLICIES:
3.1 Patients File:
3.1.1 Only authorized members of patients caregivers should have an access to the
patients
file.
3.1.2 Patients file should be maintained in the file rack when not in use.
3.1.3 Alarming laboratory results (i.e. HIV positive result, communicable diseases,
etc.) should
be disclosed only to the concerned personnel with utmost discretion and only for
the
benefit of the patient.
3.1.4 All information must be correct when documented in patients record.
3.1.5 Access to the computer file should only be by authorized person(s) and through
designated passwords.
3.1.6 The completed discharge file should be sent immediately and properly endorsed
to the
Medical Records.
RESPONSIBILITIES:
4
3.2 Communication:
4.1 Attending
3.2.1 All Physician:
communications concerning patients condition should be taken as a
4.1.1 Explains the health condition of the patient.
privileged
4.1.2 Discusses
the management and provides option to the patient/relatives
communication.
regarding
3.2.2 All information provided by the patient should be regarded as confidential.
management
of the
condition.
3.2.3
Information
obtained
from the patient should not be disclosed to another, unless
4.1.3
Provides
the
right
to
an
informed consent on all planned interventions on the
it will be
patients of benefit to the patient or there is great threat to general welfare.
case.Discussions must occur in private area where it is unlikely that conversation will
3.2.4
be 4.1.4 Avoids discussing patients case with colleagues for no beneficial reasons to the
patient at overheard.
47
all.
Republic of
Yemen 48Modern
48
Hospital
4.2 Staff:
4.2.1 Avoids posting patients identity in a public area.
4.2.2 Not allowing public postings with patients personal information in view.
4.2.3 Not allowing personnel not immediately concerned in providing care to the
patient to have
an access with the patients file.
4.2.4 Returns patients file to file rack when not in use.
48
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Provision of Patients PrivacyDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure deals with the appropriate guidelines
and practices
in the protection of patients privacy during and after admission in the hospital.
1 DEFINITIONS:
1.1 Privacy a state of the preservation of patients personal, emotional, and
psychosocial integrity
with minimal number of personnel who are concerned and necessary for providing
care.
2 PURPOSES:
2.1 To protect patients privacy, integrity, and autonomy.
2.2 To avoid unnecessary anxiety and worry on the part of the patient during hospital
stay.
2.3 To promote patients safety and security.
3 POLICIES:
3.1 Female staff should only attend to all female patients (male staff with chaperones,
only when
necessary).
3.2 Female nurse should accompany physicians when doing rounds.
3.2.1 Nurse knocks on the door and announcing selves before entering the room;
nurse to enter
first to be followed by the physician.
3.3 Visiting hours should be imposed.
3.3.1 Visiting time is from 1000H until 2200H (SGHG Policy).
3.3.2 If there is a request from the patient not to be disturbed, a No Visitors
Allowed sign
should be posted on the door.
PROCEDURES:
4
3.4
Courtesy should be observed when entering patients room.
4.13.4.1
During
Doctors
Rounds:
Greet patient politely with minimal noise.
4.1.1Provides
Knocks on
the doorinformation
gently announcing
him/herself before
entering.care.
3.4.2
necessary
to the patient/relatives
concerning
4.1.2
Allow
time
for
female
patient/guest
to
cover
head
and
face
3.4.3 Explains procedure and all intervention done to the patient. before allowing
doctor
to transporting patient, provide coverings to avoid undue exposure.
3.5 When
enter.
4.1.3 Ask the guest to leave the room, if necessary.
4.1.4 Pull on curtains and drapes to provide privacy during physical examinations.
Allow
covering to avoid undue exposure (keeping exam only as necessaries).
4.1.5 Cover the patient after the procedure. Keep patient comfortable.
4.1.6 Close the door gently when leaving the room.
4.2 During Nursing Procedure:
4.2.1 Observe courtesy when entering the room, by knocking at the door, and greet
the patient
accordingly.
4.2.2 Ask the guest to leave the room, if necessary.
4.2.3 Pull on curtains/drapes to provide privacy.
4.2.4 Explain the procedure to the patient to relieve anxiety and foster cooperation.
49 procedure. Avoid unnecessary exposure.
4.2.5 Uncover only the area needed for the
4.2.6 Keep the patient comfortable after the procedure.
4.2.7 Close the door gently when leaving the room.
Republic of
Yemen 48Modern
48
Hospital
Document patients reactions and responses to the 4.2.8

procedure.
5
5.1 Female patients must cover the head and face properly, if it is not necessary to be
seen, examined
or treated, before letting the doctor/guest to enter the room as per Islamic law.
5.2 Avoid disclosure or talk about patients case and condition in public.
5.3 Instruct patient to use call bell or telephone in case of unknown visitors inside the
room.
50
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Patients and Family Rights and ResponsibilitiesDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure deals with the patients and family
rights and
responsibilities while acquiring services from 48 MODERN HOSPITAL.
1 DEFINITIONS:
1.1 Patients Rights natural and legal privileges of every patient while admitted in the
hospital to
meet their basic human needs as a person and medical needs as a patient.
1.2 Patients Responsibilities obligations and accountabilities that a patient is liable
during the
course of stay in the hospital.
1.3 Patient an individual who comes to the facility to seek treatment and services for
his/her health
problems.
1.4 Family a patients significant others (immediate or extended family).
2 PURPOSES:
2.1 To protect patients individuality as a person.
2.2 To act for the best interest of the patient.
2.3 To protect patient from harmful procedure/ situation.
2.4 To respect patients rights at all times.
2.5 To impart to the patient the process of the informed consent.
PATIENTS
RIGHTS:
2.6 To provide
information concerning health promotion and maintenance to the patient
3.1
Right
to
and family. meet basic physiological survival requirements air, water, food,
elimination,
rest, basic
sleep,premises on the patients expectations in terms of his/her health
2.7 To explain
3
etc.
management.
3.22.8
Right
to stay in
a quiet and
safe
environment.
It includes
promotion
of adequate
To promote
confidence
and
trusting
relationship
between
patient/family
and rest
and
sleep,
members of the
prevention
of accidental
falls/trauma,
etc. the treatment procedure and during the entire
health team
to gain cooperation
during
3.3 Right
for
respect
and
dignity
to:
hospitalization.
3.3.1 receive guests known to patient during visiting hours unless contraindicated.
3.3.2 treat patient with human touch by being heard, felt with sympathy to illness.
3.3.3 get the same treatment as others regardless or religion, culture and tradition.
3.4 Right for love and security. Give patients appropriate attention to feel being loved
and secured.
Communicate, listen, and touch with sympathy.
3.5 Right for privacy and confidentiality:
3.5.1 All medical records and investigations are treated highly confidential and are
stored in
computer on line accessible only by authorized persons.
3.5.2 Members of healthcare team avoid talking about patients in areas that can be
overheard.
3.5.3 Public postings with patients personal information in view are prohibited.
3.5.4 The treating doctor provides privacy during medical examination.
3.5.5 To have medical staff of the same gender performs or assists during the
procedure.
3.5.6 No individuals nor guests not concerned with patients care to be present
during
examination or treatment without appropriate
permission.
51
3.5.7 Healthcare personnel knock on the door and announce themselves prior to
entry in the
patients room.
Republic of
Yemen 48Modern
Hospital
48
3.6 Right to participate in his treatment plan to:

3.6.1 follow treatment regime and be cooperative with the health-team members.
3.6.2 accept health-teachings being given by responsible health-team member.
3.6.3 participate in planning for his/her care involving family members.
3.6.4 refuse treatment provided he/she signs for it as against medical advice.
3.7 Right to be informed:
3.7.1 by treating physician of complete information about the diagnosis, treatment
plans, and
prognosis in language patient can understand. In case of unconscious state,
family
member shall be informed. During emergency, extensive explanation shall be
made after
patient is pacified.
3.7.2 of benefits and possible risks before doing any procedure. In such case, patient
is asked to
sign a consent form.
RESPONSIBILITIES:
3.7.3
of the bills
as patient requested
anytime of the day.
4
4.1 All patients
are responsible
for:
3.84.1.1
Rightprovision
to communication
to
complain
and
express
feelings
and
receive
written
of complete and accurate information about his/her present
communication
complaint,
history,
from relatives
unless taken
contraindicated.
and medication
or information related to health condition.
4.1.2 following hospital policies.
4.1.3 abiding and adhering to the medical regimen and treatment plan.
4.1.4 respecting clinic appointment and follow up.
4.1.5 treating the health team and other patients with respect.
4.1.6 treating hospital property and patients property with respect.
4.1.7 informing his/her treating doctor for any change in his/her health status.
4.1.8 keeping and showing PIN card and medical ID (if applicable) at all times when
availing
of hospital services.
4.2 Admission Officer:
4.2.1 Informs patient/relatives of the room accommodation according to their choice
and/or
insurance policy coverage.
4.2.2 Gives gross approximations of the cost during the hospital stay.
4.2.3 Informs the unit for the admission.
4.2.4 Prepares patients discharge necessities.
4.3 Attending Physician:
4.3.1 Examines and explains health condition to the patient and/or family.
4.3.2 Discuss management plan and offers options.
4.3.3 Explains procedures and treatment regimen before initiation.
4.3.4 Explains the advantages and disadvantages of the treatment regimen such as
medication
side effects, alterations in the patients lifestyle after undergoing certain
procedures, etc.
4.3.5 Gives gross estimate of the length of hospital stay.
4.3.6 Provides discharge instructions and necessary education.
4.4 Staff Nurse:
4.4.1 Orients patient to the unit and room facilities.
4.4.1.1 Call bell
4.4.1.2 Room amenities (television set, refrigerator, telephone, newspaper
services, etc.)
4.4.1.3 Bed control, side rails operation
4.4.2 Explains unit and hospital policy.
4.4.2.1 Visiting hours
52
4.4.2.2 Policy on keeping of valuables
4.4.2.3 Doctors rounds
4.4.2.4 Discharge time and procedure
Republic of
Yemen 48Modern
48
Hospital
4.4.2.5 Mealtime/quality/special diets

4.4.3 Offers options for food preference for guests
4.4.4 Inform patients of their rights and responsibilities during
hospitalization.
POLICIES:
5
5.1 Admission office should provide information on the nature of admission room
accommodation,
financial responsibilities, policy on safekeeping of valuables, and visiting hours.
5.2 All patients admitted in the unit should be oriented to room and hospital facilities.
5.3 Attending physicians should explain to the patient and family about patient health
condition as
well as the management plan:
5.3.1 Explanation of the patients condition (physically, psychosocial)
5.3.2 The management plan including treatment
5.3.3 Procedures to be done
5.3.4 Medications and expected side effects
5.3.5 Anticipated length of hospital stay
5.3.6 Discharge instructions
5.4 Staff nurses assigned to the patient should give appropriate health education.
5.4.1 Promotion and maintenance of activities of daily living
5.4.2 Use of equipment
5.4.3 Medication administration
5.4.4 Diet
5.4.5 Physical activities
5.5 Home care
PROCEDURES:
5
5.1 Assess patients health status.
5.1.1 Identify patients areas of concern needing education (lifestyle, equipment
operation, diet,
activity, etc.)
5.2 Formulate an educational plan based on the assessment findings. Patient teachings
include:
5.2.1 Medications received by the patient
5.2.1.1 The indication of the medicine
5.2.1.2 Drug/food interactions
5.2.1.3 Drug/drug interactions
5.2.1.4 Expected side effects
5.2.2 Equipment to be used for health care maintenance
5.2.2.1 Blood sugar monitoring devices
5.2.2.2 Blood pressure monitoring equipment
5.2.3 Dietary intake
5.2.3.1 Meal plans and food exchange for diabetics and obese
5.2.4 Exercise
53
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Patient EducationDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure focus on areas of teaching and
instruction that
nurses and other members of the health team can provide to the patients.
1 DEFINITIONS:
1.1 Patient Education process of influencing behavior and producing changes in
knowledge,
attitudes, and skills needed to maintain and improve health. An ongoing, interactive
communication consistent with the patients plan of care and educational level needed
for the
continuity of care.
2 PURPOSES:
2.1 To promote patient participation and decision-making about their health care
options.
2.2 To increase patients potential to follow health care plans.
2.3 To promote the development of self-care skills.
2.4 To improve patient/family coping abilities.
2.5 To increase participation in continuing care.
2.6 To foster patients adaptation to a healthy lifestyle.
3 POLICIES:
3.1 All nurses taking care of the patient in the unit should provide health instructions to
the patients
assigned to their cares.
3.2 Health instructions should be based on the following:
3.2.1 Assessing patients comprehension level and educational background to
determine his/her
capability and motivation to provide self-care.
3.2.2 Patients family or care provider is included in care planning.
3.2.3 Care planning should include instructions on medications including food/drug,
drug/drug
interactions.
3.2.4 Safe use of medical equipment should be given emphasis in the plan of care.
3.2.5 How to carry-out activities of daily living.
3.3 Health teachings given to the patient should be specific to patients needs.
3.4 Instruction should be presented in an easy-to-comprehend style and according to the
patients
RESPONSIBILITIES:
4
level of understanding.
4.13.5
Staff:
On teachings concerning use of equipment, patients and relatives accumulation of
Assessing patients health condition and formulating an educational plan
the 4.1.1
teachings
specific
for the
should
be evaluated in the form of return-demonstration and feedback.
condition
stating from
the
day oftoadmission.
3.6 Patient
education
should
befirst
adapted
patients age, developmental needs, culture,
Involves patients significant others during the teaching experience to have a
and4.1.2
language.
continuity
in
3.7 All patient
education assessments and responses should be recorded and
the care.
documented
in the
4.1.3
Assess
patients
patients
clinical
file.level of understanding and utilizes appropriate teaching
strategy/ies
accordingly.
4.1.4 Evaluates level of comprehension through return demonstration.
54
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Safety For Patients and StaffDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure deals with the safety guidelines for
prevention of
accidents in the hospital during patients course of admission and in the staffs delivery of
services and
care.
1 DEFINITIONS:
1.1 Safety security; freedom from danger, injury, damage, and harmful side effects.
1.2 Precautions actions, words, or signs by which warning is given or taken before any
inadvertent
or hazardous events may happen.
2 PURPOSES:
2.1 To prevent inadvertent or hazardous event to happen.
2.2 To protect the patient from any harm during the course of hospitalization.
2.3 To caution patient, relative, and the staff of any hazardous events.
2.4 To urge the patient/healthcare providers to observe safety measures to avoid
dangers when
SAFETY
PRECAUTIONS
performing
duties. FOR:
4.1
Patients:
3 POLICIES:
4.1.1
Upon
admission:
3.1
Safety
precaution
should be strictly observed at all times.
4.1.1.1
No
valuables or
moneyhospital
is allowed
to be kept
with the patient.
3.2 It is the responsibility
of every
employee
to discharge
functions without
4.1.1.2
Orientation
to
room
and
facilities
should
be
provided.
harming ones
patient is to have a PIN card and ID band attached to the wrist upon
self4.1.1.3
and/orEvery
the patient.
admission.
3.3 Patients and relatives are not an exception from observing safety measures for4their
benefit. 4.1.1.4 Home medicines are to be taken away from the bedside unless indicated
per doctors
order.
4.1.1.5 No Smoking policy to be reinforced.
4.1.2 During hospitalization:
4.1.2.1 Bedside rails should always be on.
4.1.2.2 Safety belt is always applied in transporting patient by stretcher or
wheelchair.
4.1.2.3 The procedure/operation to be done should be explained to patient/relative
before the
act.
4.1.2.4 Patient is always identified properly and correctly when dealing with
him/her.
4.1.2.5 Written informed consent should be obtained before the
procedure/operation
whenever necessary.
4.1.2.6 Emergency call bell should be available in the patients room and comfort
room.
4.1.2.7 Ensure that all bedside care/procedure is carried out properly and
correctly.
4.1.2.8 No electronic devices are allowed in the patients rooms unless with prior
approval
from the Chief of Medical Operations.
4.1.2.9 Observe fall precaution measures
55 at all times.
4.1.2.9.1 Document in daily basis a Safety Checklist Form M1200.
4.1.2.10Assistance and support to patient is rendered whenever needed.
4.1.2.11Infection control measures are observed at all times.
4.1.2.12Sharps and blunt objects are not allowed especially to Psychiatrist

patient.
4.1.2.13No authorized person is allowed to access any patient or his/her file.
4.1.2.14Medicines are prepared and administered safely and correctly. Follow ten
Republic of
(10) rights
in medication
administration.
Yemen
48Modern
48
4.1.2.14.1 All medicines of any type are properly stored and labeled.
Hospital
4.1.2.15Order patients diet as recommended by the doctor.

4.1.2.15.1 Countercheck regularly and update patients diet for any changes
ordered by
the treating doctor.
4.1.2.15.2 The pantry staff before distribution has to check patients tray.
4.1.2.15.2.1Compare diet ordered against the food on the tray.
4.1.2.15.3 Identify the right patient by calling his name.
4.1.2.16Extra caution must be taken during diet preparation according to
patients tolerance
and deglutition status.
4.1.2.16.1 Required temperature should be maintained in the Kitchen and in
the floor
Pantry.
4.1.2.16.2 Patients culinary preference must be in accordance with the
doctors order.
4.1.2.16.3 Ward nurse in-charge of the patient must check the patients food
before
meal to ensure:
4.1.2.16.3.1meal is served per doctors order.
4.1.2.16.3.2it is free from any foreign elements before patient discovers it,
if any.
4.1.2.16.3.3meal presentation is within the acceptable standard.
4.1.3 Upon discharge:
4.1.3.1 Health teachings such as: preventive maintenance; coping up with daily
activities;
proper ambulating techniques; instructions to take home medications; and
follow-up
appointment are given to every patient before discharged.
4.1.3.2 Demonstrate to the patient and relatives the proper ambulating technique
to be
followed at home.
4.1.3.3 Ensure that wound drainage, IV cannula and the likes, are removed, unless
indicated.
4.1.3.4 Every patient is accompanied or assisted in wheelchair from the room to
the hospital
exit.
4.2 Staff:
4.2.1 Observe infection control measures at all times.
4.2.1.1 Submit yourself for annual physical check-up, which is provided free of
charge for
all hospital employees.
4.2.1.1.1 Priority is given to high-risk staff.
4.2.1.1.2 Immunization vaccination should be provided regularly and when
there is an
epidemic.
4.2.1.1.3 Medical investigations and treatment should be provided to staff
exposed to
health-hazards showing manifestations such as allergy, pain, or trauma
as a
result of injury, etc.
4.2.1.1.4 Needle stick injury policy should be strictly followed.
4.2.1.2 Wear safety gadgets or devices as required.
4.2.1.3 Wear anti-static shoes as indicated when entering sterile areas.
4.2.1.4 Observe proper waste disposal.
4.2.1.4.1 Dispose used sharps in proper sharps container.
4.2.1.4.2 Dispose used needles uncapped in small sharps container.
4.2.1.4.3 Dispose contaminated wastes in orange bag.
56
4.2.1.4.3.1 Follow double-bagging procedure.
4.2.1.5 Label the bag as Contaminated. Wash hands before and after every
procedure.
4.2.1.6 Observe proper handling of cytotoxics.
4.2.1.7 Wear proper uniform and safety gadgets as required.
Republic of
Yemen 48Modern
48
Hospital
Fire Safety, how to use fire fighting equipment and to evacuate

patient safely
in the event of fire.
4.2.1.8.2 Infection Control.
4.2.1.8.3 Cardio-Pulmonary Resuscitation (CPR).
4.2.1.8.4 Proper operation of new machines and medical equipment.
4.2.1.8.1
4.2.1.9 Faulty equipment should be labeled and sent immediately to the
Maintenance
Department for repair.
4.2.1.9.1 Do not insist to use defective machine. It can endanger patients
life.
4.2.1.10Machines and electrical equipment should be properly labeled as to its
voltage and
safety warnings.
4.2.1.11Plug machines and electrical equipment into the outlet according to the
correct
voltage.
SPECIAL
CONSIDERATIONS:
5
4.2.1.12Do not use wet hand when plugging machines to its outlet.
5.1 Fire
safety
gadgets
provided
within
the
hospital
vicinity
are
as
follows:
4.2.1.13Do not use an open wire to conduct electricity.
5.1.1
Fire Alarm
4.2.1.14Do
not insist to enter a restricted area where there is danger warning
5.1.2
Fire Extinguisher
signs.
5.1.3 Fire Hose
5.1.4 Smoke Detector
5.2 Faulty machines, electrical wiring, and connections are to be reported immediately
to Maintenance
Department.
5.3 Each nursing care procedure has safety measures that must be strictly followed for
patient and
staff safety.
57
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Security for Hospital EquipmentDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure serves as methods to prevent losses of
medical
equipment.
1 DEFINITIONS:
1.1 Medical Equipment devices used to help health care professionals in the diagnosis,
therapy,
surgery, and other procedures aiming to provide quality health care to patients.
1.2 Borrowers Logbook a logbook maintained in the unit used in recording and tracking
of
equipment/devices borrowed by other units.
2 PURPOSES:
2.1 To keep intact all issued equipment to the unit.
2.2 To avoid undue losses of equipment/devices lent to other units.
2.3 To observe proper documentations of all equipment/devices accounted to the unit.
3 POLICIES:
3.1 All medical equipment should be technically evaluated periodically.
3.2 A logbook should be maintained in the unit where all borrowed equipment will be
documented.
Logbook entries should include:
3.2.1 date of borrow
3.2.2 item description
3.2.3 serial/inventory number
3.2.4 name of borrower/ID number/signature
3.2.5 name of returnee/ID number/signature
3.2.6 date or return
3.2.7 remarks
3.3 Equipment lent should be checked of the functioning status before sending and upon
returning.
3.4 All activities involved during the borrowing process should be properly documented.
3.5 There should be proper endorsement of the equipment.
3.6 Borrowing of equipment will depend on the availability of the equipment in the area.
3.7 The borrowing nurse of the equipment will take responsibility for the borrowed item.
3.8 Any item/s borrowed should be properly endorsed to the receiving charge nurse.
3.9 Borrowed equipment should be returned as soon as the procedure is finished and the
purpose for
such borrow is already met.
4 PROCEDURES:
4.1 Borrowing staff calls up the head nurse/charge nurse of the unit for the availability of
the item to
be borrowed.
4.2 Borrowing staff receives the item to be borrowed from the lending unit after having
approval from
the head nurse or the charge nurse.
4.3 Lending staff enters in the borrowers logbook all necessary information needed.
4.4 Borrowing staff takes the borrowed item including all responsibilities incurred for
such borrowing.
58
4.5 Lending staff follows-up the item borrowed if such item is not returned on the
expected schedule.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Standard AbbreviationsDue for Review:Page 1 of 6
CONTENTS: This General Ward policy and procedure deals with the standard abbreviations
used in the
hospital by all healthcare providers.
1.0 DEFINITION:
1.1 Standard Abbreviation - a generally accepted shortened form of a written word in
place of
whole word/phrase.
2.0 PURPOSES:
2.1 To communicate within medical level of understanding.
2.2 To use acceptable shortened medical words conforming to the policy of hospital.
3.0 POLICIES:
3.1 Only standard abbreviations accepted by the hospital is in use.
3.2 No personal abbreviations are accepted.
3.3 Proper use of capital and small letter is to be used to signify its meaning.
3.4 Any doubt on the abbreviation
should be
clarified.
4.0 MOST COMMON
ABBREVIATIONS:
4.1 Words and Phrases:
@- at
-aa- of each
ABG- Arterial Blood Gas
a.c.- before meals
ADL- Activities of Daily Living
AIDS- Acquired Immuno Deficiency Syndrome
alt.- alternative
a.m.- morning
AMI- Acute Myocardial Infarction
amp.- ampoule
ARDS- Acute Respiratory Distress Syndrome
AS- Aortic Stenosis
ASD- Atrial Septal Defect
b.i.d.- two times a day
Ba- Barium
BM- Bowel Movement
BMR- Basal Metabolic Rate
BP- Blood Pressure
BRP- Bathroom Privileges
BSA- Body Surface Area
BUN- Blood, Urea, Nitrogen
c- with
c/o- complain of
Ca- calcium, cancer, carcinoma
CAD- Coronary Artery Disease
cap.- capsule
CAT- Computed Axial Tomography
cath.- catheter
59
Republic of
Yemen 48Modern
48
Hospital
Complete Blood Count

CBC
Complete Bed Rest
CBR
Chief Complaint
CC
Coronary Care Unit
CCU
Central Nervous System CNS
- Congestive Heart Failure
CHF
- Carbohydrate
CHO
- Protein
CHON
- Carbon Monoxide
CO
- Carbon dioxide
CO2
- Chronic Obstructive Pulmonary Disease
COPD
- Creatinine Phosphokinase
CPK
- Cardiopulmonary Resuscitation
CPR
- Cerebrospinal Fluid
CSF
- Computed Tomography
CT
- Cerebrovascular Accident
CVA
- Central Venous Pressure
CVP
- Dilatation and Curettage
D&C
- Dextrose 5% water
D5W
- Dessiminated Intravascular
DIC
Coagulation
D/C
- discontinue
DNR
- Do Not Resuscitate
DOA
- Dead On Arrival.
DOE
- Dyspnea On Exertion
Dx
- Diagnosis
EKG
- Electrocardiogram
ECHO
- Echocardiography
ECT
- Electro Convulsive Therapy
EDC
- Expected Date of Confinement
EDD
- Expected Delivery Date
EEG
- Electroencephalogram
EMG
- Electromyelogram
EMS
- Emergency Medical Service
ER
- Emergency Room
ESRD
- End-Stage Renal Disease
EST
- Electro-Shock Therapy
ESWL
- Extra Corporeal Shock Wave Lithotripsy
FBS
- Fasting Blood Sugar
Fe
- Iron
FEV
- Force Expiratory Volume
FFP
- Fresh Frozen Plasma
FHR
- Fetal Heart Rate
FHS
- Fetal Heart Sound
FSH
- Follicle Stimulating Hormone
FUO
- Fever of Unknown Origin
Fx
- Fracture
GI
- Gastrointestinal
GTT
- Glucose Tolerance Test
H+
- Hydrogen ion
h/o
- history of
H 2O
- Water
HAV
- Hepatitis A Virus
60
Republic of
Yemen 48Modern
48
Hospital
- Hemoglobin
Hb
- Hepatitis B Surface Antigen
HBs Ag
- High Density Lipoprotein
HDL
- Human Lymphocyte Antigen
HLA
- hematocrit
hct
- hour
h.
- Herpes Simplex Virus Type 2
HSV2
- Intake and Output
I&O
- Intracranial Pressure
ICP
- Intensive Care Unit
ICU
- Insulin Dependent Diabetes Mellitus IDDM
- immunoglobulin
Ig
- immunoglobulin A, etc.
Ig A, etc.
- Intramuscular
IM
- Intermittent Positive Pressure Breathing
IPPB
- Intraocular Pressure
IOP
- irregular
irreg.
- Intravenous
IV
- Intravenous Pyelogram
IVP
- Intravenous Urogram
IVU
- Potassium
K
- Kidney, Ureter, Bladder
KUB
- Keep Vein Open
KVO
- Left Bundle Branch Block
LBBB
- Lupus Erythematosus
LE
- Left Lower Lobe
LLL
- Left Lower Quadrant
LLQ
- Left Ventricular Hypertrophy
LVH
- Mean Arterial Pressure
MAP
- Mean Corpuscular Hemoglobin
MCHC
Concentration
Med.
- Medicine
MG
- Myasthenia Gravis
MI
- Myocardial Infarction
MS
- Multiple Sclerosis
MRI
- Magnetic Resonance Imaging
Na
- Sodium
NAD
- No Abnormality Detected
NICCU
- Neonatal Intensive Coronary Care UnitNPO
- Nothing Per Orem.
NSS
- Normal Saline Solution
O2
- Oxygen
OD
- Right Eye
OOB
- Out of Bed
ORIF
- Open Reduction Internal Fixation
OS
- Left Eye
PAC
- Premature Atrial Contraction
PaO2
- Partial Pressure of Oxygen
Para
- Number of deliveries
PAT
- Paroxysmal Atrial Tachycardia
p.c.
- After Meals
PCO2
- Partial Pressure of Carbon Dioxide
PEA
- Pulseless Electrical Activity
61
TB
TIA
Republic of
Yemen 48Modern
48
Hospital
PEEP
- Positive End Expiratory Pressure
per - by way of
PERRLA
- Pupils Equal Round and Reactive to Light and
pHAccommodation
PID - Hydrogen Ion Concentration
PKU- Pelvic Inflammatory Disease
p.m.- Phenylketonuria
PMS- evening
PUO- Premenstrual Syndrome
PPD- Pyrexia of Unknown Origin
PRN- Purified Protein Derivatives
PT - as necessary
Pt - Prothrombin Time / Physio-Therapy
PTT - Patient
PVC- Partial Thromboplastin Time
PND- Premature Ventricular Contraction
q - Paroxysmal Nocturnal Dyspnea
q3h - every
q.d.- every 3 hours
q.h.- everyday
q.i.d.
- every hour
q.o.d.
- four times a day
R/O - every other day
RBBB
- Ruled Out
RBC- Right Bundle Branch Block
RDS- Red Blood Cell
Rh+- Respiratory Distress Syndrome
Rh -- Positive Rh Factor
RHD- Negative Rh Factor
RLL - Rheumatic Heart Disease
RLQ- Right Lower Lobe
RML- Right Lower Quadrant
ROM
- Right Middle Lobe
RUL
- Range Of Motion
RUQ- Right Upper Lobe
Rx - Right Upper Quadrant
s
- Treatment/Prescription
SC - without
SIDS- Subcutaneous
SLE - Sudden Infant Death Syndrome
SOS- Systemic Lupus Erythematosus
sol. - If necessary
SOL - solution
Sp. Gr.
- Space Occupying Lesion
stat - Specific gravity
susp.- immediately
tab. - suspension
TAH- tablet
TAHBSO
- Total Abdominal Hysterectomy
- Total Abdominal Hysterectomy with Bilateral
Salpingo-Oophorectomy
- Tuberculosis
- Transient Ischemic Attack
62
Republic of
Yemen 48Modern
48
Hospital
- Total Iron Binding Capacity

TIBC
- three times a day
t.i.d.
- Total Parenteral Nutrition
TPN
- Temperature, Pulse, Respiration
TPR
- Thyroid Stimulating Hormone TSH
- Urinalysis
U/A
- Ultrasound
U/S
- Upper Gastro-Intestinal Series
UGI S
- Upper Respiratory Tract Infection
URTI
- Urinary Tract Infection
UTI
- Venereal Disease
VD
- Vital Signs
V/S
- White Blood Count
WBC
- Within Normal Limit
WNL
- weight in volume
w/v
4.2 Unit of Measurement:
%- percentage
oC- degrees Celsius
oF- degrees Fahrenheit
cc.- cubic centimeter
cm- centimeter(s)
cu.- cubic
dl- deciliter (100 milliliter)
ft.- feet
g- gram(s)
gal.- gallon(s)
g/l- grams per liter
gr.- grain
gtt.- drop(s)
in.- inch(es)
IU- International Unit
kg.- kilogram(s)
l.- liter
lb.- pound(s)
m- meter(s)
mcg.- microgram
mcv.- mean cell volume
mEq- milli-equivalent
mg.- milligram
min.- minims
mu- milli unit
mIU- milli-International Unit
ml.- milliliter
mm.- millimeter(s)
3mm- cubic millimeter
mmHg- millimeters of mercury
mmol- millimol
nm- nanomolar
ng- nanogram
oz.- ounce
pg- picogram
63
Republic of
Yemen 48Modern
48
Hospital
pint
quart
tablespoon
teaspoon
unit
micrometer
microgram
micro unit
yard
64
pt.
qt.
tbsp.
tsp.
uum
ug.
uU
yrd.
-
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Prevention of Medication ErrorsDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure serves as guidelines in the practice of
medication
administration in order to avoid commission of error by the nurses in the administration of
medications to
the patient.
1 DEFINITIONS:
1.1 Medication Error any preventable events that may cause or lead to inappropriate
medication
use or patients harm while the medication is in the control of the health care
professional, patient,
or consumer.
1.2 most common and potentially most dangerous nursing error.
1.3 Most Common Types:
1.3.1 Incomplete patient information
1.3.2 Unavailable drug information
1.3.3 Miscommunication of drug orders
1.3.3.1 Poor handwriting
1.3.3.2 Confusion between drug with similar names
1.3.3.3 Misuse of zeroes and decimal points
1.3.3.4 Confusion of metric and other dosing units
1.3.3.5 Inappropriate abbreviations
1.3.4 Lack of appropriate labeling
1.3.5 Environmental factor
1.3.5.1 Poor lighting
1.3.5.2 Heat
1.3.5.3 Noise and interruptions
2
3 PURPOSES:
POLICIES:
2.1Nurses
To ensure
safety
and complete
protection
of patients.
3.1
should
gather
information
and relevant data upon admission.
2.2Drug
To prevent
commission
of medication
3.2
information
references
should be errors.
available in all nursing units.
3.2.1 Updated drug reference handbook
3.2.2 References on pharmacological interaction of different drug properties.
3.3 Nurses should observe 7Rs of medication administration.
3.3.1 Right Patient
3.3.2 Right Drug
3.3.3 Right Dose
3.3.4 Right Route
3.3.5 Right Time
3.3.6 Right Frequency
3.3.7 Right Documentation
3.4 Nurses should use 2 identifiers when administering medications (2 nurses; a doctor or
a nurse;
doctors order sheet and medication sheet; or doctors order sheet and a medication
card).
3.5 Nurses should check with physicians for any medication orders that are unclear.
3.6 Nurses should double-check with each other for any dosage calculation of high-risk
65
medications.
3.7 The following constitute the medication error:
Republic of
Yemen 48Modern
Hospital
48
3.7.1 Medication given to the wrong patient.

3.7.2 Wrong kind of medication administered.
3.7.3 Wrong dose given.
3.7.4 Wrong route.
3.7.5 Medication given on the wrong time and wrong frequency.
3.8 Medication errors should be reported using the incidental
reporting scheme.
4 RESPONSIBILITIES:
4.1 For Nurses:
4.1.1 Provides complete patient information and relevant data upon admission.
4.1.1.1 Drug/food related allergies
4.1.1.2 Medications taken at home (herbal, insulin, oral contraceptives, etc.)
4.1.1.3 Past medical history
4.1.1.4 Previous illnesses and surgeries
4.1.1.5 Laboratory results
4.1.1.6 Vital signs
4.1.2 Utilizes two identifiers when administering medications.
4.1.2.1 Using the doctors order sheet and medication sheet.
4.1.3 Checks with physicians for any medication orders that are unclear.
4.1.4 Double-check with each other for any dosage calculation of high-risk medications.
4.1.5 Checks daily equipment used in the administration of medication.
4.1.5.1 perfusor machine
4.1.5.2 diatek machine
4.1.6 Prescribes correctly ordered medicines to the pharmacy.
4.1.7 Reports incidence of adverse drug reactions to the pharmacy.
4.2 For Pharmacists:
4.2.1 Labels properly issued medicines to the requesting party, especially repacked
drugs.
4.2.2 Inform units for unavailability of the medicines.
4.2.3 Prohibits dispensing of restricted antibiotics for prescriptions without
5
PROCEDURES:
accompanying
5.5 Attending
physician
prescribes
restricted
antibiotic
form. medication for the patient in the patients file.
5.6 Attending nurse reads the order and clarifies from the physician for any unclear
orders.
5.7 Nurse transcribes the order in the medication sheet, medication card, and in the
pharmacy-ordering
sheet.
5.8 Charge nurse counterchecks the medication order.
5.9 Ward secretary encodes pharmacy order in the computer.
5.10Receiving nurse verifies the correctness of the ordered medicine by counterchecking
the
medicines in hand with the written order.
5.11Nurse prepares the medicines that are due for administration.
5.11.1 Nurse who prepares the medicine should be the one to administer.
5.11.2 For high-risk medications, two nurses should counter-check with each other for
the dosage
calculation and preparation.
5.12Nurse prepares the medications in a well-lighted room, free from interruptions.
5.13Observe 7 Rights in medication administration.
5.13.1 Right Patient
5.13.1.1Ask patient of his/her name and compares it with the ID band and
medication card.
5.13.2 Right Medicine
5.13.2.1Countercheck the medicine on hand with the doctors orders.
5.13.2.2Check the medicine against the diagnosis
and correlate the appropriateness
66
of the
ordered medicine with the diagnosis.
5.13.2.3Check for the expiration date, the color, and the consistency.
Republic of
Yemen 48Modern
48
Hospital
5.13.3 Right Dose

5.13.3.1Verify the correctness of the transcribed dose in the medication card and
medication
sheet with the doctors orders.
5.13.3.1.1 Clarify with the ordering physician for any unclear orders.
5.13.3.2Double check with other nurse on drug calculations.
5.13.3.3Only scored-tablets can be cut into parts. Avoid breaking unscored
tablets to get
accurate dose.
5.13.4 Right Time
5.13.4.1Administer the medicines on the time indicated in the doctors orders.
5.13.4.2Pharmacotherapeutic considerations should be taken into account to have
a uniform
effect.
5.13.4.2.1 Know the expected medication half-life.
5.13.4.3Follow the hospital policy on standard timing.
5.13.4.4Know the medications reactions with foods and other drugs.
5.13.4.4.1 i.e. Sulfonylureas should be given at least 30 minutes before food
intake.
5.13.5 Right Frequency:
5.13.5.1Check on the doctors orders on the frequency of medicine to be
administered.
5.13.5.2Clarifies for any vague orders on medication frequency with the ordering
physician.
5.13.6 Right Route:
5.13.6.1Check for the ordered route of medication administration.
5.13.6.1.1 Oral
5.13.6.1.2 Parenteral
5.13.6.1.3 Topical
5.13.7 Right Documentation:
5.13.7.1Only administered medications should be recorded and signed in the
medication
sheet.
5.13.7.1.1 Medications not given or not tolerated by the patient should be
documented
accordingly in the medication sheet and in the nursing notes.
5.13.7.1.2 Refused drugs must be reported to the physician.
5.13.7.1.3 Nurses should sign the drug entry in the medication sheet
immediately after
administering it.
5.13.7.2Nurses should affix complete signature and ID number in the medication
sheet.
67
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Pain ManagementDue for Review:Page 1 of 3
CONTENTS: This General Ward policy and procedure serves as a guideline in the
management of pain as
experienced by the patient.
1 DEFINITION:
1.1 Pain a subjective experience that may or may not be verbalized. It is an unpleasant
feeling
caused by injury or disease. It can also be described as An unpleasant sensory and
emotional
experience associated with actual or potential tissue damage, or described in terms of
such
damage. It may be caused by psychological trauma or secondary to physical causes.
1.1.1 Acute Pain - includes pain associated with surgery, trauma, medical
emergencies,
childbirth and diagnostic and/or therapeutic procedures. In addition, acute pain
episodes
may be associated with chronic medical conditions such as sickle cell disease,
back pain,
3 POLICIES:
migraine headaches etc.
3.1 A1.1.2
priorChronic
nursingPain
assessment
is done
to every admitted
patient
and documented
- a long term,
continuous,
intermittent
or recurrent
pain or on
Nursing
Notes
discomfort
due,
(Form but
M1016).
not limited to, cancerous disease processes, sickle cell disease, trauma, burns
3.2 When a patient perceives pain, document in the Pain Flow Sheet (Form M3052); refer
requiring
to Pain
extended healing time or any pain disorder.
Score
M3050),
a pain
assessment
tool for scoring.
Fill data
as to: or therapeutic
1.1.3(Form
Procedural
Pain
- pain
and/or discomfort
from invasive
diagnostic
3.2.1 procedures,
Location
such as lumbar puncture, bone marrow aspiration, wound and burn
3.2.2 debridement,
Severity (use patients
description
pain score, needle
if possible)
incision and
drainage&procedures,
aspiration of fluid or aid
from 3.2.3
the Radiation
3.2.4 chest
Duration
or abdomen veni-puncture etc.
3.2.5 Frequency
2 PURPOSES:
3.2.6
Characteristics
(crushing,
burning
use patients own description)
2.1
To provide
guidelines
for proper
pain assessment.
3.2.7
Precipitating
Factors including
activity
&&
pharmacological
use. This is to include
2.2
To provide
safe, consistent
and effective
pain
discomfort management.
over
the counter, Natural & native remedies which the patient may not perceive as
relevant.
3.2.8 Alleviating Factors including pharmacological interventions including over the
counter
drugs.
3.2.9 Allergy status
3.3 Observation of behavioral and physiological responses must be done for infants and
those children
& adults who have cognitive impairment, severe emotional disturbances, dementia,
elderly and
those who have an altered level of consciousness and unable to communicate the
existence and
intensity of their pain.
3.4 All patients in the in-patient areas and emergency
room will be asked about pain
68
observed for
behavioral responses indicating pain during the nurses and clinicians assessments.
(See
Republic of
Yemen 48Modern
Hospital
48
3.5 attached Flow Chart on page 3-2A, which must be followed when assessing pain and
documenting
findings in the patients file.)
3.6 Any patient admitted for pain treatment will have analgesia and pain assessment
management
commenced within 30 minutes.
3.7 Pain intensity, location, pain relief, sedation score, effectiveness and adverse effects
or analgesia
therapy will be recorded by a nurse on the Pain Flow Sheet (Form M3052).
3.8 All patients undergoing invasive procedures will have post-operative
pharmacological analgesia
orders recorded in the Doctors Order Sheet (Form M1043).
3.9 All patients undergoing invasive procedures without general anesthesia will be
evaluated for the
need for pharmacological intervention.
3.10Doctors will be informed when patients are assessed with pain, discomfort or
analgesia side
4 PROCEDURES:
4.1effects.
Assess thoroughly every admitted patient including pain. Within 30 minutes, findings
3.11Effectiveness
of interventions will be reassessed within thirty (30) minutes to one
are
to be
(1)documented
hour of
on Nursing Notes (Form M1016). Assess patient further for pain using a
implementation to be documented on Pain Flow Sheet (Form M3052).
systematic
3.12Reassessment
will continue
every four
(4) hours
until pain score
isand
lesslevel
than of
two (2)
approach with appropriate
assessment
tools
(i.e. appropriate
to age
for
24
hours
understanding, etc.)
then reassessed
every
shift.
4.2and
Document
on Pain Flow
Sheet
(Form M3052) when a patient is identified with pain as
3.13Analgesic
orders
written
before
the pain starts or written in a routine way e.g. q 4
an ongoing
hourly
are
to
pain assessment frequency.
be
considered
empirical
and
topolicy.
be reviewed
in the
actual
pain(Form
relief.M3052).
Therapy
4.2.1
Pain is assessed
per
the
(Document
onlight
PainofFlow
Sheet
must be
4.2.1.1 Pain assessment should commence within 30 minutes. Refer to Pain Score
increased or reduced according to the patients response. Pain relief may require
(Form
flexibility with
M3050) to determine severity of pain.
analgesia.
4.2.1.2 Pain reassessment will continue every four (4) hours.
4.2.1.3 Pain Score less than 2 for 24 hours, should then be reassessed every shift.
4.3 Notify attending physician of the patients pain based on the assessment tool.
4.4 Teach patients and family members the importance of communicating pain/discomfort
and how to
assess and manage pain using appropriate pain assessment tool.
4.5 Administer doctors order on pharmacological interventions according to pain
assessment.
Reassess the effectiveness and document on Pain Flow Sheet (Form M3052) within thirty
(30)
minutes to one (1) hour.
4.5.1 Carry out and administer pharmacological interventions prior to painful
procedures and
evaluate the effectiveness during and after the procedure.
4.6 Determine and apply non-pharmacological interventions based on age, gender, cultural
background, and history.
4.7 Communicate patients response to pain management to the attending physician and
other healthrelated care providers, as necessary.
4.8 Contact and inform attending physician if pharmacological and/or non-pharmacological
interventions are not effective within one hour, i.e. patient is still having moderate or
severe pain.
4.9 Evaluate and document the effectiveness of pain management plans and record any
concern to
69
nursing staff on pharmacological and/or non-pharmacological interventions used,
evaluation data,
and patients response on Pain Flow Sheet (Form M3052) and in the Nursing Notes.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Manual:
General Nursing Departmental Manual
Title: Clients Personal BelongingsDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure deals with the guidelines procedure on
how to
manage clients personal belongings.
1 DEFINITION:
1.1 Personal Belongings - include all clothing and personal items which the patient has in
his/her
possession at the time of admission to Saudi German Hospital.
1.2 Lost Property - any item of personal or monetary value which is lost by the client within
the SGH
facility e.g.: jewelry, ID card, keys, watches, etc.
2 PURPOSE:
2.1 To provide safety and proper handling of patients personal belongings.
3 POLICIES:
3.1 Upon admission to the unit, patient is oriented with the hospital policy on personal
belongings.
3.1.1 Any valuables should not be kept inside the patients room. A safe deposit box is
available
in the Admission and Discharge Office for use.
3.1.2 Patient and family is reminded that any loss of valuables is not the responsibility
of the
hospital management.
3.2 Patients clothing shall be stored in the locker in the patients room, and soiled
clothing shall be
given to the family.
3.3 Patients personal belongings that may be of significance to a police case shall be
handed over to
the police authority, upon request. The receiving police officer, should in turn, sign for
the receipt
of such belongings.
3.4 If a patient dies, his/her personal belongings shall be given to the individual who
comes to collect
his/her body. Any personal belongings of the deceased patient left on the unit/ward will
be kept in
the area until a family member collects them.
3.4.1 The person collecting the left clothing and valuables should sign in the valuables
logbook
acknowledging receipt of the valuables.
RESPONSIBILITIES:
3.4.2 The staff will record in the valuables logbook the itemized contents and the4 name
4.1
Admission/Discharge Officer on Duty
of
the
4.1.1 Upon
Admission:
person
who received the items.
4.1.1.1
Informs
and children,
patients shall
relatives
that valuables
are not
3.5 Toys brought in the
for, patient
or left with
be checked
by the nurse
orallowed
attending
and
should
be
physician to
home.
If safe.
patient
refused
to sent it home.
ensuretaken
that they
are
If the
physician/nurse
decides a toy is not safe, the child will
4.1.1.1.1 He/she must endorse to Admission/Discharge Officer the valuables
not be
against
allowed to keep it with her/him.
itemized
by both The
the patient
3.6 No valuables
of anylists
kindForm
shallM1056
be leftsigned
with children.
parents and
will be instructed to
Admission/Discharge Officer.
remove all
4.1.1.1.2
He/she takes the risk of the valuables
and must sign waiver.
jewelry,
if possible.
70
3.7 Personal property or belongings of patients who absconded should be kept in the
nursing station
and should be released only once bill is settled.
Republic of
Yemen 48Modern
48
Hospital
4.1.2 When Returning Belongings to the Patient:

4.1.2.1 Hand over the valuables only to the person who endorsed and signed.
4.1.2.2 Valuables should be shown to the patient against the itemized list.
4.1.2.3 Obtain the patients signature in the valuables logbook, acknowledging
receipt.
4.2 Unit Nurse
4.2.1 Upon Admission:
4.2.1.1 Inquires/checks with patient upon admission if he/she has belongings and
valuables
that should not be with him in the hospital.
4.2.1.2 Requests patient to send home with the relatives any belongings and
valuables that are
not needed.
4.2.1.3 If patient refused and wanted to retain valuables to his/her possession:
4.2.1.3.1 a waiver form should be filled up and signed by the patient.
4.2.1.3.2 items should be endorsed to the unit head nurse against list to be
signed by the
patient.
4.2.1.3.3 valuables is kept in the safe or a locked cabinet controlled by the head
nurse/charge nurse or team leader.
4.2.1.4 When Returning Belongings/Valuables to the patient refer to procedure
4.1.2.
71
Republic of
Yemen 48Modern
4 PROCEDURES:
Hospital
48
Title: WAIVED and POINT of CARE TESTINGDue for Review:Page 1 of 4

48 MODERN
HOSPITAL
CONTENTS: This General
Ward policy
and procedure describes the point of care nursing and
laboratory
responsibilities in SGH.
1 DEFINITION:
1.1 Point of Care Testing - Laboratory testing, at any complexity level, that is performed
and
documented within the hospital organization at sites of immediate client care (e.g. clinic,
nursing unit,
ED), where the results of the test are used for clinical decision making (see Appendix A for
a list of such
sites). It does not pertain to histologic or cytologic assessments or to testing performed in
settings
outside of those associated with immediate client care.
NOTE: Point-of Care Testing may also be referred to as decentralized testing, ancillary
testing and
bedside testing. Based on Clinical Laboratory Improvement Amendment (CLIA) criteria,
point-of-care
testing is generally divided into two categories of complexity (waived and non-waived
testing).
1.2 Waived Testing - Non-critical tests which have been approved by the FDA for home use
employ
methodologies that are as simple and accurate as to render the likelihood of erroneous
results negligible,
or pose no reasonable risk of harm to the client if performed incorrectly.
1.3 Non-Waived Testing :
1.3.1 Moderately Complex Testing - Tests which require minimal scientific and technical
knowledge
and training to perform accurately, operational steps are either automatically executed
or easily
controlled, and minimal interpretation and judgment are required.
1.3.2 Highly Complex Testing: Tests which require specialized scientific and technical
knowledge,
training and experience to perform accurately, operational steps require close
monitoring or control,
and extensive independent interpretation and judgment are required.
2 PURPOSES:
2.1 Equipment is managed and maintained in a safe condition to minimize the risk to
patients and staff
in SGH.
2.2 POCT is performed in accordance with the quality requirements of the SGH and
International
Standards.
2.3 POCT equipment is standardized throughout the SGH.
2.4 Test results are accurate and reliable.
3 POLICIES :
3.1 Any laboratory testing, including testing that is performed outside of the Clinical
Laboratories by
non-clinical laboratory personnel must conform to the CBAHI regulations.
3.2 The Point-of-Care Testing Committee establishes standards for Point-of-Care Testing,
monitors all
Point-of-Care Testing sites for compliance & proficiency as required, reviews for approval
all requests
to establish Point-of-Care Testing, arranges for evaluation of all POC test devices/kits
bycentral
laboratory and approves all such devices/kits
72 before they are put into service.
3.3 Questions about the implementation of these guidelines should be addressed to the
POC committee /
co-coordinator in the Clinical Laboratory.
Republic of
4.1 Point-of-Care Testing Committee

Yemen
48Modern
48Director
4.1.1 The
Point-of-Care
Testing Committee is chaired by the Clinical Laboratory
and
includes
Hospital
the following people or their designees; OPD Nursing Supervisor, Assistant Nursing Director,
Nursing Educator , QI Representative Nurse , Chief Med. Tech. and Lab. QI Supervisor. Others
are
73
Republic of
Yemen 48Modern
Hospital
48
invited as necessary to participate, on regular basis. POCT Committee assigned, Lab

Tech, as the Lab
POCT designee and QI nurse, as the Nursing POCT Coordinator.
4.1.2 The Committee meets at least quarterly with conclusions, recommendations, and
actions
documented in the minutes.
4.1.3 The POCT Committee:
4.1.3.1 Reviews for approval all requests for Point-of-Care Testing, taking into
consideration the
following issues:
4.1.3.1.1 Medical need for immediate turnaround time
4.1.3.1.2 Procedure complexity
4.1.3.1.3 Regulatory compliance
4.1.3.1.4 Ongoing testing proficiency
4.1.3.1.5 Cost
4.1.3.2 Assigns Point-of-Care testing oversight to the appropriate laboratory staff.
Reviews
reportsofofPOCT
performance
for all areas performing laboratory testing and
4.2 4.1.3.3
Evaluation
& Selection
Equipment
recommends
4.2.1
POCT committee must be involved in the initial assessment, installation and set-up
corrective.
of new
POCT
equipment.
4.2.2 POCT committee must be included in discussions with suppliers regarding POCT
equipment.
4.2.3 There must be a clear definition of the problem that the POCT would solve so that a
full
investigation of all possible solutions can be made.
4.2.4 Specialist clinical staff e.g. diabetes physicians and nurses would be consulted on
proposed
changes or the introduction of new POCT equipment.
4.2.5 The evaluation and selection of POCT equipment is coordinated by the POCT
Committee and
follows the SGH Laboratories- Equipment Evaluation Guidelines. This includes:
4.2.5.1 Needs assessment
4.2.5.2 Accuracy, precision and correlation studies
4.2.5.3 Space and service requirements
4.2.5.4 Methodology assessment
4.2.5.5 Environmental assessment
4.2.5.6 Computer requirements
4.2.5.7 Efficiency assessment
4.2.6 The final decision to proceed is a considered consensual agreement by the
4.3 Documentation
participants
of the
4.3.1
All POCT
procedures
mustorganizes
be documented
in consultation
with the
POCTstaff
Committee.
process
The POCT
Committee
in conjunction
with relevant
clinical
the
4.3.2
A
permanent
record
of
all
POCT
testing
must
be
maintained
within
the
appropriate
installation of
clinicalrecord
POCT equipment.
of the
client.
4.2.7
The
POCT Coordinators completes the SGH Laboratories Procurement of New Test
4.4
Quality
Equipment Control Program
4.4.1 POCTThe
must
have
the same level
quality
assurance
as is hold
provided
forof
testing
Checklist.
POCT
Coordinators
and of
the
relevant
clinical staff
a copy
the
performed within
checklist.
SGH Laboratories.
4.4.2 An appropriate quality control program is agreed and documented for all POCT and
must be
adhered to. A system must be in place to ensure that POCT results are comparable with
the results
produced by SGH Laboratories
4.4.3 Internal QC is performed on daily basis74
(and whenever the client result is
questionable) by those
clinical staff producing the results in the clients care setting, who are also responsible
for recording,
Republic of
Yemen 48Modern
48
Hospital
reviewing and action in QC results. The laboratory staff regularly reviews the QC data.
External QC
is performed whenever possible.
4.5 Training/Competency
4.5.1 All staff using POCT equipment receives training in the use of the equipment.
4.5.2 The POCT Coordinator will ensure a training program is in place and there is a
system for
documenting when training has been given. The training program should include:
4.5.2.1 Collection, transportation and disposal of specimens
4.5.2.2 Quality control requirements
4.5.2.3 Step by step procedures
4.5.2.4 Recording results
4.5.2.5 Interpretation of results
4.5.2.6 Troubleshooting
4.5.2.7 Maintenance of equipment
4.5.3 Staff may not train each other unless approved by the POCT Coordinator or
designated
representative.
4.5.4
All staffPOCT
using POCT equipment must have up to date competency/audit records.
4.6 Performing
Competency is
4.6.1 Only clinical staffs that have been trained in POCT can perform POCT.
reviewed
at least
forbe
allclearly
POCT. documented. POCT procedures must be
4.6.2
Procedures
for annually
POCT must
authorised bythe
relevant laboratory staff.
4.6.3 All client and quality control results must be recorded. This can be electronically or
on paper. The
record must include:
4.6.3.1 At least 2 unique client identifiers e.g. PIN & name
4.6.3.2 Date and time of test
4.6.3.3 The result
4.6.3.4 The identity of the operator
4.6.4 The transfer of results into the clients clinical record must be traceable and stated
in the POCT
4.7
Troubleshooting/Maintenance/Cleaning of POCT Equipment
procedure.
4.7.1Unexpected
All POCT equipments
must
havemust
a documented
preventative
maintenance
schedule
4.6.5
and extreme
results
be checked
by sending a
sample to the
which is either
laboratory.
done by the using clinical staff or by the SGH maintenance department.
4.7.2 Appropriate back up must be available in case of breakdown.
4.7.3 When a fault is found with POCT equipment it is labelled OUT OF ORDER and must
not be
used.
4.7.4 The POCT Coordinator and other relevant staff must be notified immediately.
4.7.5 Trouble shooting procedures must be documented and include the contact details for
assistance.
4.7.6 Only approved and appropriately qualified and competent SGH or external service
staff must
service POCT equipment.
4.7.7 A service history must be maintained which includes maintenance, faults, corrective
actions
4.8 List and
of POCT Equipments and Testing Locations
repairs by named individuals.
4.8.1 Rapid Point Blood Gas Analyzer (Bayer): Only One machine located in the Open heart
/ 4.7.8
ICUin Procedures for cleaning and decontamination of POCT equipment must be
documented and
the second floor of the Open Heart building.
carried out before any servicing is performed.
75
Republic of
Yemen 48Modern
48
Hospital
4.8.2 Optium Xceed Device (Abbott): 31 devices distributed throughout the hospital as
following (this
list is subject for updating whenever there is a change):
4.8.2.1 8 devices in the inpatient wards: Two in N2S , one in N2N, one in N3S, one in
N4S, and
one in N5S.
4.8.2.2 10 devices in the special units : four in the ER, one in the ICU, one in the NBD ,
one in the
OHU, 1 in the hemodialysis unit, 1 in the delivery room and 1 in the anesthesia.
4.8.2.3 12 devices in the outpatient clinics in the medical tower building : 8 devices in
the Internalprocedures, calibration steps, QC, maintenance and trouble shooting details for
Operational
Medicine Clinics, 1 device in the Ob/Gynecology clinic, 1 device in the Family Medicine
either
Clinic
the Blood Gas analyzer or the Glucometer devices are included under each machine section.
and 2 devices backup with the OPD supervisor.
76
Republic of
Yemen 48Modern
48
Hospital
GENERAL WARD
INTERNAL
POLICIES
AND
PROCEDURES
77
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Manual: Nursing Administration Policies and

Procedures
Title: General Wards Staff Competency AssessmentDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure describes the method of assessing
the General
Ward staffs competency assessment.
1 DEFINITION:
1.1 General Ward for the purpose of policy and procedure, general wards refer to the
following
units according to the hospital branches:
1.1.1 SGH-Jeddah N2N, N2S, N3S, N4S, N5S
1.1.2 SGH- Aseer N2N, N2S, N3S
1.1.3 SGH-Riyadh 2nd Floor, Male Ward, Female Ward
1.1.4 SGH-Madinah NS1 (Female Ward), NS2 (Male Ward)
1.2 Competency - is the individuals knowledge and skills required to do the job well. It
has to be
assessed, measured, and documented in an ongoing manner.
1.3 Competency Statement - is a specific, measurable statements of criteria used to
assess
demonstrated skills. It is based on an established standards, policies, and practices.
1.4 Competency Assessment Checklist A tool used in measuring and documenting the
skill level
of the staff.
1.5 Procedure an instruction on how to conduct the skills assessment of the staff.
1.6 Assessor a person duly licensed form the home country origin, Saudi Council for
Health
Specialties and Saudi Arabian Ministry of Health, who is assessing the staffs
competence of the
procedure/s against the pre-set competency checklist.
1.7 Preceptor a person duly licensed form the home country origin, Saudi Council for
Health
Specialties and Saudi Arabian Ministry of Health, who is guiding and mentoring the
staff before
the staff is scheduled to undergo competency assessment.
POLICIES:
3
2 PURPOSES:
3.1 Staff competency assessment starts on the Nursing Orientation Period.
2.1 To assess the knowledge and skill level of the staff in performing the procedures
3.2 New-hired staffs should be subjected for skills/competency assessment on the
before
procedures being
assigning in the unit.
performed in the unit.
2.2 To assess the preparedness of the staff in his/her assumptions of his/her duties and
3.3 Nurse educator, acting as the assessor, assesses the skill level of the staff
responsibilities.
according to the list of
2.3 To ensure that the staff possesses the required knowledge, skills, and abilities
procedures being performed in the ward.
necessary to
3.4 After the orientation period is finished, the nurse educator makes the staff
perform his/her duties and responsibilities.
competency
assessment file and gives it to the staffs respective head nurse to continue with
the assessment
on the procedures that have not been assessed.
3.4.1 Nurse educator keeps a file of all nursing service personnels competency
summary
against the list of mandatory procedures to serve as bases in developing
78
educational
program.
Republic of
Yemen 48Modern
48
Hospital
3.5 Upon the staffs assumption of his/her duty in his/her assigned unit, he/she will be
assigned to
the preceptor in the unit who will be orienting and mentoring him/her with the
responsibilities in
the unit.
3.6 Competency assessment will be done on the staffs that are not competent against
the list of the
set procedures.
3.7 If the staff is not competent on a certain procedure, he/she is not allowed to
perform such
procedure alone. He/she needs to be guided by any senior or qualified staff in the
performance
of the procedure.
3.7.1 He/she will be subject for close monitoring by the preceptor.
3.7.2 The staff will also be under the close monitoring by the clinical instructor.
3.8 For procedures considered to be low frequency, or seldom occurring procedures
such as code
blue, etc., the following should be done:
3.8.1 Wait for a maximum period of 3 months to have an actual experience, if not;
3.8.2 A simulation or mock procedure will be set-up.
3.9 Unit manager/clinical instructor follows-up the staff in the unit especially on
procedures where
staff got insufficient assessment result.
3.9.1 For any signs of incompetence, it should be reported at once to the Nursing
Education.
The nurse-educator in turn will design a remedial program to help improve
this staff.
3.9.2 Skills assessment must be reviewed periodically as required.
3.10Ward procedures that require competency assessments include:
3.10.1 CPR
3.10.2 Fire/disaster
3.10.3 Infection control
3.10.4 Safety
3.10.5 Blood transfusions
3.10.6 Hazardous materials
3.10.7 Performance appraisal
3.10.8 Use of restraints
3.10.9 Lifting and transferring of patients
3.10.10Monitoring of patient vital signs and impact of deviations
3.10.11Assessment of patients according to scope of service
3.10.12Medication administration
3.10.13IV therapy (insertion, maintenance, discontinuing)
3.10.14Infection control guidelines
3.10.15Patient falls
3.10.16Use of pulse oximetry
3.10.17Nurses role in cardiac/respiratory arrest
RESPONSIBILITIES:
4
3.10.18Nasogastric tubes and gastrostomy tubes and feedings
4.1 Nursing Director:
3.10.19Urinary catheters
4.1.1 Ensures that staffs competency assessment is implemented.
3.10.20Sterile dressings
4.1.2 Sees to it that the staff has undergone skills assessment before being
3.10.21Skin care and the prevention of care of pressure ulcers
assigned in the
3.10.22Nurses role in disaster, fire, and other emergencies
unit.
3.10.23Use of restraints
4.1.3 Assigns the staff in the unit based on his/her competency level.
3.10.24Operation of blood sugar testing equipment
3.10.25How to safely clean up chemical spills
79
Republic of
Yemen 48Modern
Hospital
48
4.2 Nurse-Educator:
4.2.1 Initiates skills assessment verification.
4.2.2 Prepares the staffs competency assessment file and gives it to the staffs
head nurse
who will continue with the competency assessment in the unit.
4.2.3 Reviews staffs competency status for program planning.
4.2.4 Makes recommendations to the department head for staffs unit assignment
based on his
level of competency.
4.2.5 Schedules periodic in-service education and skills training to improve staffs
competency status.
4.3 Clinical Instructor:
4.3.1 Assists the educator in initiating skills assessment verification.
4.3.2 Conducts follow-up to the staff in their unit assignment.
4.3.3 Tabulates individual staffs competency performance.
4.3.4 Informs the unit about the schedule of in-service educational activities.
4.4 Preceptor:
4.4.1 Coaches the staff in the performance of the procedure to be assessed and
makes
necessary recommendations.
4.4.2 Observes staff during the competency assessment process.
4.5 Assessor
4.5.1 Assesses the staffs competence to perform the procedure against the
competency
checklist.
4.5.2 Accomplishes staffs skills assessment form (date of completion, scoring,
etc.), if
applicable.
4.5.3
Evaluates staffs performance and makes referral to the Education
PROCEDURES:
Department
any he/she attends the 2-week-orientation program where competency
5.1 For new staff,
proof
assessment willof staffs incompetence.
Forwards
the completed
competency
assessment
form to the
Education in
be4.5.4
made.
For old staff,
the designated
assessor
will do competency
assessment
Office,
when
their
necessary.
5
respective
unit assignment.
4.5.5
Makes
schedule
of
staffs
attendance
to
the
in-service
education
programs.
5.2 Nurse-educator conducts didactic sessions of all unit-specific and general
4.6 Staff:
departmental
4.6.1 Shows integrity in the performance of any assigned procedure.
procedures.
4.6.2will
Signs
the competency
form after every
skill
evaluation.
5.3 Staff
be made
to perform assessment
a return demonstration
of the
procedure.
4.6.3
Attends
the
in-service
educational
program
when
scheduled.
5.3.1 Assessor should use the official competency assessment form in assessing the
skills.
5.3.2 Put a TICK MARK in the space provided if the staff performs the procedure
correctly. If the staff did not make it right, the assessor should put an X
mark.
5.4 Assessor accomplishes the competency assessment form and has the staff signs it
and forwards
it to the Education Department.
5.5 Low-frequency procedures will be assessed during actual situation or a
mock/simulation
procedure will be conducted.
5.6 Staffs skills assessment may be done in the classroom by the assessor or in the
unit, when
necessary.
5.7 Nurse-educator/clinical instructor/assessor make a summary of the staffs
competency status.
80
5.8 Nurse-educator/clinical instructor/assessor make appropriate recommendation for
the staffs area
of assignment depending on the level of competency.
Republic of
Yemen 48Modern
48
Hospital
5.9 Use only the Official Competency Assessment

Format.
SUPPLIES/EQUIPMENT REQUIRED
6.1 Supplies/equipment necessary to perform the
procedures.
6.2 Competency assessment checklist
SPECIAL CONSIDERATION:
7.1 Staffs area of assignment may be changed based on the result of the
competency assessment
after appropriate recommendations.
81
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Scope of Service - In-Patient Nursing UnitsDue for Review:Page 1 of 3
CONTENTS: This general wards policy and procedure deals with the scope of service of the
in-patient
nursing units.
1 DEFINITIONS:
1.1 Scope of Service the coverage of services offered by the In-Patients Nursing Units
to cater to
the demands of the patients admitted in the unit.
1.2 Scope of Practice the extent of the duties and responsibilities provided by the
unit personnel
to meet the health care demands of all patients.
2 PURPOSES:
2.1 To have a clear definition of the coverage of services that the unit is offering to all
its clients.
2.2 To specify the duties and responsibilities of all unit personnel in the provision of
patient care.
2.3 ToOF
identify
the extent of service of each member of the health team in the delivery
SCOPE
PRACTICE:
3
of 3.1
patient
In-patient units provide appropriate, comprehensive, individualized, safe, and
care.
quality
patient
2.4
To to
protect
all personnel working in the unit from any legal accountabilities in the
care
the patients.
practice
of
the
3.2 Patients admitted to the unit include patients from all ages and wide range of
profession.
illness
conditions.
3.3 Provides comprehensive patient care to patients admitted in the unit.
3.4 Patient care services include but not limited to:
3.4.1 Nursing care to non-surgical patients.
3.4.1.1 Performs assessment.
3.4.1.2 Develops patients plan of care.
3.4.1.3 Provides health teachings.
3.4.1.4 Develops discharge plan.
3.4.1.5 Delivers dependent and independent nursing interventions to alleviate
patients
illness/es.
3.4.1.5.1 Safe medication preparation and administration.
3.4.1.5.2 Routine nursing cares such as vital signs monitoring, etc.
3.4.1.5.3 Provides patient comfort i.e. bed bath, massage, etc.
3.4.2 Pre and post-operative care
3.4.2.1 Prepares patient for surgery
3.4.2.1.1 Ensures that informed consent is signed and witnessed
appropriately
3.4.2.1.2 Pre-operative preparations are done properly
3.4.2.1.3 Pre-operative checklist is accomplished
3.4.2.1.4 Patient is made ready for the contemplated operations
3.4.2.2 Provides post-operative care to the patient.
3.4.2.2.1 Monitors patients condition post recovery.
3.4.2.2.2 Administers due medications post-operatively.
3.4.2.2.3 Assist physician in performing post-operative procedure such as
82
dressing
change, etc.
Republic of
Yemen 48Modern
48
Hospital
DEPARTMENT
OVERSIGHT:
4.1 Accountability
4.1.1 There is a Head Nurse who assumes the unit responsibility. Head nurses
3.4.2.3
schedule
is Provides post-operative health teachings to the patient in accordance to
the nature 10-hour-duty. After duty hours, the accountability of the unit is passed to the
on-duty and type of operation.
3.5 Every patient
to the unit can expect to have an individualized plan of
charge admitted
nurse.
care. Plan
of
care
4.1.2 There is an assigned unit assessor/s and preceptor/s (who may or may not be
is multidisciplinary
including patient and input when possible.
the
head
3.6 Teachings
willor
be
provided
patients
throughout
their stay
including
nurse
the
charge to
nurse),
whoand
arefamilies
responsible
in unit staffs
competency
but
not
after
limited to
patient and from
family
rights
and
responsibilities, pain management, patient4
endorsement
the
Nurse
Educators.
safety,4.1.3
and Staffing needs and problems are taken cared of by the head nurse of the unit
scheduled procedures.
in
coordination with the Director of Nursing.
4.2 Patient Assignment Scheme
4.2.1 Duty roster of the unit staff is prepared by the head nurse or the charge nurse
(in the
absence of the head nurse).
4.2.2 Comprehensive nursing care or Total Patient Care is utilized in the delivery of
care to
the patients. However, in cases where there is shortage of staff, Functional
Method of
Patient Care Delivery is advocated.
4.2.3 Manner of staff assignment is based on staffs competency level and patient
acuity.
4.2.4 Staffing is made up of full time nursing. In-patient staff meetings are held
monthly.
Internal memoranda are used for updates.
4.3 Practices
4.3.1 Ward Policies and Procedures Manuals are available in all in-patient units for
staffs
reference.
4.3.2 Safety
4.3.2.1 It is the responsibility of the unit manager to monitor visiting hours if
they interfere
with the patients well-being, or with the activities of the unit.
4.3.2.2 All unit staff will be identified with ID badges.
4.3.2.3 All staff has the right to question anyone in the unit regarding their
presence if they
are not properly identified.
4.3.2.4 Each staff member has the responsibility to protect the safety and
confidentiality of
the patient.
4.3.2.5 All patients should have waterproof ID bands.
4.3.2.6 All machines and equipments are having periodic preventive
maintenance by
Biomedical Engineers.
4.3.3 Infection Control
4.3.3.1 Infection control policies and practices should be followed.
4.3.3.2 Patients rooms and equipments are cleaned between each patient use.
4.3.3.3 Universal precautions of handwashing and use of protective barriers are
used to
prevent spread of infection.
4.3.4 Emergency
4.3.4.1 Emergency equipments and supplies can be found in the crash cart
located in the
strategical place inside the nurses83
station.
4.3.5 Emergency Plan
4.3.5.1 In-patient units follow protocols as stated in the Emergency
Preparedness Plan.
Republic of
Yemen 48Modern
48
Hospital
STAFFING:
5
5.1 Nursing Personnel
5.1.1 Head Nurse
5.1.2 Charge Nurse
5.2 Support Service Personnel
5.2.1 Nurse Aides
5.2.2 Porters
5.2.3 Ward Secretary
5.2.4 Ward Receptionist
5.3 Qualifications
5.3.1 Registered Nurses
5.3.1.1 Current license from the country of origin
5.3.1.2 Licensed by the Saudi Arabian Ministry of Health
5.3.1.3 BLS certified
5.3.1.4 Competencies as stated in the General Ward Policy and Procedure
Manual
5.3.2 Support Service Personnel
5.3.2.1 Minimum secondary school education
5.3.2.2 Training on hospital works
5.3.2.3 BLS certified
84
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Isolation Standards/PrecautionsDue for Review:Page 1 of 3
CONTENTS: This General Ward policy and procedure discusses in details the importance of
isolation
precautions and standards in the unit.
1 DEFINITIONS:
1.1 Isolation the separation, for the period of communicability, of infected persons
POLICIES:
from
in precautions for blood and body fluids, secretions, excretions, mucous
3.1 others
Standard
membranes
non- or limit the direct or indirect transmission of the infectious agent
order toand
prevent
fromintact
the skin shall be used in the care of all patients.
3.2 infected
Key Components
of those
Isolation/Standard
Precautions:
person to
who are susceptible
or who may spread the agent to others.
3.2.1
Hand
washing
the
most
important
procedure
fororpreventing
cross-contamination
1.2 Standards the statement of the levels of service
care related
to specific topic
and
and the
removal
of transient
from outcomes.
the hands by using mechanical friction,
process
needed
to attainmicroorganisms
specific observable
soap
and
2 PURPOSES:
water, washing
with responsibilities
the use antimicrobial
agent.
2.1 To establish
individual
in order
to minimize the transmission of
3.2.2 Consider every person (patient or staff) as potentially infectious and susceptible
3
infectious agents
to
between patients and all other people in SGH facilities.
infection.
2.2
To prevent other people (patients family or health care workers) from being
3.2.3 Use of physical protective barriers gloves, facemasks, goggles, gowns, etc. when
infected
getting by the
patient.
in contact with blood and body fluids.
3.2.4 Environmental Cleaning routine care, cleaning, and disinfections of equipment
and
furnishings in patient care areas.
3.2.5 Use of antiseptic agents for cleaning of the skin, mucous membrane prior to
surgery and
wound dressing.
3.2.6 Safe work practices such as proper sharps disposal procedures; sending of
instruments and
other equipment to CSSD for disinfections and sterilization.
3.2.7 Safe disposal of infectious waste materials.
3.3 Door signs for transmission-based precautions shall be posted at the entrance of the
patients room.
3.4 All suspected infectious cases or potential infections admitted in the unit should be
reported to
the appropriate personnel so that necessary precautions will be implemented.
3.5 All isolation cases or suspected cases should be admitted in the isolation ward or
isolation
precaution shall be instituted. If the attending clinician shall not be persuaded to
observe
isolation precautions, nursing personnel shall contact the infection control officer
assigned to
their area.
3.5.1 When possible, a single room is indicated for the following:
3.5.1.1 Patients with highly transmissible or epidemiologically important
microorganisms
(e.g. MRSA, tuberculosis, chickenpox).
3.5.2 When a single room is not available, infected patients shall be placed with
appropriate
85
roommates (cohorting). Patients infected by the same microorganisms can
usually share
a room.
Republic of
Yemen 48Modern
48
Hospital
3.5.3 An infection control officer may be contacted when a single room is not
available for
cohorting.
3.5.4 For all isolation cases should follow the infection control policy and
precautions for the
patient as well as the staff.
3.5.5 Inform departments involved in the provision of patient care such as the Xray,
Laboratory, Physiotherapy, etc. regarding patients condition so that
necessary
precautionary measures will be taken.
3.5.6 Hand washing should be done according to the infection control guidelines.
3.5.7 All health care workers and visitors should use isolation control materials
such as
gloves, facemasks, and gowns, when getting in contact with the patient.
3.5.8 Equipment and other articles necessary to protect health care workers and
visitors shall
be kept available at the nurses station or near the patients bedside.
3.5.8.1 Reusable equipment and supplies in contact with non-intact skin, blood,
body
fluids or mucous membrane shall be bagged or placed in a punctureresistant
container and labeled, before it is sent to CSSD.
3.5.9 All contaminated items should be disposed in the yellow plastic bags.
4
3.5.10 Disposable fluid-filled containers (suction bottles) shall not be emptied but
4.1 For more comprehensive discussions on standard isolation precautions, refer to
shall be
Infection
disposed as follows:
Control Policy and Procedure Manual (IC 7-1).
3.5.10.1Place the container in a plastic bag, tie the bag close. Double-bag if
necessary.
3.5.10.2Place the bag into the infectious waste container.
86
Republic of
Yemen 48Modern
48
Hospital
GENERAL
NURSING
INTERNAL
POLICIES
AND
PROCEDURES
87
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Absconding of Clients
Applies to: General Ward and Specialty Units
CONTENTS: This General Ward policy and procedure serves as guidelines in handling clients
that have
the possibilities to abscond.
1 DEFINITION:
1.1 Absconding the act or intention of leaving the hospital in a sudden and discreet
manner without
the knowledge of the staff in the concerned unit/area.
2 PURPOSES:
2.1 To prevent possibility for absconding of any client of the hospital.
2.2 To ensure that hospital policy of discharging patient is being followed.
2.3 To ensure that necessary actions are taken and implemented for hospital claim.
2.4 To serve as a basis for reporting to legal authorities for appropriate interventions.
3 POLICIES:
3.1 A client on the following conditions is put on Absconding Precaution.
3.1.1 Those clients having accumulated hospital bills.
3.1.2 Long staying patients.
3.1.3 Patients who are due for discharge but not able to leave due to non-payment of
bills.
3.1.4 Psychiatric clients.
3.2 Patients with any possibility of absconding should be placed under absconding
precautions.
3.2.1 All staff should be able to identify patients appropriately with potential to
abscond.
3.2.2 Patients with potential to abscond should be endorsed to the guard-on-duty.
3.3 Any incident of absconding of patient should be reported immediately to the proper
PROCEDURES:
authority
4.1 Patient/s having the possibility to abscond should be placed under absconding
observing the protocol as soon as the incident is discovered.
precautions.
3.3.1Frequent
Proper authority
includes
the
attending physician, director of nursing, nursing
4.1.1
rounds to
patients
room.
supervisor,
4.1.2 Having the patient wears the prescribed hospital gowns and ID band at all 4
CMO, and admission/discharge officer.
times.
3.4
Concerned
staff
should
incident
4.1.3
Advising
patient
to write
avoid an
leaving
the report.
room to roam around.
4.2 Any actual incident of patient absconding.
4.2.1 As soon as the incident is discovered and confirmed, the staff discovering it
should inform
the unit manager at once, who in turns, inform proper authorities (refer to 3.2.1
for proper
authority).
4.2.2 Information is given to the security guard.
4.2.2.1 Security guard shall search the entire hospital premises to look for the
patient.
4.3 Unit manager performs the investigation of the incident and forwards report to the
nursing office.
4.4 If, despite the search, and the patient is not seen, the unit staff makes inquiries at
the patients
residence.
4.4.1 If patient is at home, requests for the88patient to come back to the hospital.
4.4.1.1 If patient fails to return to the hospital, give the patients file to the ward
secretary for
discharge.
Republic of
Yemen 48Modern
48
Hospital
4.5 Concerned nurse fills-up an incident report.

4.6 Patients belongings left will be kept in the nurses station
4.7 In case a relative comes to settle the bill, accompany the relative to go to the
Admission/Discharge
Office.
4.7.1 Once the bill is settled, give the patients belongings to the relative.
4.7.2 Inform the nursing supervisor that the bill of the patient that had absconded is
already
settled.
5
5.1 For long staying patients, bill should be updated weekly and deposits should be
taken from
patients.
5.2 Absconding Precaution Label should be written on the kardex and must be
endorsed properly.
5.3 Security is requested and provided, as appropriate, by the management.
89
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Answering Call Bells

CONTENTS: This General Ward policy and procedure deals with the procedure of
answering call bells.
1 DEFINITION:
1.1 Answering of Call Bells - a prompt response made by the nurse to a patients call. It is
a
manifestation of nurses concern in the promotion of patients welfare and well being by
meeting
his/her needs.
2 PURPOSES:
2.1 To attend to patients problems/inquiries.
2.2 To satisfy patients needs.
3 POLICIES:
3.1 Call bells should be answered within one minute.
3.2 Ensure that patients need is met and inquiries are answered.
3.3 Upon admission, patient/relative is oriented to the unit call bell system.
4 PROCEDURES:
4.1 Patient/relative presses the call bell button to summon help.
4.2 Nurse detects call bell sound on the main console on the nurses station.
4.3 Nurse checks on the call bell light locator on the ceiling, on both wings to identify
location of the
patients room.
4.4 Nurse confirms call on the call bell light outside the patients individual room.
4.5 Gently knock at the door.
4.6 Enter the room and close the door slowly.
4.7 Press red button once to keep the green light on to signify someone has attended the
call.
4.8 Ask the patient the reason why he/she called. Show concern and willingness to meet
his/her needs.
4.9 After any request or needs has been attended, ensure if there is something else the
patient wants.
4.10Upon leaving, press the green button to turn off the light.
4.11Leave the room and close the door.
5 SPECIAL CONSIDERATIONS:
5.1 Green light signifies normal call, while red light signifies emergency call.
5.2 Prompt response to call bell is required.
5.3 Ensure that inquiries, needs and problems are met and/or relayed to proper authority.
90
Republic of
Yemen 48Modern
48
Hospital
91
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
REFERENCE:
5
Manual:
General Ruth
Nursing
Departmental
Manual
5.1 Fundamentals of Nursing, Human Health
and Function,
F. Craven,
Constance
J.
Hirnle, pp.
Title: Kardex
238.
CONTENTS: This General Ward policy and procedure discusses the use of kardex in the unit
as a
guideline in the continuity in the provision of patient care.
1 DEFINITION:
1.1 Kardex - a name for a filing system allowing for a quick reference to the particular
needs of the
patient. It is a flip-over card usually kept in a portable index file that contains pertinent
information about patient and their ongoing plan of care.2 PURPOSES:
2.1 To organize information in a useful manner needed for end of shift endorsement.
2.2 To eliminate the need for continual referral to patients file for routine information.
2.3 To provide opportunity for nursing team to promote continuity of care.
3 POLICIES:
3.1 The kardex should include the following information:
3.1.1 Name, age, sex, nationality, PIN and room number
3.1.2 Date of admission
3.1.3 Chief complaints
3.1.4 Diagnosis, name of attending physician
3.1.5 Allergies
3.1.6 Medications
3.1.7 Type of account
3.1.8 Diet
3.1.9 Ongoing IV fluid, if any
3.1.10 Nursing care plan
3.1.11 Referrals, if any
3.1.12 X-ray and laboratory investigations
3.1.13 Special procedure
3.1.14 Surgery done, if any
3.1.15 Respiratory therapy, such as use of oxygen, mechanical ventilation, or
suctioning
3.1.16 Contraptions (NGT, Foleys Catheter, Colostomy, ICD, etc.)
3.1.17 Special precautions related to patient care
3.2 Pencil should be used in writing on the kardex.
3.3 Kardex should be updated on time.
3.4 All entries in the kardex should be written clearly.
3.5 A nursing care plan should be updated regularly to suit patients needs.
3.6 Kardex should be used as a basis for endorsement.
3.6.1 Kardex is discarded as soon as the patient is discharged.
4 RESPONSIBILITIES:
4.1 Charge nurse will be responsible to update clients data (medicine, laboratory, etc.)
4.2 Clients personal data should be completed.
4.3 Diagnosis, special procedure, operations should be clearly written
4.4 Room number should be updated when client is transferred to other room.
4.5 Kardex should be endorsed properly to the next shift.
92
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Comprehensive Nursing Assessment
CONTENTS: This General Ward policy and procedure defines the responsibility of the staff
providing
direct patient care to perform initial, periodic, and pre-discharge nursing assessments in the
formulation of
specific, effective, and efficient patient care plan.
1 DEFINITION:
1.1 Nursing Assessment the systematic collection of subjective and objective data with
the goal of
making a clinical nursing judgment about an individual patient in order to formulate a
sound
clinical nursing care plan.
1.2 Initial Assessment Also called an admission assessment, performed when a client
enters a
healthcare facility.
1.3 Periodic Re-assessment the everyday assessment done by the nurse to the patient
to observe for
any changes or development in the patients condition. Periodic assessment enables
the nurse to
evaluate the effectiveness of nursing interventions as well as the medical management
on the
patient. This also serves as avenue for the nurse to observe for any development or
deterioration on
the patients status.
1.4 Pre-Discharge Assessment the assessment done by the nurse prior to patients
discharge. This
gives the nurse cues about what type of discharge instructions to be given to the
patient and his/her
family kind.
1.5 Nursing Care Plan is a written summary of care that a client will receive. These
plans of care
may be handwritten notes, electronic records, preprinted forms, care paths or maps,
individualized
preprinted plans of care, or standards of practice.
2 PURPOSES:
POLICIES:
3
2.1 As an initial identification of normal function, functional status, and collection of data
3.1 All patients admitted to the unit should be assessed initially from their entry unit.
concerning
3.1.1 Patient admitted through ER should be assessed initially in the ER to determine
actual or potential dysfunction of patients.
the
2.2 To evaluate clients health status.
presenting problem(s) and to focus the plan of care based on the problems
2.3 To identify functional health patterns that are problematic or dysfunctioning.
identified;
2.4 To provide an in-depth, comprehensive database critical for evaluating changes in the
likewise with other entry point of admission (OPD, etc.)
clients
3.1.2 Using Nursing Admission Assessment Form (Form No. M5252 Jan 2004),
health status.
assessment
2.5 To serve as baseline data for reference and future comparison.
should include:
2.6 Initial, periodic and pre-discharge patient assessment enables the nurse to make an
3.1.2.1 Vital signs
effective plan
3.1.2.2 History of main complaint
of care to promote rapid recovery and restore patients well being.
3.1.2.3 Drug allergies
93
2.7 To communicate effectively patients condition
to other members of health team.
2.8 To provide effective health education necessary for patients condition to the patient
and family.
Republic of
Yemen 48Modern
48
Hospital
3.1.2.4 Physical condition

3.1.2.5 Psychological status (to be written in the space provided for other
observation/findings in the form)
3.1.2.6 Pain assessment, if applicable using the Pain Flow Sheet (Form No.
M3052).
3.2 Thorough patient assessment should be done by Registered Nurses.
3.3 Admitting nurse should conduct patient assessment the patient within his/her shift.
3.4 The staff assigned to the patient, based on the assessment findings, should
formulate a
comprehensive plan of care.
3.5 Assessment of patients condition should also be done periodically to determine
changes or
development in the health status. Communication should be made accordingly to
other members of
healthcare team.
3.6
Prior to patients discharge, nurse should make the reassessment of the patients
PROCEDURES:
4
condition to verify
4.1 Using the Form No. M5252 (Nursing Admission Assessment Form) and Form No.
the(Pain
discharge plan of care formulated for the patient.
M3052
Flow Sheet) when necessary, the nurse performs patient assessment employing
techniques of
inspection, palpation, percussion, and auscultation.
4.2 Admitting nurse fills-up the assessment form and formulate care plan depending on
the identified
patient problem/s.
4.3 The nurse explores patients related history of illness through interview with the
patient and
significant others.
4.4 Attending nurse formulates patient-specific plan of care based on the assessment
findings.
4.5 Staff conducts periodic re-assessment of patients condition to determine changes in
5
the patients
status and to revise the plan of care formulated for the patient.
4.6 Prior to patient discharge, attending nurse makes an assessment to gather data in
making patients
discharge health education.
4.7 The nurse communicates with other members of the health team for any significant
findings in the
assessment to make necessary adjustments in the plan of care.
MATERIALS/EQUIPMENT NEEDED
5.1 Form No. M5252 Nursing Admission Assessment
5.2 Form No. M3052 Pain Flow Sheet
94
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Nursing Care Plan
CONTENTS: This General Ward policy and procedure of 48 MODERN HOSPITAL defines the
formulation and implementation of individualized patient care plan.
1 DEFINITION:
1.1 Nursing Care Plan also called patient care plan, is a written guideline on the
intended care to be
administered to the patient based on the assessment findings. It is designed to
ameliorate client
problems. It contains nursing diagnoses, goals, outcome criteria, nursing interventions,
and
evaluation.
1.2 Nursing Interventions any treatment, based upon clinical judgment and knowledge
that a nurse
performs to enhance patient/client outcomes. It is used to monitor health status;
prevent, resolve, or
control a problem; assist with activities of daily living; or promote optimum health and
independence. Interventions are written as specific activities on the plan of care.
1.3 Multidisciplinary Care Plan also called Collaborative (Integrated) Care Plan, is a
patient plan
of care involving all members of the healthcare team.
2 PURPOSES:
2.1 To direct patient care activities related to the person for whom the goals and outcome
criteria were
developed.
2.2 To direct the activities of the nursing staff towards the provision of client care.
2.3 To promote continuity of care.
2.4 To allow for delegation of specific activities.
2.5 To establish coordinated activities of all members of the health team in delivering
patient care.
3 POLICIES:
3.1 An individualized-tailored plan of care should be formulated and developed for every
patient who
stays in the hospital for more than 24 hours.
3.2 Nursing care plan is developed with input from physicians and other health care
disciplines.
4 RESPONSIBILITIES:
3.3 Plan of care is reviewed every shift and when there is an observed significant changes
4.1 Nursing Director:
in the
4.1.1 Ensures that all patients admitted to the facility for more than 24 hours have a
patients condition or when new treatments are added and discontinued.
developed
3.4 All changes and revision in the plan of care should always be documented.
individualized nursing care plan.
3.5 All significant findings are documented in the nursing care plan.
4.1.2 Assesses staff performance in the implementation of the policy and to make
3.6 A standard nursing care plan form should be utilized. Form is kept in the Kardex
necessary
(Attachment
revisions in the policy when needed in collaboration with the TQM Team.
Form M1058). All problems identified, plan of care, and interventions implemented are
4.2 Nurse Supervisor:
written in
4.2.1 Verifies the implementation of the patient care plan in the unit.
the form. Evaluation results of the care are reflected in the documentations in the
4.2.2 Coordinates with the unit managers in the implementation of the policy.
nursing notes.
4.3 Unit Manager:
Black ink is used in writing entries.
95
Republic of
Yemen 48Modern
48
Hospital
4.3.1 Assists the staff in the development of patient care plan.

4.3.2 Evaluates effectiveness of the care plan.
4.4 Staff:
4.4.1 Formulates an individualized plan of care based on the assessment findings and
addresses
the unique needs of an individual patient.
4.4.2 Utilizes the nursing process such as objective cues, nursing diagnoses, plan of
care,
intervention, and evaluation.
4.4.3 Coordinates with other disciplines regarding the type of interventions to the
identified
patients problem(s).
4.4.4 Reviews the plan of care every shift.
5 PROCEDURES:
5.1 Staff nurses, in coordination with other disciplines taking care of the patient, identifies
patient
problem using the nursing process.
5.2 Using the nursing care plan form, the staff formulates and develops plan of care by
accomplishing
the following:
5.2.1 Identification of patients problem(s);
5.2.2 The date problem is identified;
5.2.3 The plan of care or the interventions to the identified problems;
5.2.4 The evaluation results whether the problem has been resolved or interventions
need to be
revised;
5.2.5 The plan for patients education;
5.2.6 Discharge needs (equipment/supplies);
5.2.7 Nursing consultations with other disciplines and with patient or family, and the
subject of
consultation;
5.2.8 The list of medications taken by the patient.
5.2.9 All observations, procedures, nursing activities, and interventions are recorded in
the
nursing care plan form.
5.3 Staff updates the plan of care every shift or whenever there is a change of treatment
regimen.
5.4 Resolved problems or any changes in the patients condition should be documented in
the care
plan.
5.5 All procedures specific to the patient are included in the plan of care.
5.6 Nurses communicate results of care to the patients treating physician and to the
health care team.
6 SPECIAL CONSIDERATION:
6.1 Nursing care plan may not be formulated and developed to clients who are admitted to
the unit for
less than 24 hours.
96
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Nursing Documentations
CONTENTS: This General Ward policy and procedure stresses on the guidelines and practices
in making
documentations in the medical record.
1 DEFINITIONS:
1.1 Nursing Documentations a systematic, clear and concise written accounts of all
patients care
management.
2 PURPOSES:
2.1 Means of communication among health personnel.
2.2 Serves as legal document.
2.3 Serves as a basis in determining prognosis.
2.4 For continuity of care.
2.5 For future reference in education and research.
2.6 For auditing, monitoring, and financial billing.
2.7 For research purposes.
3 CHARACTERISTICS:
3.1 Accurate.
3.1.1 uses precise measurements
3.1.2 follows standard hospital abbreviations
3.1.3 timely and well written
3.1.4 legible handwriting
3.2 Concise sequential and exact accounts of events.
3.3 Consistent and complete.
3.4 Confidential.
3.5 Relevant and clear.
3.6 Systematic and orderly.
4 POLICIES:
4.1 There should be at least one entry every shift (12-hour-shift) written in English
language.
4.2 Only Registered Nurses should do all charting. Any charting done by midwives should
be
countersigned by RNs.
4.3 Ensures correct file by checking patients name, PIN, and room number.
4.4 All entries should be clearly and legibly written in black ink.
4.5 Follows standard hospital abbreviations.
4.6 Never chart or record ahead of time and for anyone else. Follow policy in making
corrections.
4.6.1 Draw a single line across an incorrect entry.
4.6.2 Write error above the incorrect word or entry and enclose with a parenthesis.
4.6.3 Write the correct entry in a paragraph form.
4.6.4 Never use correction fluid in correcting errors in the medical record.
error
Example: (post tyroidectomy)post Thyroidectomy
4.7 Entries should be in chronological order according to the right sequence of time or
occurrence.
4.7.1 To write shift time (0700H-1930H / 1900H-0730H) as heading.
4.7.2 When failed to record on time, write by97indicating late entry and put the correct
time.
4.8 Each entry should be written with a date, time, and signature of the staff with his/her
complete
Republic of
Yemen 48Modern
Hospital
48
name and ID number.

4.9 Patients responses to any treatment should be documented accordingly.
4.10All documentations should be counterchecked by the HN/CN before transferring,
discharging, and
sending to the Medical Records Department for scanning.
4.11When a nurse is carrying out any procedure or going for rounds with the doctors in
the absence of
the assigned nurse, the attending nurse will be the one to record the observations
and outcomes of
the procedure, followed by a detailed endorsement to the assigned nurse upon his/her
arrival.
4.12No space should be skipped between entries or leave a space before the signature.
If any, draw a
single line across and affix signature.
5 PROCEDURES:
4.13Never
a wrong
entry
correctionpatients
fluid, scratching,
pasting.
5.1 Identifyerase
each page
in the
fileusing
by embossing
name andor
PIN.
All blank spaces in
4.14Clients
discharge
planning
and
health
teaching
should
be
documented.
the first
4.15Do
rely
your memory.
entries
should
be sheet.
updated on time.
sheet not
must
beon
properly
filled-upAll
before
using
a new
5.2 Read the previous recordings at the start of the shift.
5.3 Describe the reported symptoms, nursing actions, and patients responses; clear and
complete in a
sequential manner.
5.4 Record the objective facts that are actually observed, heard, and felt. Use flow sheets,
as necessary.
5.5 Record clearly and in details all doctors visits, treatments, and procedures done.
5.6 Admission notes should include:
5.6.1 Age, sex, nationality
5.6.2 Mode of admission and routine admission care
5.6.3 Chief complaints (not diagnosis)
5.6.4 Preliminary observations (utilizing admission assessment sheet Form M5252)
5.6.5 Initial vital signs
5.6.6 Accompanying relatives or person, if any
5.6.7 Admitting physician
5.7 Discharge notes should contain the following:
5.7.1 Condition of the patient
5.7.2 Health education given
5.7.3 Instructions for take home medicines and diet
5.7.4 Follow-up visit
5.7.5 Mode of discharge
5.7.6 Accompanying person
5.7.7 Type of discharge
5.7.7.1 Routine
5.7.7.2 Discharge against medical advice (DAMA)
5.8 Trans-in notes should have
5.8.1 General summary of the present condition
5.8.2 Specified notes about drains, or catheters attached, or ongoing IVF, if any
5.8.3 Valuable or personal belongings, if any
5.8.4 Specific instructions, if any, x-ray films, medications or reports, if present
5.8.5 Vital signs
5.8.6 Mode of transfer
5.8.7 Specific unit where patient came from
5.9 Trans-out notes should include
5.9.1 Condition of the patient at the time of transfer and area/unit to be transferred
5.9.2 Contraptions, drains, catheters, if nay
5.9.3 X-ray films, medications or reports, if 98
present
5.9.4 Valuables or personal belongings, if any
Republic of
Yemen 48Modern
48
Hospital
5.9.5 Follow-ups to be done.

5.9.5.1 Referral
5.9.5.2 Procedure
5.10Pre-operative notes should include complete
preparation
5.10.1 Physical
5.10.1.1Surgical procedure
5.10.1.2Site (skin preparation)
5.10.1.3Bath given to/taken by patient
5.10.1.4Change of gown/linen
5.10.2 Physiological
5.10.2.1Bowel and bladder preparations done
5.10.2.2Pre-operative medications given
5.10.2.3NPO maintained
5.10.2.4Blood investigations
5.10.2.5Number of units of blood kept ready
5.10.2.6X-ray, ECG results
5.10.2.7Vital signs and blood sugar, if indicated
5.10.2.8Consultations done
5.10.3 Legal
5.10.3.1Consent signed
5.10.3.2Company approval or payment done
5.10.4 Mode and time of transport to the operating
room
5.11Post-operative/Post partum notes should consist
of:
5.11.1 Surgery done
5.11.2 Type of anesthesia given
5.11.3 Name of surgeon/obstetrician
5.11.4 Condition of the patient
5.11.5 Observations made
5.11.5.1level of consciousness
5.11.5.2drains, catheters, if any
5.11.5.3dressing
5.11.5.4IVF or ongoing blood transfusion
5.11.6 Vital signs
5.11.7 Post-operative orders
5.11.8 Specific instructions given to the unit staff.
99
Republic of
Yemen 48Modern
Hospital
48
48 MODERN
Applies to: General Ward and Specialty
Units HOSPITAL
CONTENTS:This General Ward policy and procedure discusses about the procedure of nursing
endorsements.
1 DEFINITION:
1.1 Nursing Endorsement a method or process used to communicate or disseminate
Title: Nursing Endorsement
information
from outgoing shift to incoming shift regarding patients health problem, plan,
treatment and
desired outcome reflected in the kardex for continuity of patients care. (Kardex
contains all
relevant information concerning the patients current on-going care).
2 PURPOSES:
2.1 To give a vivid information about the patients present health condition and plan of
care.
2.2 To provide as a baseline for comparison and indicate the kind of care to be anticipated
on the next
shift.
2.3 To identify priorities to which incoming staff must attend.
2.4 To give basic identifying information about each patient - name, room number, bed
designation,
current diagnosis, etc.
2.5 To give a summary of each newly admitted patient, including his/her diagnosis, age,
plan of
therapy, and general condition.
2.6 To report patients who have been transferred or discharged.
3 POLICIES:
3.1 Must provide only essential information regarding the patient. It should be accurate,
complete,
concise, current and confidential.
3.2 Should start on time attended by all incoming nurses. Morning shift - 7:00 AM - 7:30
AM and
Night Shift - 7:00 PM - 7:30 PM.
3.3 Endorsement should be given by a charge nurse or a team leader .
3.4 Must be done in nurses room followed by a group rounds. The following must be
observed
during group rounds:
3.4.1 Knock on the door softly and announced your presence before entering.
3.4.2 Ensure patients privacy.
3.4.3 Speak in a low voice to avoid disturbing the patient.
3.5 All clarifications should be made during the time of endorsement.
3.6 Outgoing nurses should not leave the unit until all reports are completed and/or any
question about
patient is answered.
3.7 Kardex must be updated before the endorsement.
3.8 Receiving nurses should take written note of the pertinent and important data
regarding patients
care.
3.9 Endorsement is communicated in a language (English) that is understood by all.
4 PROCEDURES:
4.1 The following must be endorsed to the incoming shift:
4.1.1 Total census:
4.1.2 Number of admission and discharge 100
4.1.3 Number of expired patients
4.1.4 Transferred in/transferred out
4.2 Specific patient information such as:
Republic of
Yemen 48Modern
48
Hospital
4.2.1 Name
4.2.2 Age
4.2.3 Sex
4.2.4 Nationality
4.2.5 Diagnosis
4.2.6 Doctors name
4.2.7 Type of account (cash or charge)
4.2.8 Name of company (for charge cases)
4.2.9 Diet
4.3 Specific procedures to be done.
4.4 Consultation and investigation to be followed up
4.5 Current orders (especially any newly changed orders in medication, IV fluids, diet and
activity
level)
4.6 Changes in medical condition and response to medical therapy
4.7 Needs/problems identified, nursing actions carried out and patients response during
the shift.
SPECIAL
CONSIDERATIONS:
5
5.1 Unprofessional and judgmental comments about the patient should be avoided because
this could
predispose incoming nurses to view and respond to patient negatively.
5.2 Any conflict that happened between nurses during endorsement must be settled
immediately.
101
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Assessing Patients Psychological
Needs
CONTENTS: This General Ward policy and procedure of 48 MODERN HOSPITAL describes the
techniques to be used in assessing and identifying patients psychological needs for the
purpose of
developing a comprehensive plan of care during the entire period of patients
hospitalization.
1
DEFINITION:
1.1 Human Needs any physiological or psychological factors necessary for a healthy
existence.
1.2 Psychological Needs deep, intangible human needs that can be possessed by a human
being in
his search for meaningful occurrences in life.
2 PURPOSES:
2.1 To be able to identify patients psychological needs in order to formulate an
appropriate and
effective plan of care.
2.2 To understand the underlying cause of the attitudes and behaviors exhibited by the
patient during
the treatment phase.
3 2.3
POLICIES:
To administer a therapeutic relationship with patient and significant others.
3.1 Staff should utilize therapeutic nurse-patient interactions in assessing patients level
of needs.
3.2 Staff should be alert of non-verbal cues presented by the patient towards illness state
in order to be
an effective care-provider.
3.3 Staff should develop a plan of care focusing on the patients psychological well being in
order to
establish a therapeutic nurse-patient relationship to speed up patients recovery.
4 RESPONSIBILITIES:
4.1 Director of Nursing:
4.1.1 Ensures that policy on the assessment of patients psychological needs in the
formulation
of patient care plan is done by all staff.
4.1.2 Reviews staff performance in the implementation of policy and to make revision of
the
policy when necessary.
4.2 Nurse-Supervisor:
4.2.1 Reviews unit performance in the implementation of the policy.
4.2.2 Coordinates with the head nurses for any case of ineffective patient psychological
needs
assessment and nursing interventions.
4.3 Nurse-Educator:
4.3.1 Conducts orientation on the techniques and strategies to be employed in
assessing patient
psychological needs in relation to the development
of patient care plan.
102
4.3.2 Conducts periodic in-service education on updates concerning patient
psychological needs
assessment.
Republic of
Yemen 48Modern
48
Hospital
4.4 Unit Manager:

4.4.1 Reviews patients psychological needs assessment and the formulated plan of
care made
by the staff.
4.4.2 Assists staff in the planning of intervention phases, when necessary.
4.4.3 Conducts evaluation to determine the effectiveness of the interventions to the
identified
problems.
4.5 Staff:
4.5.1 Establish good rapport with the patients.
4.5.2 Conducts therapeutic nurse-patient interactions to assess psychological needs.
4.5.3 Formulates plan of care to employ effective interventions in meeting this needs.
4.5.4 Evaluate effectiveness of the nursing interventions.
5 PROCEDURES:
5.1 Using the standard patient assessment form, assess patients psychological needs
employing
therapeutic nurse-patient interactions.
5.2 Pay courtesy to the patient and identify yourself as the patient care-provider.
5.3 Establish a trusting relationship to the patient in order to gain patients cooperation.
5.4 Explore patients covert feelings about the hospitalization.
5.5 Initiate open-ended communications to enable patients verbalization of feelings.
5.6 Avoid asking questions answerable by yes or no. Be sensitive to patients exhibited
verbal and nonverbal cues.
5.7 Identify nursing problems using objective and subjective judgments.
5.8 Formulate a plan of care focusing on patients psychological needs.
5.9 Implement interventions and evaluate patients response.
5.10Communicate assessment findings to other members of the health team for any needs
of
professional consultations or referrals.
5.11Review and revise plan of care when necessary.
103
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Unit Rounds

CONTENTS: This General Ward policy and procedure deals with the guidelines procedure on
how to
perform unit/ward rounds.
1 DEFINITION:
1.1 Unit Rounds - a systematic and organized way of visiting patients in the unit. This is to
assess
patients needs and problems (subjective or objective). It also serves as a chance for a
quick and
intelligent mean of extracting nursing problems concerning patients physical
condition.
1.2 Administrative Rounds a rounds conducted jointly by the Exec. Medical Director,
Nursing
Director or Asst. Nursing Director with the Nursing Supervisor on duty and unit/area
Head nurse.
1.3 Supervisor Rounds - conducted randomly by the nursing supervisor on duty in every
nursing
station.
1.4 Head Nurse Rounds - done frequently by the unit/area Head nurse within her area of
responsibility.
1.5 Staff Rounds - individual nurse/group of nurses conducting rounds to their respective
patient.
2 PURPOSES:
2.1 To establish rapport with the patient.
2.2 To identify and solve patient exists needs/problems.
2.3 To evaluate patients reaction to medical nursing management and treatment as well
as support
services.
2.4 To provide opportunity for quick assessment of patients condition.
3 POLICIES:
3.1 Rounds are done as scheduled, randomly or frequently depending upon the situation.
3.1.1 Administrative Rounds - done on a daily basis (except Fridays and holidays).
3.1.2 Supervisor Rounds - done at random in every floor for 24 o at anytime depending
upon the
4 PROCEDURES:
load
in the
area.
4.1
Knock
at clinical
the door
before entering patients room.
3.1.3 Head
Rounds
- frequently
conducted
by the respective
HN/CN
in the
4.1.1 nurse
Patients
who are
asleep, post-op,
post-partum
or just slept
should
not be
unit/area.
disturbed.
3.1.4
Rounds
usually
conducted
8am-10pm.
4.2Doctors
Introduce
self to
the patient
and/orbetween
relative and
inform about the objective of
3.1.5
Staff Rounds - conducted before the start of duty after the endorsement at
the rounds.
7:30am (morning
4.3 Ask/inquire from patient/relative about his/her present condition.
shift)
and
(evening shift)
as a group
rounds.the
Individual
in
4.4
Listen
to7:30pm
any patient/family
complaints
regarding
service rounds
provided.
conducted 4.4.1 Ensure that prompt corrective action/s is done.
frequently
within the
shift.
4.5
Identify patients
subjective
or objective needs/problems.
3.2 Every
considered
genuine
information
bias. connected to the
4.6 complaint
Check IVs,iswound
dressing,
drainage,
and/orwithout
other gadgets
3.3 Patient
patient.and family rights are respected at all times.
104
3.4 All4.7
identified
problems food
during
the rounds
are documented
Evaluate/assess
intake,
elimination
pattern andaccordingly.
mobility.
Republic of
Yemen 48Modern
48
Hospital
4.8 Ensure that patients environment is safe, clean, tidy and

hazard free.
4.9 Document properly any identified problems and its corrective
measures.
5.1 Proper reporting mechanism is
observed:
5.1.1 CMO/Nursing Director to COO
5.1.2 Supervisor to Nursing Director
5.1.3 Headnurse to Supervisor
5.1.4 Staff to Headnurse
105
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
CONTENTS: This General Ward policy and procedure serves Title:
as guidelines
when
to summon
Calling For
a Physician
for a
physical presence of a physician in the unit for various purposes such as referral of patients
conditions,
evaluation of the health status, and other patient-management related purposes.
1 DEFINITIONS:
1.1 Levels of physicians according to the clinical privileges assigned by the Clinical
Services
Directorate and Clinical Privileging, Credentialing and Promotions Committee:
1.1.1 House Officer assists medical members assigned in the department; an MBBS or
MBBCH (or its equivalent); fresh graduate; MD under board. Has undergone a
minimum
of (1) year rotation.
1.1.2 Resident works under the supervision of a treating supervisor or other
consultant; an
MBBS or MBBCH degree holder; with minimum of one (1) year residency training
after
qualification; published at least one (1) paper.
1.1.3 Specialist works under the supervision of Associate Consultant; an MBBS or
MBBCH
degree holder; has minimum of above one (1) year residency training after
qualifications;
published one (1) paper.
1.1.4 Associate Consultant works under the supervision of a Consultant; an MBBS or
MBBCH degree holder with one (1) year internship; Msc followed by MD or Board,
or
equivalent in the specialty; has a minimum of 3 years as consultant after
qualifications and
has published 3 papers in reputable local/international journal in his/her specialty.
1.1.5 Consultant works under the supervision of a Senior Consultant; an MBBS or
MBBCH
degree holder with one (1) year internship; Msc followed by MD or Board, or
equivalent in
the specialty; has a minimum of 5 years as consultant after qualifications and has
published
5 papers in reputable local/international journal in his/her specialty.
1.1.6 Senior Consultant works under the supervision of a Department Head; an MBBS
or
MBBCH degree holder with one (1) year internship; Msc followed by MD or Board,
or
equivalent in the specialty; has a minimum of 7 years as consultant after
qualifications
3 POLICIES: and
has published
7 papers
inresident
reputable
local/international
journal
inon
his/her
specialty.
3.1 Unit nurses
should inform
the
physicians
first before
calling
the attending
2
PURPOSES:
physician,
2.1
To inform
patients
attending
physician about their admission(s) in the unit.
unless
requested
by the
patient.
Patients
admittingshould
complaints
and
impression.
3.2 2.1.1
Calling
of the physician
include
the
following purposes:
2.1.2To
The
roomabout
number.
3.2.1
inform
the patients admission in the unit.
2.1.3For
Thereferral
results of
of patients
diagnostic
examinations.
3.2.2
condition.
2.2 For evaluation of the patients status and for any deterioration in his present
condition.
106
2.3 To relay results of diagnostic examinations indicated for the patient.
2.4 To perform evaluation of patients condition prior to discharge.
2.5 Upon request of the patient and relatives for the physicians presence in the unit.
Republic of
Yemen 48Modern
48
Hospital
3.2.3 To relay results.

3.2.4 For discharge evaluation.
3.3 All calls done by the unit nurse should be considered as urgent matters and should be
attended at
once.
4 RESPONSIBILITIES:
4.1 Staff Nurse:
4.1.1 Coordinates with the charge nurse for the needs to call the physician.
4.1.2 Calls the physician and inform him/her of the reason of the calls.
4.2 Physician:
4.2.1 Responds to the calls of the unit staff.
5 PROCEDURES:
5.1 Staff nurse makes an assessment evaluation of the needs of calling for a physician in
the unit.
5.2 Coordinates with the charge nurse or the head nurse before calling for the physician for
whatever
purposes.
5.3 Calls the specialist on duty for whatever purposes of the referral.
5.4 In case specialist cannot make it to attend to the referral, charge nurse informs the
patients
attending physicians/consultant.
5.5 Presence of physician(s) can be summoned through:
5.5.1 The telephone
5.5.1.1 Use the unit telephone set and dial the physicians extension number.
5.5.1.2 Relay the purpose of the call.
5.5.2 The mobile phone
5.5.2.1 Request the operator to call the physician mobile phone number.
5.5.2.2 Relay the purpose of the call.
5.5.3 Bleeper system
5.5.3.1 Dial 33, then bleeper number, then press 1, dial the extension number to
contact
followed by a hash (#).
5.5.3.2 If there is no response from the bleeped party for 3 times, request the
operator to bleep
again.
5.5.4 Paging system
5.5.4.1 Request the operator to page the concerned physician.
5.6 Informs/explains the reasons of the call to the physician concerned.
5.7 Physician:
5.7.1 Verifies the reasons of the calls.
5.7.2 Comes to see the patient according to the purpose of the call.
6.1 If the Specialist is busy or cannot be contacted, the Consultant can be informed directly
or his/her
designee from the medical ladder in the department.
6.2 If there is no response from the called doctors, inform the nursing supervisor. The
supervisor will
inform the Chief Medical Operations (CMO) for any arrangement.
107
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Airway Management
CONTENTS: This General Ward policy and procedure deals with the procedural guidelines on
the use of
artificial aid or appliance to maintain patency of the airway, in case of an airway obstruction.
1 DEFINITIONS:
1.1 Airway the passage by which the air enters and leaves the lungs from the nose or the
mouth to
the alveoli, or vice versa.
1.2 Obstruction an act of blockage in the passage due to the narrowing of the respiratory
passageways.
1.2.1 Obstruction Can Be Due To:
1.2.1.1 Tongue fallen back in the throat.
1.2.1.2 Chocking by food or foreign body.
1.2.1.3 Trauma due to head or neck injury.
1.2.1.4 Aspiration of vomitus or blood
1.2.1.5 Diphtheria in children
2 PURPOSES:
2.1 To facilitate proper and normal breathing.
2.2 To prevent the risk for aspiration or suffocation.
2.3 To prevent complications that would endanger the lives of an
individual.
3 OBJECTIVES:
3.1 Identify the clinical settings in which airway compromise is likely to occur.
3.2 Recognize the signs and symptoms of acute airway obstruction.
3.3 To know the techniques to establish and maintain a patent airway and confirm the
adequacy of
ventilation and oxygenation.
3.4 Actual or impending airway obstruction should be suspected in all injured patients.
3.5 With all airway maneuvers, the cervical spine must be protected by in line
immobilization.
4 POLICIES:
4.1 Airway clearance should be ensured at all times by means of proper breathing
assessment.
4.2 Airway management should be done as early as possible to prevent complications like
brain death,
life term disability, or death of the client.
4.3 Airway management should be done by a health care provider, a skilled person or a
doctor, to
avoid malpractice and associated complications.
4.4 The health care provider should be able to recognize the possibilities of airway
obstructions in
trauma patients that includes:
4.4.1 Maxillofacial Trauma facial fractures with associated hemorrhage, increased
secretions,
108
and dislodged teeth.
Republic of
Yemen 48Modern
Hospital
48
Neck Trauma causes disruption of the larynx, trachea, and compression of the
soft
tissues.
4.4.2
4.4.3 Laryngeal Trauma
4.5 Should know about the definite airway maintenance and cervical spine protection.
4.6 Always know the location of airway or emergency equipment in the unit.
5 EQUIPMENT NEEDED:
5.1 Protective barriers for healthcare professionals e.g. disposable gloves, masks,
apron, goggles
5.2 Different sizes of oropharyngeal and nasopharyngeal airways
5.3 Ambubag and oxygen masks
5.4 Suction equipment and suction catheters
5.5 Tracheostomy sets and tubes in cases of surgical interventions
6 PROCEDURES:
5.6 Laryngoscope with different sizes of blades
6.1 Assess
the airway.
5.7 Oxygen
delivery equipment
6.1.1
Look for of
symmetrical
rise and fall of chest and adequate chest wall excursion.
5.8 Syringes
different sizes
6.1.2
Listen for if
the
movement of air on both sides of the chest. Rapid respiratory rate
5.9 Ventilator,
needed
indicates
air hunger.
6.1.3 Use of pulse oximeter gives the information regarding the [patients oxygen
saturation and
peripheral perfusion.
6.2 Call assistance for help to reduce the risk for injury especially for trauma cases.
Cervical spine
must be protected by in-line immobilization.
6.3 If the mouth is closed, open it gently by tilting the head backward and lift the chin if
not
contraindicated.
6.3.1 If the tongue is blocking the airway, this position will reposition the tongue and
allow the
air to enter the lungs.
6.4 If still there is no response, again, follow the basic look, listen, and feel. Do the finger
sweep to
remove the obstruction or do suction if there is secretions blocking the airway.
6.5 Insert oropharyngeal or nasopharyngeal airway and check for spontaneous respiration.
6.6 If there is no respiration, initiate artificial respiration by ambubag or with oxygen.
Continue efforts
until the assistance arrive.
6.7 If the client is stable, keep him under observation.
6.8 Check the need for definitive airway by using:
6.8.1 Endotracheal intubation to be done only by experts.
6.8.2 Surgical airway if there is any difficulty or inability to intubate the trachea.
6.8.2.1 Jet insuflation of the airway can provide temporary supplemental
oxygenation
through an insertion of a needle through the cricothyroid membrane or into
the
trachea (by placing a large caliber plastic cannula G10-12 for adult; G-16-18
for
children).
6.8.2.2 Surgical cricothyroidectomy for the insertion of endotracheal or
tracheostomy tube.
6.9 Assessment of breathing.
6.9.1 Quiet breathing normal breathing or just audible
6.9.2 No sound complete obstruction
109
6.9.3 Snoring tongue fallen back in throat
6.9.4 Bubbling/gurgling fluids ( vomitus/blood) in the throat
6.9.5 Wheezing or whistling foreign body in throat or trachea
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Applying an External Catheter
CONTENTS: This General Ward policy and procedure deals with the guidelines in the
application of
external catheter.
1 DEFINITION:
1.1 External Catheter a rubber appliance applied in the perineal area to collect urine for
incontinent
patients.
2 PURPOSES:
2.1 To relieve acute or chronic urinary retention and incontinence.
2.2 To prevent discomfort from urine wetting.
2.3 To prevent skin breakdown.
3 EQUIPMENTS/SUPPLIES:
3.1 Leg drainage bag with tubing or urinary drainage bag with tubing
3.2 Condom sheath
3.3 Bath blanket or similar drape
3.4 Disposable gloves
3.5 Basin of warm water and soap
3.6 Washcloth and towel
3.7 Elastic tape or Velcro strap
4 POLICIES:
4.1 Doctors order must be obtained.
4.2 Proper identification and assessment of patients condition prior to procedure.
4.3 Procedure should be performed by a qualified nurse of the same gender.
4.4 Infection control measures should be followed.
5 PREPARATIONS:
5.1 Assess:
5.1.1 The clients voiding pattern
5.1.2 The clients penis for swelling or excoriation that would contraindicate use of
the condom
catheter
5.2 Determine:
5.2.1 If the client has had an external catheter previously, and, if so, any difficulties
with it
5.3 Perform:
5.3.1 Any procedures that are best completed without the catheter in place
5.4 Assemble equipment and supplies.
5.4.1 Assemble the leg drainage bag or urinary drainage bag for attachment to the
condom
6 PROCEDURES:
sheath.
6.1
Explain
to the client
what
youitself
are going
to do, why
it is
necessary, and how he can
5.5
Roll
the condom
outward
onto
to facilitate
easier
application.
cooperate.
5.6 Position the client in either a supine or a sitting position.
6.2 Discuss if using a condom catheter will impact further care or treatments.
6.3 Wash hands and observe other appropriate infection control procedures.
6.4 Provide for client privacy.
6.5 Inspect and clean the penis. Clean the genital area, and dry it thoroughly.
110
Republic of
Yemen 48Modern
48
Hospital
6.6 Apply and secure the condom.

6.6.1 Roll the condom smoothly over the penis, leaving 2.5 cm. (1 in) between the
end of the
penis and the rubber or plastic connecting tube
6.6.2 Secure the condom firmly, but not too tightly, to the penis.
6.7 Securely attach the urinary drainage system.
6.7.1 Make sure that the tip of the penis is not touching the condom and that the
condom is not
twisted.
6.7.2 Attach the urinary drainage system to the condom.
6.7.3 Remove the gloves and wash your hands.
6.7.4 If the client is to remain in bed, attach the urinary drainage bag to the bed
frame.
6.7.5 If the client is ambulatory, attach the bag to the clients leg.
6.8 Teach the client about the drainage system.
6.8.1 Instruct the client to keep the drainage bag below the level of the condom, and
to avoid
loops or kinks in the tubing.
6.9 Inspect the penis 30 minutes following the condom application, and check urine flow.
6.9.1 Assess the penis for swelling and discoloration.
6.9.2 Assess urine flow if the client has voided.
6.10Change the condom daily, and provide skin care.
6.10.1 Remove the elastic or Velcro strip, apply clean gloves, and roll off the condom.
6.10.2 Wash the penis with soapy water, rinse, and dry it thoroughly.
6.10.3 Assess the foreskin for signs of irritation, swelling, and discoloration. Apply a
new
condom.
6.11Document in the client record, using forms or checklists supplemented by narrative
notes, when
appropriate. Record:
6.11.1 Application of the condom
REFERENCE:
6.11.2 The time7condom
applied
7.1 Fundamentals of Nursing concepts, process, and practice 7 th
6.11.3 Pertinent observations
Edition
Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder
111
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Assessing the Neurological System
CONTENTS: This General Ward policy and procedure serves as guidelines in assessing
clients
neurological system.
1 DEFINITION:
1.1 Assessment the method of appraising the clients condition that can aid in the
formulation of
nursing diagnosis and patient care planning.
2 PURPOSES:
2.1 To utilize the four methods of physical assessment and health examination.
2.2 To identify the expected outcomes of health assessments.
2.3 To utilize variations in examination techniques appropriate for clients of different
ages.
3 POLICIES:
3.1 Unit staffs should conduct health assessments to all patients admitted in the unit.
3.2 Four (4) methods of examination should be employed inspection, palpation,
percussion, and
auscultation.
3.3 Assessment results are used as the bases in the identification of nursing problems
and in the
formulation of nursing care plan.
3.4 Staff should perform neurological system assessment to patients suspected to have
neurological
deficits.
4 PREPARATIONS:
4.1 Assemble equipment and supplies:
5 PROCEDURES:
4.1.1 Percussion hammer
5.14.1.2
Explain
to the
client what
youbroken
are going
to do, why
is necessary,
and how he can
Tongue
depressors
(one
diagonally,
for it
testing
pain sensation)
cooperate.
4.1.3 Wisps of cotton, to assess light touch sensation
5.24.1.4
WashTest
hands
andofobserve
appropriate
infection
control
procedures.
tubes
hot andother
cold water,
for skin
temperature
assessment
(optional)
5.4 Determine clients history of the following:
5.4.1 Presence of pain in the head, back, or extremities, as well as onset and
aggravating and
alleviating factors
5.4.2 Disorientation to time, place, or person
5.4.3 Speech disorders
5.4.4 Any history of loss of consciousness, fainting, convulsions, trauma, tingling or
numbness,
tremors or tics, limping, paralysis, uncontrolled muscle movements, loss of
memory, or
mood swings
5.4.5 Alterations in smell, vision, taste, touch, or hearing
5.5 Language
5.5.1 If the client displays difficulty speaking:
5.5.2 Point to common objects, and ask the client to name them.
112to match the printed and written words
5.5.3 Ask the client to read some words and
with
pictures.
your
Ask the client to respond to simple verbal and written commands, e.g., point to
Republic
toes or raise
of your left arm.
5.6 Orientation
Yemen
48Modern
48
5.6.1 Determine the clients orientation to time, place, and person by tactful
questioning. Hospital
5.6.1.1 Ask the client the city and state of residence, time of day, date, day of the
week,
duration of illness, and names of family members.
5.6.1.2 More direct questioning may be necessary for some people, e.g., Where
are you
now? What day is it today?
5.7 Memory
5.5.4
5.7.1 Listen for lapses in memory.
5.7.1.1 Ask the client about difficulty with memory. If problems are apparent, three
categories of memory are tested: immediate recall, recent memory, and
remote
memory.
5.7.2 To assess immediate recall:
5.8 Ask the client to repeat a series of three digitse.g., 7-4-3spoken slowly.
5.9 Gradually increase the number of digitse.g., 7-4-3-5, 7-4-3-5-6, and 7-4-35-6-7-2
until the client fails to repeat the series correctly.
5.10 Start again with a series of three digits, but this time asks the client to
repeat them
backward.
5.11 The average person can repeat a series of five to eight digits in sequence,
and four to
six digits in reverse order.
5.8 To assess recent memory:
5.8.1 Ask the client to recall the recent events of the day, such as how he got to the
clinic. This
information must be validated, however.
5.8.2 Ask the client to recall information given early in the interview, e.g., the name
of a
doctor.
5.8.3 Provide the client with three facts to recalle.g., a color, an object, an
address, or a
three-digit numberand ask the client to repeat all three. Later in the interview,
ask the client
to recall all three items.
5.9 To assess remote memory:
5.9.1Ask the client to describe a previous illness or surgery.
5.10 Attention Span and Calculation
5.10.1 Test the ability to concentrate or attention span by asking the client to
recite the
alphabet or to count backward from 100.
5.10.2 Test the ability to calculate by asking the client to subtract 7 or 3
progressively from
100i.e., 100, 93, 86, 79, or 100, 97, 94.
5.11 Level of Consciousness
5.11.1 Apply the Glasgow Coma Scale.
5.12 Cranial Nerves
5.12.1 Test Cranial Nerves.
5.12.1.1 Cranial Nerve IOlfactory
5.12.1.1.1.Ask client to close eyes and identify different mild aromas,
such
as coffee, vanilla.
5.12.1.1.2Cranial Nerve IIOptic
5.12.1.1.2.1 Ask client to read Snellens chart, check visual fields by
confrontation, and conduct an ophthalmoscopic examination.
5.12.1.1.3 Cranial Nerve IIIOculomotor
5.12.1.1.3.1 Assess six ocular
113 movements and pupil reaction.
5.12.1.1.4 Cranial Nerve IVTrochlear
5.12.1.1.4.1 Assess six ocular movements.
5.12.1.1.5 Cranial Nerve VTrigeminal
Republic of
Yemen 48Modern
Hospital
48
5.12.1.1.5.1 While client looks upward, lightly touch lateral sclera of

eye to
wipe a
deep
elicit blink reflex. To test light sensation, have client close eyes, and
wisp of cotton over clients forehead and paranasal sinuses. To test
sensation, use alternating blunt and sharp ends of a safety pin over
same
area.
5.11.1 Cranial Nerve VIAbducens
5.11.1.1Assess directions of gaze.
5.11.2 Cranial Nerve VIIFacial
5.11.2.1Ask client to smile, raise the eyebrows, frown, puff out his cheeks, close
his eyes
tightly. Ask client to identify various tastes place on tip and sides of tongue
sugar,
saltand identify areas of taste.
5.11.3 Cranial Nerve VIIIAuditory
5.11.3.1Assess clients ability to hear spoken word and vibrations of tuning fork.
5.11.4 Cranial Nerve IXGlossopharyngeal
5.11.4.1Apply tastes on posterior tongue for identification.
5.11.4.2Ask client to move tongue from side to side and up and down.
5.11.5 Cranial Nerve XVagus
5.11.5.1Assessed
with CNusing
IX; assess
clients speech
for
hoarseness.
5.12Reflexes
- Test reflexes
a percussion
hammer,
comparing
one side of the body
5.11.6
Cranial
Nerve
XIAccessory
with the
5.11.6.1Ask
clientthe
to shrug
shoulders
against resistance from your hands and to
other
to evaluate
symmetry
of response.
turn
his
head
5.12.1 Biceps Reflex
to side against
resistance
from
your
hand.
5.12.1.1The
biceps
reflex tests
the
spinal
cord level C-5, C-6.
5.11.6.2
Repeat
for
the
other
side.
5.12.1.1.1 Partially flex the clients arm at the elbow, and rest the forearm over
5.11.7
Cranial Nerve XIIHypoglossal
the
5.11.7.1Ask client
to placing
protrude
hispalm
tongue
at midline,
then move it side to side.
thighs,
the
of the
hand down.
biceps
5.12.1.1.2 Place the thumb of your nondominant hand horizontally over the
tendon.
5.12.1.1.3 Deliver a blow (slight downward thrust) with the percussion hammer
to your
thumb.
5.12.1.1.4 Observe the normal slight flexion of the elbow, and feel the bicepss
contraction through your thumb.
5.12.2 Triceps Reflex
5.12.2.1The triceps reflex tests the spinal cord level C-7, C-8.
5.12.2.1.1 Flex the clients arm at the elbow, and support it in the palm of your
nondominant hand.
5.12.2.1.2 Palpate the triceps tendon about 25 cm (12 in) above the elbow.
5.12.2.1.3 Deliver a blow with the percussion hammer directly to the tendon.
5.12.2.1.4 Observe for the normal slight extension of the elbow.
5.12.3 Brachioradialis Reflex
5.12.3.1The brachioradialis reflex tests the spinal cord level C-3, C-6.
5.12.3.1.1 Rest the clients arm in a relaxed position on your forearm or on the
clients
own leg.
5.12.3.1.2 Deliver a blow with the percussion hammer directly on the radius 25
cm
(12 in) above the wrist or the
114 styloid process, the bony prominence on
the
thumb side of the wrist.
5.12.3.1.3 Observe the normal flexion and supination of the forearm.
5.12.3.1.4 The fingers of the hand may also extend slightly.

5.12.4 Patellar Reflex
5.12.4.1The patellar reflex tests the spinal cord level L-2. L-3, L-4.
5.12.4.1.1 Ask the client to sit on the edge of the examining table so that his
Republic of
legs hang
Yemen freely.
48Modern
48
5.12.4.1.2 Locate the patellar tendon directly below the patella.
Hospital
5.12.4.1.3 Deliver a blow with the percussion hammer directly to the tendon.
5.12.4.1.4 Observe the normal extension or kicking out of the leg as the
quadriceps
muscle contracts.
5.12.4.1.5 If no response occurs, and you suspect the client is not relaxed, ask
the
client to interlock the fingers and pull.
5.12.5 Achilles Reflex
5.12.5.1The Achilles reflex tests the spinal cord level S-1, S-2.
5.12.5.1.1 With the client in the same position as for the patellar reflex, slightly
dorsiflex the clients ankle by supporting the foot lightly in the hand.
5.12.5.1.2 Deliver a blow with the percussion hammer directly to the Achilles
tendon
just above the heel.
5.12.5.1.3 Observe and feel the normal plantar flexion (downward jerk) of the
foot.
5.12.6 Plantar (Babinskis) Reflex
5.12.6.1The plantar or Babinskis reflex is superficial. It may be absent in adults
without
pathology, or overridden by voluntary control.
5.12.6.1.1 Use a moderately sharp object, such as the handle of the percussion
hammer,
a key, or the dull end of a pin or applicator stick.
5.12.6.1.2 Stroke the lateral border of the sole of the clients foot, starting at
the heel,
continuing to the ball of the foot, and then proceeding across the ball of
the
foot toward the big toe.
5.12.6.1.3 Observe the response. Normally, all five toes bend downward; this
reaction
is negative Babinskis. In an abnormal Babinski response, the toes
spread
outward and the big toe moves upward.
5.13Motor Function
5.13.1 Gross Motor and Balance Tests
5.13.1.1Walking Gait
5.13.1.1.1 Ask the client to walk across the room and back, and assess the
clients gait.
5.13.1.2Rombergs Test
5.13.1.2.1 Ask the client to stand with feet together and arms resting at the
sides, first
with eyes open, then closed.
5.13.1.3Standing On One Foot With Eyes Closed
5.13.1.3.1 Ask the client to close his eyes and stand on one foot, then the other.
5.13.1.3.2 Stand close to the client during this test.
5.13.1.4HeelToe Walking
5.13.1.4.1 Ask the client to walk a straight line, placing the heel of one foot
directly in
front of the toes of the other foot.
5.13.1.5Toe or Heel Walking
5.13.1.5.1 Ask the client to walk several steps on the toes and then on the
heels.
5.13.1.6Fine Motor Tests for the Upper Extremities
5.13.1.6.1 Finger-to-Nose Test
5.13.1.6.1.1Ask the client to abduct and extend the arms at shoulder height
and
rapidly touch the nose alternately with one index finger and then the
115
other.
5.13.1.6.1.2Have the client repeat the test with the eyes closed if the test is
performed easily.
5.13.1.6.2 Alternating Supination and Pronation of Hands on Knees
5.13.1.6.2.1Ask the client to pat both knees with the palms of both hands
and then
with the backs of the hands alternately at an ever-increasing rate.
5.13.1.6.3 Finger to Nose and to the Nurses Finger
Republic
of the client to touch the nose and then your index finger,
5.13.1.6.3.1Ask
held
at a
Yemen
48Modern
48
distance at about 45 cm (18 in), at a rapid and increasing rate.
Hospital
5.13.1.6.4 Fingers to Fingers

5.13.1.6.4.1Ask the client to spread the arms broadly at shoulder height
and then
bring the fingers together at the midline, first with the eyes open
and
then closed, first slowly and then rapidly.
5.13.1.6.5 Fingers to Thumb (Same Hand)
5.13.1.6.5.1Ask the client to touch each finger of one hand to the thumb of
the
same hand as rapidly as possible.
5.13.1.6.6 Fine Motor Tests for the Lower Extremities
5.13.1.6.6.1Ask the client to lie supine and to perform these tests:
5.13.1.6.7 Heel Down Opposite Shin
5.13.1.6.7.1Ask the client to place the heel of one foot just below the
opposite knee
and run the heel down the shin to the foot.
5.13.1.6.7.2Repeat with the other foot. The client may also use a sitting
position for
this test.
5.13.1.6.8 Toe or Ball of Foot to the Nurses Finger
5.13.1.6.8.1Ask the client to touch your finger with the large toe of each
foot.
5.13.1.6.8.2Light-Touch Sensation.
5.13.1.6.8.2.1 Compare the light-touch sensation of symmetric areas of
the
body.
5.13.1.6.8.2.2 Ask the client to close the eyes and to respond by saying
yes
or now whenever the client feels the cotton wisp touching
his
skin.
5.13.1.6.8.2.3 With a wisp of cotton, lightly touch one specific spot and
then
the same spot on the other side of the body.
5.13.1.6.8.2.4 Test areas on the forehead, cheek, hand, lower arm,
abdomen,
foot, and lower leg. Check a specific area of the limb first.
5.13.1.6.8.2.5 Ask the client to point to the spot where the touch was
felt.
5.13.1.6.8.2.6 If areas of sensory dysfunction are found, determine the
boundaries of sensation by testing responses about every
2.5 cm
(1 in) in the area. Make a sketch of the sensory loss area for
recording purposes.
5.13.1.7Pain Sensation
5.13.1.7.1 Assess pain sensation as follows:
5.13.1.7.1.1Ask the client to close his eyes and to say sharp, dull, or
dont
know when the sharp or dull end of the broken tongue depressor
is felt.
5.13.1.7.1.2 Alternately, use the sharp and dull end of the sterile pin or
needle to
lightly prick designated anatomic areas at random.
5.13.1.7.1.3The face is not tested in this manner.
5.13.1.7.1.4 Allow at least 2 seconds between each test.
5.13.1.8Temperature Sensation
5.13.1.8.1 Touch skin areas with test tubes filled with hot or cold water.
5.13.1.8.2 Have the client respond say 116
saying hot, cold, or dont know.
5.13.1.9Position or Kinesthetic Sensation
5.13.1.9.1 Commonly, the middle fingers and the large toes are tested for the
kinesthetic sensation.
5.13.1.9.2 To test the fingers, support the clients arm with one hand and hold
Republic of
Yemen 48Modern
48
Hospital
examining table.
5.13.1.9.3 Ask the client to close his eyes.
5.13.1.9.4 Grasp a middle finger or a big toe firmly between your thumb and
index
while
client
finger, and exert the same pressure on both sides of the finger or toe
moving it.
5.13.1.9.5 Move the finger or toe until it is up, down, or straight out, and ask the
to identify the position.

5.13.1.9.6 Use a series of brisk up-and-down movements before bringing the
finger or
toe suddenly to rest in one of the three positions.
5.13.1.10Tactile Discrimination
5.13.1.10.1For all tests, the clients eyes need to be closed:
5.13.1.10.2One- and Two-Point Discrimination
5.13.1.10.2.1Alternately stimulate the skin with two pins simultaneously and
then
with one pin.
5.13.1.10.2.2Ask whether the client feels one or two pinpricks.
5.13.1.11Stereognosis
5.13.1.11.1Place familiar objectssuch as a key, paper clip, or coinin the
clients
hand, and ask the client to identify them.
5.13.1.11.2If the client has a motor impairment of the hand and is unable to
manipulate
an object, write a number or letter on the clients palm, using a blunt
instrument, and ask the client to identify it.
5.13.1.12Extinction Phenomenon
6 REFERENCES:
5.13.1.12.1Simultaneously
stimulate two symmetric areas of the body, such as
the
thighs,Edition
the cheeks, or the hands.
Barbara
Glenora Erb, Audrey Berman, Shirlee Snyder
5.14Document findings in the
clientKozier,
record.
117
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Application of Skin Traction
CONTENTS: This General Ward policy and procedure deals with the procedure in the
application of skin
traction.
1 DEFINITION:
1.1 Traction - is a treatment modality in which a pulling force is applied to separate parts
of an
injured, diseased and deformed portion of the body or extremity.
1.1.1 Types of Traction
1.1.1.1 Manual - use as a primary form of traction accomplished by an individual
exerting a
temporary, steady pull on anothers extremity or joint.
1.1.1.2 Mechanical - uses gadgets and devices and is further classified depending
on the
nature of attachment and the nature of the pulling force.
1.1.1.2.1 Skin Traction - the traction force is applied over a large area of skin
from
where it is transmitted to the musculoskeletal structures.
1.1.1.2.2 Skeletal - applies force directly to the bone using aseptically inserted
pins,
wire or traction screws.
2 PURPOSES:
2.1 To reduce stable fractures or dislocations prior to casting, splinting or application of
skin traction.
2.2 Restore and maintain alignment of bone ends following fracture.
2.3 Relieve pain and/or muscle spasm.
2.4 Provide immobilization to prevent soft tissue damage.
2.5 Correct, lessen or prevent deformities.
2.6 Reduce and treat subluxations.
2.7 Rest an inflamed, diseased or injured body parts.
2.8 Prevent or correct the development of soft tissue contracture.
2.9 Expand joint spaces prior to surgery
2.10Maintain the desired position post-operatively.
3 CONTRAINDICATIONS:
3.1 Presence of an existing skin condition (e.g. wounds, sores, abrasions).
3.2 Where the skin is thin and friable.
3.3 If there is circulatory impairment or loss of normal skin sensation.
4 EQQUIPMENTS/SUPPLIES:
4.1 Adhesive/non-adhesive skin traction
4.2 Weight/pulley system
4.3 Thomas splint POLICIES:
(optional)
5
4.4 Bed frame with5.1
traction
bars
Counter-traction
must be present for any type of traction to be
4.5 Razor
effective.
4.6 Blue sheet
5.2 Continuous traction should be maintained.
4.7 Traction Rope
4.8 Disposable Gloves
118
Republic of
Yemen 48Modern
48
Hospital
5.3 Prevention of complication for patient on traction is a must. Proper body alignment
and
positioning is maintained.
5.4 Maintain the prescribed direction of pull.
5.5 Nurse must be aware of the physicians order for type of traction, amount of weight
to be used and
length of time to be applied
6
PROCEDURES:
6.1 Skin Traction
6.1.1 Verify doctors order.
6.1.2 Explain and discuss the procedure with the patient.
6.1.3 Provide privacy.
6.1.4 Wash hands, wear gloves. Cleanse the affected site; shave any limb covered by
thick
hairs.
6.1.5 Check for the affected part and ensure that the skin is intact.
6.1.6 Apply tincture of benzoin compound on the affected part to increase the
adhesive quality
of the material used.
6.1.7 Apply the extension strapping and bandage without folds or creases leaving the
patellae
and the knee 10-15 degrees off full flexion.
6.1.8 Leave the ankle joint free and apply latex foam to bony prominences.
6.1.9 Ensure that the affected part is in the correct anatomical position.
6.1.10 Connect traction rope into the pulley and hang the prescribed weight freely.
6.1.11 Remove gloves and wash hands.
6.1.12 Document the following:
6.1.12.1Date and time applied
6.1.12.2Site of the affected part
6.1.12.3 Condition of the affected part prior and after the procedure as to:
6.1.12.3.1 Temperature
6.1.12.3.2 Color
6.1.12.3.3 Degree of sensation and movement
7
6.1.12.4Prescribed weight
6.1.13 Charge the supplies used.
7.1 Care of patient on traction
7.1.1 Provide physical and psychological support.
7.1.2 Prevent or reduce friction by ensuring the following:
7.1.2.1 Weights are hanging freely and not resting on the floor, bed or chair.
7.1.2.2 Traction ropes are unobstructed and move freely through pulleys.
7.1.2.3 Counter-traction is sufficient to prevent shearing forces from damaging the
patients
skin.
119
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Back Care / Back Rub

CONTENTS: This General Ward policy and procedure deals with the procedure in performing
back
care/back rub.
1 DEFINITION:
1.1 Back Rub - is the application of motion pressure by the hands with the intent of
improving or
promoting comfort.
2 PURPOSES:
2.1 To promote comfort and relaxation.
2.2 To relieve muscular tension.
2.3 To assess skin condition.
2.4 To stimulate circulation and prevent bedsore.
2.5 To prevent complication.
2.6 As a means of communication through the use of touch.
3.1 Rib or vertebral fracture or back injury.
3.2 Burns or open wound.
4.1 Towel
4.2 Underpads
4.3 Basin
4.4 Lotion/powder
4.5 Thermometer
4.6 Sphygmomanometer and Stethoscope
5 POLICIES:
5.1 Effective back rub should take 4-6 minutes maximum to complete.
5.2 Vital signs should be taken before back rub in cases of hypertension (HPN),
dysrrhythmia.
5.3 Prevention of cross-contamination.
6 PREPARATIONS:
6.1 Assess:
6.1.1 Behaviors indicating potential need for a back massage, such as a complaint of
stiffness,
muscle tension in the back or shoulders, or difficulty sleeping related to
tenseness or
anxiety.
6.1.2 If the client is willing to have a massage, as some individuals may not enjoy a
massage
6.1.3 Contraindications for back massage
6.3 Determine:
6.3.1 Previous assessments of the skin
6.3.2 Special lotions to be used
6.3.3 Positions contraindicated for the client
120
6.3.4 Arrange for a quiet environment with no interruptions to promote maximum
effect of the
back massage.
Republic of
Yemen 48Modern
48
Hospital
PROCEDURES:
7
7.1 Explain to the client what you are going to do, why it is necessary, and how she can
cooperate.
7.4 Prepare the client.
7.4.1 Assist the client to move to the near side of the bed, within your reach, and
adjust the bed
to a comfortable working height.
7.4.2 Establish which position the client prefers.
7.4.3 Expose the back from the shoulders to the inferior sacral area.
7.5 Massage the back.
7.5.1 Pour a small amount of lotion onto the palms of your hands and hold it for a
minute.
7.5.2 The lotion bottle can also be placed in a bath basin filled with warm water.
7.5.3 Using your palm, begin in the sacral area, using smooth, circular strokes.
7.5.4 Move your hands up the center of the back and then over both scapulae.
7.5.5 Massage in a circular motion over the scapulae.
7.5.6 Move your hands down the sides of the back.
7.5.7 Massage the areas over the right and left iliac crests.
7.6 Apply firm, continuous pressure without breaking contact with the clients skin.
7.6.1 Repeat above for 35 minutes, obtaining more lotion as necessary.
7.6.2 While massaging the back, assess for skin redness and areas of decreased
circulation.
7.7 Pat dry any excess lotion with a towel.
8
7.8 Document that a REFERENCE:
back rub was performed, and the clients response.
8.1 Fundamentals of Nursing concepts, process, and practice
7th Edition
121
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Bathing
CONTENTS: This General Ward policy and procedure deals with the procedure in giving bath
to the
patient.
1 DEFINITION:
1.1 Bathing - a hygienic/therapeutic procedure of washing or cleansing the body with
water and/or
medicated solution, as required.
1.2 Types:
1.2.1 Hygienic bath
1.2.1.1 Bed bath
1.2.1.2 Shower/tub bath
1.2.2 Therapeutic bath:
1.2.2.1 Tepid Bath - to reduce fever.
1.2.2.2 Sitz Bath - for post perineal and anal surgery as indicated to promote good
blood
circulation and wound healing.
1.2.2.3 Medicated Bath - for dermatological therapy.
1.2.2.4 Hydrotherapy - for burns and as part of physiotherapy.
2 PURPOSES:
2.1 To promote comfort and relaxation.
2.2 To cleanse and refresh.
2.3 To stimulate circulation; provide mild exercise; and improve muscle tone.
2.4 To provide treatment to some specific cases.
2.5 To help improve self-image.
2.6 To allow the health provider to assess the skin color and conditions, joint mobility and
muscle
strength and provide health-teaching.
2.7 To regulate body temperature.
2.8 To establish effective nurse-patient relationship.
3 POLICIES:
3.1 Ensure safety by observing falls precaution and infection control measures.
3.2 Privacy must be observed at all times.
3.3 Patients cultural and religious beliefs must be taken into consideration.
EQUIPMENTS/SUPPLIES:
4
3.4 Planning must be done with patient noting his/her personal preferences, if possible.
4.1
Basin
or
sink
with
warm
water
3.5 Therapeutic bath must be given with a written order from the treating doctor.
4.2
Soap
and soap
dish
3.6
Provided
to all
patients as a part of morning and/or evening care, unless
4.3
Linens:
bath
blanket,
two bath towels, washcloth, clean gown or pajamas or clothes
contraindicated.
as needed,
additional bed linen and towels, if required
4.4 Gloves, if appropriate
4.5 Personal hygiene articles
4.6 Shaving equipment for male clients
4.7 Table for bathing equipment
4.8 Laundry hamper
122
Republic of
Yemen 48Modern
Hospital
48
PREPARATIONS:
5
5.1 Assess:
5.1.1 Condition of the skin
5.1.2 Fatigue
5.1.3 Presence of pain and need for adjunctive measures before the
bath
5.1.4 Range of motion of the joints
5.1.5 Any other aspect of health that may affect the clients bathing
process
5.3 Determine:
5.3.1 The purpose and type of bath the client needs
5.3.2 Self-care ability of the client
5.3.3 Any movement or positioning precautions specific to the client
5.3.4 Other care the client may be receiving
PROCEDURES:
5.3.5 what
Clients
comfort
level
being
bathed
by someone
else
6.1 Explain to the client
you
are going
towith
do, why
it is
necessary,
and how
she can
6
cooperate.
6.4 Prepare the client and the environment:
6.4.1 Invite a family member or significant other to participate, if desired.
6.4.2 Close windows and doors to ensure the room is a comfortable temperature.
6.4.3 Offer the client a bedpan or urinal, or ask whether the client wishes to use the
toilet or
commode.
6.4.4 Encourage the client to perform as much personal self-care as possible.
6.4.5 During the bath, assess each area of the skin carefully.
6.5 Bed Bath
6.5.1 Prepare the bed and position the client appropriately.
6.5.1.1 Position the bed at a comfortable working height. Lower side rail on the
side close to
you. Keep the other side rail up.
6.5.1.2 Assist the client to move near you.
6.5.1.3 Place bath blanket over top sheet.
6.5.1.4 Remove the top sheet from under the bath blanket by starting at clients
shoulders
and moving linen down towards clients feet.
6.5.1.5 Ask the client to grasp and hold the top of the bath blanket while pulling
linen to the
foot of the bed.
6.5.1.6 Note: If the bed linen is to be reused, place it over the bedside chair. If it is
to be
changed, place it in the linen hamper.
6.5.1.7 Remove clients gown while keeping the client covered with the bath
blanket.
6.5.1.8 Place gown in linen hamper.
6.5.2 Make a bath mitt with the washcloth.
6.5.3 Wash the face.
6.5.3.1 Place towel under clients head.
6.5.3.2 Wash the clients eyes with water only, and dry them well.
6.5.3.3 Use a separate corner of the washcloth for each eye.
6.5.3.4 Wipe from the inner to the outer canthus.
6.5.3.5 Ask whether the client wants soap used on her face.
6.5.3.6 Wash, rinse, and dry the clients face,
123 ears and neck.
6.5.3.7 Remove the towel from under the clients head.
6.5.4 Wash the arms and hands.
6.5.4.1 Place a towel lengthwise under the arm away from you.
6.5.4.2 Wash, rinse, and dry the arm by elevating the clients arm and supporting
the clients
Republic of
wrist and elbow.
Yemen
48Modern
48
6.5.4.3 Apply deodorant or powder if desired.
Hospital
6.5.4.4
Optional: Place a towel on the bed and put a washbasin on it.
6.5.4.5 Place the clients hands in the basin.
6.5.4.6 Assist the client as needed to wash, rinse, and dry her hands, paying
particular
attention to the spaces between her fingers.
6.5.4.7 Repeat for hand and arm nearest you.
6.5.5 Wash the chest and abdomen.
6.5.5.1 Place bath towel lengthwise over chest. Fold bath blanket down to the
clients pubic
area.
6.5.5.2 Lift the bath towel off her chest, and bathe her chest and abdomen with
your mitted
hand, using long, firm strokes.
6.5.5.3 Rinse and dry well.
6.5.5.4 Replace the bath blanket when the areas have been dried.
6.5.6 Wash the legs and feet.
6.5.6.1 Expose the leg farthest from you by folding the bath blanket towards the
other leg,
being careful to keep the perineum covered.
6.5.6.2 Lift leg and place the bath towel lengthwise under the leg.
6.5.6.3 Wash, rinse, and dry the leg, using long, smooth, firm strokes from the
ankle to the
knee to the thigh.
6.5.7 Reverse the coverings and repeat for the other leg.
6.5.7.1 Wash the feet by placing them in the basin of water.
6.5.7.2 Dry each foot.
6.5.7.3 Obtain fresh, warm bathwater now or when necessary.
6.5.8 Wash the back and then the perineum.
6.5.8.1 Assist the client into a prone or sidelying position facing away from you.
6.5.8.2 Place the bath towel lengthwise alongside the back and buttocks while
keeping the
client covered with the bath blanket as much as possible.
6.5.8.3 Wash and dry the clients back, moving from the shoulders to the buttocks,
and upper
thighs, paying attention to the gluteal folds.
6.5.8.4 Perform a back massage now or after completion of bath.
6.5.8.5 Assist the client to the supine position and determine whether the client
can wash the
perineal area independently.
6.5.8.6 If the she cannot do so, drape the client and wash the area.
6.5.9 Assist the client with grooming aids such as powder, lotion, or deodorant.
6.5.9.1 Use powder sparingly.
6.5.9.2 Release as little as possible into the atmosphere.
6.5.9.3 Help the client put on a clean gown or pajamas.
6.5.9.4 Assist the client to care for hair, mouth, and nails.
6.6 For a Tub Bath or Shower
6.6.1 Prepare the client and the tub.
6.6.1.1 Fill the tub about one-third to onehalf full of water at 4346C (110115F).
6.6.1.2 Cover all intravenous catheters or wound dressings with plastic coverings,
and
instruct the client to prevent wetting these areas, if possible.
6.6.1.3 Put a rubber bath mat or towel on the floor of the tub if safety strips are
not on the tub
floor.
6.6.2 Assist the client into the shower or tub.
6.6.2.1 Assist the client taking a standing shower with the initial adjustment of the
water
temperature and water flow pressure,
124 as needed.
6.6.2.2 Explain how the client can signal for help, leave the client for 25 minutes,
and place
an occupied sign on the door.
Republic of
Yemen 48Modern
48
Hospital
6.6.3 Assist the client with washing and getting out of the tub.
6.6.3.1 Wash the clients back, lower legs, and feet, if necessary.
6.6.3.2 Assist the client out of the tub.
6.6.4 Dry the client, and assist with follow-up care.
6.6.4.1 Assist the client back to her room.
6.6.4.2 Clean the tub or shower in accordance with agency practice, discard the
used linen in
the laundry hamper, and place the unoccupied sign on the door.
6.7 Document:
6.7.1 Type of bath given
6.7.2 Skin assessment, such as excoriation, erythema, exudates, rashes, drainage, or
skin
breakdown
6.7.3 Nursing interventions related to skin integrity
6.7.4 Ability of the client to assist or cooperate with bathing
6.7.5 Client response to bathing
6.7.6 Educational needs regarding hygiene
6.7.7 Information or teaching shared with the client or their family
6.8 Variation: Bathing Using a Hydraulic Bathtub Chair
6.8.1 Bring the client to the tub room in a wheelchair or shower chair.
6.8.1.1 Fill the tub and check the water temperature with a bath thermometer.
6.8.1.2 Lower the hydraulic chair lift to its lowest point, outside the tub.
6.8.1.3 Transfer the client to the chair lift and secure the seat belt.
6.8.1.4 Raise the chair lift above the tub.
6.8.1.5 Support the clients legs as the chair is moved over the tub.
6.8.1.6 Position the clients legs down into the water and slowly lower the chair lift
into the
tub.
6.8.1.7 Assist bathing the client, if appropriate.
6.8.1.8 Reverse the procedure when taking the client out of the tub.
6.8.1.9 Dry the REFERENCE:
client and transport her to her room.
7
7th Edition
125
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Bed Making
CONTENTS: This General Ward policy and procedure deals with the procedure in bed making.
1 DEFINITION:
1.1 Bedmaking - is a procedure of changing bed linens either:
1.1.1 Unoccupied bed one which is prepared to be ready to receive patient.
1.1.1.1 Open Bed - a bed which is made either for a new patient or anambulatory
patient.
1.1.1.2 Closed Bed - a bed which will remain empty until the admission of a patient.
1.1.2 Occupied Bed one which is made with patient on it.
1.1.3 Post-op Bed one which is prepared for post-operative patient.
2 PURPOSES:
2.1 To provide comfort.
2.2 To promote rest and sleep.
2.3 To adapt to the needs of the patient and be ready for any emergency or critical
condition.
2.4 To promote cleanliness and prevent bedsore.
2.5 To establish an effective nurse-patient relationship.
3.1 Clean linens:
3.1.1 Bottom sheet
3.1.2 Top sheet
3.1.3 Draw sheet
3.2 Blanket/comforter
3.3 Tuckables
3.4 Pillow with pillowcase
3.5 Trolley with hamper bags (for soiled linen)
3.6 Masks, gloves, disposable apron, as needed
4 POLICIES:
4.1 Ensure safety by:
4.1.1 Observing fall precautions
4.1.2 Follow infection control measures for infectious cases.
4.2 Bed making should be done once a day or as required.
4.3 Soiled linens should not be left on the floor. It should be placed inside the hamper bag.
4.4 Do not allow uniform in contact with soiled linen.
4.5 Bed should be made without wrinkles.
4.6 Observe /maintain body mechanics.
4.7 As soon as patient is discharged, bed linens should be stripped off immediately.
Housekeeping is
informed to clean the room to prepare for incoming admission.
PREPARATIONS:
5
5.1 Assess:
5.1.1 Note specific orders or precautions for moving and positioning the client.
5.1.2 Determine presence of incontinence or excessive drainage from other sources
indicating
the need for protective waterproof pad.
126
Republic of
Yemen 48Modern
Hospital
48
5.1.3 Assess
6.7.1 Unoccupied
bed:skin condition and need for special mattress, footboard, or heel
protectors.
6.7.1.1
Place the fresh linen on the clients chair or overbed table; do not use
5.2clients
Assemble equipment and supplies.
another
bed.
PROCEDURES:
6
6.7.1.2
Assess
and
assist
theyou
client
of bed.
6.1
Explain
to the
client
what
areout
going
to do, why it is necessary, and how she
6.7.1.3
Make sure that this is an appropriate and convenient time for the client to
can
cooperate.
be
out
of
6.2 Wash hands before and after the procedure.
bed.
6.3 Assemble
equipment and other items needed.
6.7.2
Assist
clientand
to aexplain
comfortable
chair
6.4 Providethe
privacy
the procedure.
6.7.3
Strip
the
bed.
6.5 Lower bed height within your reach.
6.7.3.1
bed
for anyunless
items contra-indicated.
belonging to the client, and detach the call
6.6
Keep Check
the bed
in linens
flat position,
bell
or
any
6.7 Follow bed making procedures according to type:
drainage tubes from the bed linen.
6.7.3.2 Loosen all bedding systematically, starting at the head of the bed on the
far side and
moving around the bed up to the head of the bed on the near side.
6.7.3.3 Remove the pillowcases, if soiled, and place the pillows on the bedside
chair near the
foot of the bed.
6.7.3.4 Fold reusable linens, such as the bedspread and top sheet on the bed, into
fourths.
6.7.3.5 First, fold the linen in half by bringing the top edge even with the bottom
edge, and
then grasp it at the center of the middle fold and bottom edges.
6.7.3.6 Remove the waterproof pad and discard it, if soiled.
6.7.3.7 Roll all soiled linen inside the bottom sheet, hold it away from your
uniform, and
place it directly in the linen hamper.
6.7.3.8 Grasp the mattress securely, using the lugs, if present, and move the
mattress up to
the head of the bed.
6.7.4 Apply the bottom sheet and drawsheet.
6.7.4.1 Place the folded bottom sheet with its center fold on the center of the
bed.
6.7.4.2 Make sure the sheet is hem-side down for a smooth foundation.
6.7.4.3 Spread the sheet out over the mattress, and allow a sufficient amount of
sheet at the
top to tuck under the mattress.
6.7.4.4 Miter the sheet at the top corner on the near side and tuck the sheet
under the mattress,
working from the head of the bed to the foot.
6.7.4.5 If a waterproof drawsheet is used, place it over the bottom sheet so that
the center fold
is at the center line of the bed and the top and bottom edges extend from
the middle of
the clients back to the area of the mid-thigh or knee.
6.7.4.6 Fanfold the uppermost half of the folded drawsheet at the center or far
edge of the
bed, and tuck in the near edge.
6.7.4.7 Lay the cloth drawsheet over the waterproof sheet in the same manner.
6.7.4.8 Optional: Before moving to the other side of the bed, place the top linens
on the bed
hem-side up, unfold them, tuck them in, and miter the bottom corners.
6.7.5 Move to the other side and secure the bottom
linens.
127
6.7.5.1 Tuck in the bottom sheet under the head of the mattress, pull the sheet
firmly, and
miter the corner of the sheet.
6.7.5.2 Pull the remainder of the sheet firmly so that there are no wrinkles.
6.7.5.3 Complete this same process for the drawsheet(s).
6.7.6 Apply or complete the top sheet, blanket, and spread.
6.7.6.1 Place the top sheet, hem-side up, on the bed so that its center fold is at the
Republic of
center of
the bed
and the top edge is even with the top edge of the mattress.
Yemen
48Modern
48
6.7.6.2 Unfold the sheet over the bed.
Hospital
6.7.6.3 Move to the other side of the bed, and secure the top bedding in the
same
manner.
6.7.7 Put clean pillowcases on the pillows as required.
6.7.7.1 Grasp the closed end of the pillowcase at the center with one hand.
6.7.7.2 Gather up the sides of the pillowcase, and place them over the hand
grasping the case.
Then grasp the center of one short side of the pillow through the pillowcase.
6.7.7.3 With the free hand, pull the pillowcase over the pillow.
6.7.7.4 Adjust the pillowcase so that the pillow fits into the corners of the case and
the seams
are straight.
6.7.7.5 Place the pillows appropriately at the head of the bed.
6.7.8 Provide for client comfort and safety.
6.7.8.1 Attach the signal cord so that the client can conveniently use it.
6.7.8.2 If the bed is currently being used by a client, either fold back the top covers
at one
side or fanfold them down to the center of the bed.
6.7.8.3 Place the bedside table and the overbed table so that they are available to
the client.
6.7.8.4 Leave the bed in the high position if the client is returning by stretcher, or
place in the
low position if the client is returning to bed after being up.
6.7.9 Document and report pertinent data.
6.8 Occupied bed:
6.8.1 Remove the top bedding.
6.8.1.1 Remove any equipment attached to the bed linen, such as a call bell.
6.8.1.2 Loosen all the top linen at the foot of the bed, and remove the spread and
the blanket.
6.8.1.3 Leave the top sheet over the client, or replace it with a bath blanket:
6.8.1.4 Spread the bath blanket over the top sheet.
6.8.1.5 Ask the client to hold the top edge of the blanket.
6.8.1.6 Reaching under the blanket from the side, grasp the top edge of the sheet
and draw it
down to the foot of the bed, leaving the blanket in place.
6.8.1.7 Remove the sheet from the bed and place it in the soiled linen hamper.
6.8.2 Change the bottom sheet and drawsheet.
6.8.2.1 Assist the client to turn on the side facing away from the side where the
clean linen is.
6.8.2.2 Raise the side rail nearest the client.
6.8.2.3 If there is no side rail, have another nurse support the client at the edge of
the bed.
6.8.2.4 Loosen the foundation of the linen on the side of the bed near the linen
supply.
6.8.2.5 Fanfold the drawsheet and the bottom sheet at the center of the bed, as
close to the
client as possible.
6.8.2.6 Place the new bottom sheet on the bed, and vertically fanfold the half to be
used on
the far side of the bed as close to the client as possible.
6.8.2.7 Tuck the sheet under the near half of the bed, and miter the corner if a
contour sheet is
not being used.
6.8.2.8 Place the clean drawsheet on the bed with the center fold at the center of
the bed.
6.8.2.9 Fanfold the uppermost half vertically at the center of the bed, and tuck the
near side
edge under the side of the mattress.
128 you onto the clean side of the bed.
6.8.2.10 Assist the client to roll over toward
6.8.2.11 Have the client roll over the fanfolded linen at the center of the bed.
6.8.2.12 Move the pillows to the clean side for the clients use.
6.8.2.13Raise the side rail before leaving the side of the bed.
6.8.2.14 Move to the other side of the bed, and lower the side rail.
Republic of
Yemen 48Modern
48
Hospital
6.8.2.15Remove the used linen and place it in the portable hamper.

6.8.2.16 Unfold the fanfolded bottom sheet from the center of the bed.
6.8.2.17 Facing the side of the bed, use both hands to pull the bottom sheet so
that it is
smooth, and tuck the excess under the side of the mattress.
6.8.2.18 Unfold the drawsheet fanfolded at the center of the bed and pull it
tightly with both
hands.
6.8.2.19Pull the sheet in three sections:
6.8.2.19.1 Face the side of the bed to pull the middle section.
6.8.2.19.2 Face the far top corner to pull the bottom section.
6.8.2.19.3 Face the far bottom corner to pull the top section.
6.8.2.20Tuck the excess drawsheet under the side of the mattress.
6.8.3 Reposition the client in the center of the bed.
6.8.3.1 Reposition the pillows at the center of the bed.
6.8.3.2 Assist the client to the center of the bed.
6.8.3.3 Determine what position the client requires or prefers, and assist the
client to that
position.
6.8.4 Apply or complete the top bedding.
6.8.4.1 Spread the top sheet over the client, and either ask the client to hold the
top edge of
the sheet or tuck it under the shoulders.
6.8.4.2 The sheet should remain over the client when the bath blanket or used
sheet is
removed.
6.8.4.3 Complete the top of the bed.
6.9 Surgical Bed
6.8.5 Ensure the continued safety of the client.
6.9.1 Strip the bed.
6.8.5.1 Raise the side rails. Place the bed in the low position before leaving the
6.9.1.1 Place and leave the pillows on the bedside chair.
bedside.
6.9.1.2 Apply the bottom linens as for an unoccupied bed. Place a bath blanket
6.8.5.2 Attach the signal cord to the bed linen within the clients reach.
on the
6.8.6 Put items used by the client within easy reach.
foundation of the bed, if this is agency practice.
6.9.1.3 Place the top covers on the bed as you would for an unoccupied bed.
6.9.1.4 Do not tuck them in, miter the corners, or make a toe pleat.
6.9.1.5 Make a cuff at the top of the bed as you would for an unoccupied bed.
6.9.1.6 Fold the top linens up from the bottom.
6.9.1.7 On the side of the bed where the client will be transferred, fold up the
two outer
corners of the top linens so they meet in the middle of the bed forming a
triangle.
6.9.1.8 Pick up the apex of the triangle, and fanfold the top linens lengthwise
to the other
side of the bed.
7
6.9.1.9 Leave
7.1 For isolation
area the bed in high position with the side rails down.
6.9.2
Lock the
wheels
ofdisposable
the bed if the
bedmask
is not
to be
moved.
7.1.1
Nurses
should
wear
apron,
and
gloves
during bedmaking and
stripping
off.
7.1.2 Soiled linens are not placed in the laundry bag but are kept in double orange
bag labeled
with the contents inside.
129
Republic of
Yemen 48Modern
48
Hospital
8
REFERENCE:
7th Edition
130
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Breastfeeding
CONTENTS: This General Ward policy and procedure deals with the breastfeeding
procedures.
1 DEFINITION:
1.1 Breastfeeding - is the safest, simplest, and least expensive method for providing
complete infant
nutrition.
2 PURPOSES:
2.1 Provides immunological, nutritional, and psychological advantages.
2.2 Maternal bonding or attachment are enhance during breastfeeding.
2.3 Helps delay a pregnancy.
2.4 Protects mothers health.
3.1 Mothers with active infection such as meningitis, pulmonary tuberculosis and AIDS
(Acquired
Immunodeficiency Syndrome).
3.2 Mother who are taking medications that may be passed through breast milk and are
harmful to the
newborn. (e.g. chemotherapy agents).
3.3 Mothers who refuse to breastfeed.
3.4 Baby with galactosemia.
4 POLICIES:
4.1 Breastfeeding should be encouraged to all mothers through ante-natal counseling and
post-natal
support.
4.2 Breastfeeding should be initiated within hour of birth for all well babies born
through
spontaneous vaginal delivery.
4.3 Breastfeeding should be allowed after 1 hour for all well babies born through cesarean
section if
mother is conscious.
4.4 Sick babies admitted in neonatal unit should received breast milk as their first oral
feeding either
by direct breastfeeding for the mother or through expressed breast milk (EBM).
4.5 All premature babies who are unable to suck and those with NGT should be given with
PROCEDURES:
5
expressed
5.1 Have the mother wash her hands before feeding.
breast milk to all mothers.
5.2 Instruct the mother to clean her breast by gently squeezing until small amount of
4.6 Breastfeeding per demand should be encouraged to all mothers.
milk ejected.
4.7 All Maternity and Newborn unit staff should attend the scheduled training program for
Using a circular motion, the milk should be wiped around the breast from the inner to
the
outer, with
promotion and support of breastfeeding.
clean hands.
4.8 No pacifiers or dummies should be allowed to be given to the newborn babies.
5.3 Assist the mother in a comfortable position of her choice.
4.9 No free sample of breast milk substitutes (BMS) are permitted to be supplied to the
5.4 Explain to the mother how to hold her baby. Make sure the following is observed:
mothers or
5.4.1 The head and body of baby should be in straight line.
babies.
131
The babys face should face the breast, with nose opposite the nipples.
The babys body should be closed to the mother.
If the baby is newborn, the mother should support the babys bottom and not just
the head
Republic of
or shoulder.
Yemen
48Modern
48 out:
5.5 Teach mother how to support her breast. The following should be stressed
Hospital
5.5.1 She
should rest her finger on chest wall under her breast so that her first
finger
will form a
support at the base of the breast.
5.5.2 She can use her thumb to press the top of her breast slightly. This can improve
5.4.2
the shape of
5.4.3
the breast so that it is easier for the baby to attach well.
5.4.4
5.5.3 She should not hold the part of her breast near to the nipple.
5.6 Position the baby to the breast and show the mother how to help the baby to attach:
5.6.1 Touch her babys lips with her nipple.
5.6.2 Wait until her babys mouth is opening wide.
5.6.3 Move her baby quickly onto her breast, aiming his lower lip to the nipple.
5.6.4 Instruct the mother to offer her whole breast to the baby not just the nipple. She
should not
touch the nipple or areola with her finger or to try push the nipple into the babys
mouth.
5.7 Observe how the mother responds (if she feels any pain) and ask her how her babys
suckling feels.
5.8 Look for signs of good attachment:
5.8.1 The babys whole body is facing his mother and close to her.
5.8.2 The babys face is close up to the breast.
5.8.3 The baby chin is touching the breast.
5.8.4 The babys mouth is wide open.
5.8.5 The babys lower lip is curled outwards.
5.8.6 There is more areola showing above the babys upper lip and less areaola
showing below
the lower lip.
5.8.7 You can see the baby taking slow, deep sucks.
5.8.8 The mother does not feel nipple pain.
5.8.9 You may be able to hear the baby swallowing.
5.8.10 The baby is relaxed and happy and satisfied at the end of the feed.
5.9 If attachment is not good, try to attach the baby again.
5.10During feeding the mother should:
5.10.1 Let the baby finish the first breast to make sure that he gets the hindmilk
(hindmilk is the
milk that is produced later in a feed). Offer the second breast and let the baby
take if he/she
wants to, but do not force him.
5.10.2 Start feeding from the right breast at one feeding and the left breast of the
next feeding. So
both breast have the same amount of stimulation and both continue to produce
milk.
5.10.3 Let the baby sucks as long as he/she wants.
5.10.4 If the baby does not want to take one side, the mother can try to hold the baby
in different
position. (e.g. under her arm). This may make the other breast seem more like
the favorite
breast to the baby.
5.11Have the mother breastfeed frequently and on a demand schedule.
5.12Have the mother break the infants suction by placing her finger in the corner of
babys mouth.
5.13Have the mother air dry nipples for 15-20minutes after each feeding.
5.14Have the mother burp the baby at the end or midway though the feeding.
5.14.1 Held the baby upright against the chest and gently pat the back.
5.14.2 Let the baby sit on the mothers lap making him/her bend forwards and to the
left to bring
the air bubble under the cardiac orifice of the stomach.
5.15After feeding is completed health teaching should be given:
5.15.1 Avoid taking medications and drugs
without doctors order.
132
5.15.2 Eat a well balanced diet with extra vitamins, calcium and protein.
5.15.3 Encourage to increase fluid intake daily.
5.15.4 Have adequate rest and to avoid tension, fatigue and stressful environment.
Republic of
Yemen 48Modern
48
Hospital
5.16Wash hands after

feeding.
6
6.1 Do not wash nipples with soap as it removes natural oil from the skin of the nipple
and areola. The
skin become dry and more easily damaged and fissured (cracked).
6.2 The following are several common breast conditions which cause difficulties in
breastfeeding.
6.2.1 Flat or inverted nipples, and long or big nipples
6.2.2 Engorgement
6.2.3 Blocked duct and mastitis
6.2.4 Sore nipple and nipple fissure
6.3 Explain to mother that she may feel uterine cramping during breastfeeding. (Nursing
stimulates
release of oxytocin causing uterine muscle contraction). Administer pain reliever per
doctors
order.
6.4 A normal baby is born with a store of water which keeps him well hydrated until the
milk comes
in. Baby does not need drinks water or glucose water because they interfere with
breastfeeding.
6.5 The baby should be breast feed at night as long as possible.
6.6 In situation where breastfeeding is difficult, it is necessary to express the milk.
Breast milk under
room temperature can be use within 8 hours, and if refrigerated, it can last for 48
hours.
6.7 Make sure that the mother is psychologically and physically prepared before
initiating
breastfeeding.
6.8 All mothers should be taught how to express breast milk properly either manually or
by breast
pump.
6.9 Proper attachment during breastfeeding should be shown to all mothers. Advantages
of
breastfeeding and advantages of bottle feeding should be stressed out.
6.10All mothers should be informed to exclusively breast feed their babies for the first 46 months.
6.11All babies should be given supplementary food along with breastfeeding after the
age of 6 months.
133
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Blood Extraction
CONTENTS: This General Ward policy and procedure deals with the procedure of
DEFINITION:
blood. - a procedure of obtaining a sample of blood through venipuncture
1.1extracting
Blood Extraction
for
diagnostic tests through aseptic technique.
1
1.2 Venipuncture - a technique in which a vein is punctured through the skin by a sharp
rigid stylet
such as butterfly needle, cannula or by a needle attached to a syringe.
PURPOSES:
2.1 As a source of valuable information to screen patients for disease.
2
2.2 To evaluate the progress of therapy.
2.3 To monitor the well-being of the patient.
2.4 As a tool to establish or workout a diagnosis.
CONTRAINDICATIONS:
3.1 Do not take blood sample from extremities that contain arteriovenous shunts/graft
3 or
loop shunts.
3.2 Site with signs of infection, infiltration or thrombosis.
3.3 On upper extremity from the same side where mastectomy or axillary dissection was
4
performed.
4.2 Alcohol swabs
4.3 Sterile 2 x 2 gauze
4.4 Rubber tourniquet
4.5 Band aid or adhesive tape
4.6 Appropriate blood collection tube with label containing clients name and PIN.
4.7 Completed laboratory requisition form
4.8 Butterfly needle
4.9 IV cannula
4.10Needle g 23
4.11Syringe (depending on the amount of blood to be collected)
4.12Small sharp container
5
4.13Goggles/face shield
POLICIES:
5.1 Before doing any blood extraction, staff doing the extraction (phlebotomist or
qualified nurse) uses
two (2) identifiers to verify patients identity (patients name and PIN, etc.) especially
prior to
blood drawing.
5.2 Observe the routine schedule for blood extraction usually every 3 hours from 6am12mn;
phlebotomist performs this.
5.3 For urgent or stat extraction, the nurse is the one who extracts blood and send
sample to laboratory
immediately with request through computer specifying Urgent.
5.4 For STAT lab test results will be delivered immediately through phone or computer
monitor.
134
5.5 Observe/Follow standard infection control policy.
5.6 Any specimen sent to laboratory must be properly labeled containing patients name
and PIN.
Republic of
Yemen 48Modern
Hospital
48
PROCEDURES:
7.1 Verify physicians
order. POLICIES:
INFECTION
CONTROL RELATED
6
7.2 Anyone
Prepare who
the needed
equipments.
6.1
performs
tasks involving contacts with blood, blood-related procedures
7.3 Wash
should
be hands and wear gloves.
7.4vaccinated
Identify the
client:Hepatitis B.
against
Ask his/her
name.blood and blood product exposures should be reported to the
6.27.4.1
All incidents
involving
7.4.2 Check ID band
Nurse
7.5Supervisor
Explain the
procedure
to the client.
and
to the Infection
Control Team utilizing an incident reporting scheme.7
7.6 Assist the client in a comfortable position.
7.7 Provide privacy.
7.8 Select the site for extraction. The ideal site is a straight prominent vein that feels
firm and slightly
rebounds when palpated.
7.9 Apply the tourniquet 4-6 inches above the venipuncture site. Most often the
antecubital fossa site
is used. The tourniquet should be applied wherein it can be removed by pulling the
end with a
single motion.
7.10Check for the distal pulse, if no pulse tourniquet is applied neither too tight or too
loose.
7.11Have client open and close fist several times to distend the vein, leaving fist
clenched prior to
venipuncture.
7.12Disinfect site with alcohol swab using a circular motion at the site and extending the
motion 2
inches beyond the site. Allow the alcohol to dry.
7.13Maintain tourniquet only for 1-2 minutes.
7.14Wear goggles or face shield.
7.15Prepare to obtain blood sample. Technique varies depending on the following:
7.15.1 Syringe Method :
7.15.1.1Hold syringe needle at 15-30o angle from the skin with bevel up. Slowly
insert the
needle.
7.15.1.2Gently pull back the syringe plunger and look for blood return.
7.15.1.3Obtain desired amount of blood into the syringe.
7.15.2 Butterfly Needle Method :
7.15.2.1Connect the syringe to the butterfly needle tubing.
7.15.2.2Grasp the wings of the butterfly needle and insert at 20-30 o angle with
bevel up.
7.15.2.3Check for return flow and aspirate desired amount of blood into the
syringe.
7.15.3 Cannula Method :
7.15.3.1Refer to IV Cannula Insertion.
7.15.3.2After removing the needle, aspirate the desired amount.
7.16When collection is completed, remove the tourniquet.
7.17Quickly remove the needle from the vein while applying pressure to the site with 2 x
2 sterile
gauze.
7.18After extraction transfer the blood to appropriate tube and properly label tube
immediately.
7.19After the site clots, apply band-aid.
7.20Dispose the needle into the sharp disposal container.
7.21Remove gloves. Wash hands.
7.22Send sample to laboratory immediately after charging along with properly filled-up
laboratory
135
request.
7.23Charge all supplies used.
7.24Chart in the nursing note the procedure done and amount of blood extracted.
Republic of
Yemen 48Modern
48
Hospital
7.25Follow up result and notify the physician once

available.
8
8.1 Blood samples should not be drawn from the arm with an intravenous infusion. In
certain cases in
which there is absolutely no other option, the infusion may be turned off for several
minutes,
allowing the sample to be taken.
8.2 Clients with history of abnormal clotting disorder, low platelets or related disorders
(hemophilia)
may be at risk of increased bleeding at the site or hematoma formation.
8.3 Since many clients are fearful of needles especially children, additional help may be
needed. Very
young children may need to have extremity restrained during the procedure.
8.4 Any laboratory investigation that requires fasting, clients should be instructed.
8.5 All incidents involving blood and blood product exposures should be reported to the
Head Nurse,
Nursing Supervisor and Infection Control Nurse utilizing Incident Reporting scheme.
136
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Blood Transfusion
CONTENTS: This General Ward policy and procedure deals with the procedure of blood
transfusion.
1 DEFINITION: All intravenous administration of a component of blood or whole blood. This
can be
categorized into 3 types.
1.1 Homologous Transfusion - standard transfusion which random donors are used for
transfusion
to other individuals.
1.2 Autologous Transfusion - blood products donated by the patient for his own use.
1.3 Direct Transfusion - blood products donated by an individual for transfusion to a
specified
recipient.
2 PURPOSES:
2.1 To increase blood volume after surgery, trauma/hemorrhage.
2.2 To increase the number of RBC in patient with severe chronic anemia.
2.3 To provide platelets for those with low platelet counts due to treatment and
chemotherapy.
2.4 To provide clotting factors in plasma for patients with hemophilia or DIC (Disseminated
Intravascular Coagulopathy).
2.5 To replace plasma proteins such as albumin.
2.6 To provide antibodies (IMMUNOTRANSFUSION) to those who are sick and having
lowered
immunity by giving blood or plasma taken from person who have just recovered from
the same
disease.
2.7 To replace the blood with hemolytic agents with fresh blood (exchange blood
transfusion) as in
case of erythroblastosis fetalis in hemolytic anemia etc.
2.8 To combat infection in patients with leukopenia.
2.9 To improve the leukocyte count of blood in agranulocytosis.
2.10Patient with cardiovascular failure, to increase blood volume and RBC while avoiding
cardiovascular overload.
3.1 Blood administration set, IV set
3.2 Blood / Blood components
3.3 NSS 500cc
3.4 Antiseptic solution, tourniquet
3.5 Disposable gloves, blue pads, alcohol swabs
3.6 IV pole, small sharp container
3.7 IV 3000 transparent dressing, cannula g. 16, 18, 20, 22
3.8 Pressure pump (if needed)
3.9 Infusion pump (optional)
3.10Armboard (if needed)
POLICIES:
137
Republic of
4.1 No blood should be transfused without proper typing, cross matching and screening.
48Modern
4.2 PriorYemen
to blood drawing
for blood typing and cross matching, 1 phlebotomist48
and
1 nurse or 2
nurses should
verify patients identity.
Hospital
4.3 The doctor should countercheck and sign in the cross matching report Form M2028
4.4 Obtain doctors order and client or family member consent, and explain about the needs for
blood
transfusion.
138
Republic of
Yemen 48Modern
Hospital
48
4.5 Blood received from blood bank should be started within 30 minutes which is at
room temperature,
if not, return to blood bank with the filled up form blood returned to blood bank
information sheet
M2043.
4.6 Two (2) nurses or 1 nurse and 1 physician should verify the patients identity prior to
the
administration of blood.
4.7 Administration time should not exceed 4 hours because of the increase risk of
bacterial
proliferation.
4.8 Vital signs should be taken and monitored every 5 minutes for the first 15 minutes
then every 15
minutes for 30 minutes then hourly until the transfusion is finished.
4.9 Identification label from the blood bag should not be removed until the transfusion is
completed.
4.10Blood components should not be mixed/primed with any solutions other than Normal
Saline.
4.11Used blood bag with the tubing should be saved for a period of 24 hours after
transfusion.
4.12If the patient is to receive more than 1 unit of blood, a new transfusion set should
be used per
transfusion.
5
PREPARATIONS:
4.13Follow
infection
control
measures.
5.1 Assess:
4.13.1
Perform hand-washing
techniques before initiating blood transfusion.
5.1.1 Manifestations
of hypervolemia
4.13.2
All
blood
units
for
transfusion
should be screened appropriately to reduce the
5.1.2 Status of infusion site
risk5.1.3
of Any unusual symptoms
infectious
5.1.4 transmitting
Vital signs for
baseline diseases.
data
All blood products should be assumed to be infectious and should be handled
5.24.13.3
Determine:
with
gloves.
5.2.1
That a signed consent form was obtained
4.14For
reaction
identified,
immediately
discontinue
5.2.2 any
Anytransfusion
known allergies
or previous
adverse
reactions
to blood the transfusion.
Inform
5.2.3the
Assemble equipment and supplies:
physician
5.3attending
Prepare the
client. and fill-up an incident report.
5.3.1 Instruct the client to report promptly any sudden chills, nausea, itching, rash,
dyspnea,
back pain, or other unusual symptoms.
5.3.2 If the client has an intravenous solution infusing, check whether the needle and
solution
PROCEDURES:
6
are
appropriate
to administer
blood.
6.1 Check
the
doctors order
and obtain
client or family members consent for blood
transfusion.
6.2 Identify correct patient by calling the patient full name and checking the ID band.
6.3 Assess the patients condition, vital signs as baseline and any history of previous
blood transfusion
reaction.
6.4 Explain to the patient/relatives the procedure, approximate duration and desired
outcome of the
transfusion.
6.5 Wash hands, put on gloves.
6.6 Prepare infusion site, select a large vein.
6.7 If cannula is not present, prepare the site for venipuncture, insert cannula and start
NSS @ KVO
rate.
6.8 Remove gloves and wash hands.
6.9 Obtain correct blood component for the client
139 from blood bank and check for the
following:
6.9.1 Check the physicians order with the requisition.
6.9.2 Check the requisition form and the blood bag label with a laboratory technician.
6.9.3 Observe
Republic
the blood
of for abnormal color, RBC clumping, gas bubbles, and
extraneous
Yemen
48Modern
48
material.
Hospital
6.9.4 Return
outdated or abnormal blood to the blood bank.
6.10With another nurse, compare the laboratory blood record with:
6.10.1 The clients name and PIN
6.10.2 The number on the blood bag label
6.10.3 The ABO group and Rh type on the blood bag label
6.10.4 If any of the information does not match exactly, notify the charge nurse and
the blood
bank.
6.10.5 Do not administer blood until discrepancies are corrected or clarified.
6.10.6 Sign the appropriate form with the other nurse
6.11Call the doctor to countercheck the blood and have him sign in the cross matching
report Form
M2028.
6.12Assess the patients physical condition.
6.13Verify the clients identity.
6.13.1 Ask the clients full name.
6.13.2 Check the clients ID band.
6.14Set up the infusion equipment.
6.14.1 Ensure that the blood filter inside the drip chamber is suitable for whole blood
or the
blood components to be transfused.
6.14.2 Attach the blood tubing to the blood filter, if necessary.
6.14.3 Put on gloves.
6.14.4 Close all the clamps on the Y-set: the main flow rate clamp and both Y-line
clamps.
6.14.5 Using a twisting motion, insert the piercing pin (spike) into a container of 0.9
percent
saline solution.
6.14.6 Hang the container on the IV pole about 1 m (36 in) above the planned
venipuncture site.
6.15Prime the tubing.
6.15.1 Open the upper clamp on the normal saline tubing, and squeeze the drip
chamber until it
covers the filter and one-third of the drip chamber above the filter.
6.15.2 Tap the filter chamber to expel any residual air in the filter.
6.15.3 Remove the adapter cover at the tip of the blood administration set.
6.15.4 Open the main flow rate clamp, and rime the tubing with saline.
6.15.5 Close both clamps.
6.16Prepare the blood bag.
6.16.1 Invert the blood bag gently several times to mix the cells with the plasma.
6.16.2 Expose the port on the blood bag by pulling back the tabs.
6.16.3 Insert the remaining Y-set spike into the blood bag.
6.16.4 Suspend the blood bag.
6.16.5 Close the upper clamp below the IV saline solution on the Y-set.
6.16.6 Open the clamp on the blood arm of the Y-set, and prime the tubing.
6.17Establish the blood transfusion.
6.17.1 The blood will run into the saline filled drip chamber. If necessary, squeeze the
drip
chamber to reestablish the liquid level with drip chamber one-third full.
6.17.2 Readjust the flow rate with the main clamp.
6.18Observe the client closely for the first 510 minutes.
6.18.1 Run the blood slowly for the first 15 minutes at 20 drops per minute.
6.18.2 Note adverse reactions, such as chilling, nausea, vomiting, skin rash, or
tachycardia.
6.18.3 Remind the client to call a nurse immediately if any unusual symptoms are felt
during the
transfusion.
6.18.4 If any of these reactions occur, report140
these to the nurse in charge, and take
appropriate
nursing action.
6.19Document relevant data. Record:
6.19.1 Starting the blood

6.19.2 Vital signs
6.19.3
Republic
Type of blood
of
6.19.4 Blood unit number
Yemen 48Modern
48
6.19.5 Sequence number
Hospital
6.19.6 Site
of the venipuncture
6.19.7 Size of the needle
6.19.8 Drip rate
6.20Observe for any transfusion reactions as follows.
6.20.1 Circulatory Overload
6.20.1.1dyspnea, cyanosis, sudden anxiety orthopnea, cough, tachypnea,
increased central
venous pressure, crackles at the base of the lungs and neck vein distention.
6.20.2 Septic Reaction
6.20.2.1Chills, fever vomiting, diarrhea, marked decreased in blood pressure and
shock.
6.20.3 Anaphylactic (life threatening reaction)
6.20.3.1Urticaria, nausea and vomiting, chest pain, anxiety, wheezing,
hypotension and
cardiac arrest.
6.20.4 Hemolytic Reaction the most dangerous type of transfusion reaction occurs
when the
donor is incompatible with that of the recipient.
6.20.4.1Acute Hemolytic
6.20.4.1.1 Fever, chills, hypotension, nausea and vomiting, flushing,
tachycardia,
tachypnea, anxiety, hemoglobinemia, hemoglobinuria, coagulation
disorder
and renal failure.
6.20.4.2Delayed Hemolytic
6.20.4.2.1 Continued anemia, hemoglubinuria
6.20.4.3Febrile Nonhemolytic
6.20.4.3.1 Fever (>1oC), flushing, chills, headache, anxiety, muscle pain.
6.20.5 Graft-versus-host-disease - Normal donor lymphocytes reproduce in a recipient
who is
immunocompromised (e.g. patients receiving high dose of chemotheraphy).
6.20.5.1Fever, skin rash, diarrhea, infection, liver dysfunction, manifested by
jaundice, bone
marrow depression.
6.21Monitor the client.
6.21.1 Fifteen minutes after initiating the transfusion, check the vital signs of the
client.
6.21.2 If there are no signs of a reaction, establish the required flow rate.
6.21.3 Do not transfuse a unit of blood for longer than 4 hours.
6.22 Assess the client, including vital signs, every 30 minutes or more often, depending
on the health
status, until 1 hour post-transfusion.
6.22.1 If the client has a reaction and the blood is discontinued, send the blood bag
to the
laboratory for investigation of the blood.
6.22.2 If there is transfusion reaction:
6.22.2.1Stop transfusion immediately by keep IV line open with a saline solution in
case IV
medication should be needed rapidly.
6.22.2.2Notify the physician.
6.22.2.3Monitor vital signs every 15 minutes.
6.22.2.4Send blood samples and collect urine sample for testing per doctors
order.
6.22.2.5Return blood bag and tubing to blood bank with Blood Returned Blood
Bank
Information Sheet (Form M2043) properly filled-up.
6.22.2.6Administer medication per doctors order.
6.22.2.7Fill-up the incident report for intensive
investigation.
141
6.23After transfusion, flush with NSS 20-250 ml.
6.24Terminate the transfusion.
6.24.1 Don clean gloves.
Republic of
Yemen 48Modern
Hospital
48
6.24.2 If no infusion is to follow, clamp the blood tubing and remove the needle.
6.24.3 If another transfusion is to follow, clamp the blood tubing and open the saline
infusion
arm.
6.24.4 If the primary IV is to be continued, flush the maintenance line with saline
solution.
6.24.5 Disconnect the blood tubing system and reestablish the intravenous infusion
using new
tubing.
6.24.6 Save the used blood bag for 24 hours.
6.24.7 Adjust the drip to the desired rate.
6.24.8 Needles should be placed in a labeled, puncture-resistant container designed
for such
disposal. Blood bags and administration sets should be bagged and labeled
before being
sent for decontamination and processing.
6.24.9 Monitor vital signs again.
6.24.10After care of equipment.
6.24.11Wash hands and remove gloves.
6.25Document the following:
6.25.1 Completion of the transfusion
6.25.2 Amount of blood absorbed
6.25.3 The blood unit number
6.25.4 Vital signs
6.25.5 If the primary intravenous infusion was continued, record connecting it.
6.25.6CONSIDERATIONS:
Also record the transfusion on the IV flow sheet and Intake and Output record.
SPECIAL
7
6.26Charge the procedure and supplies used.
7.1 Make sure platelets/fresh frozen plasma are administered immediately when
obtained, and follow
doctors order for the rate and maximum duration.
7.2 Nurses must be aware of the appropriate measures to be done in case of any
untoward reaction
occur. After transfusion, it should be flushed with 20-250 ml of NSS.
7.3 Metric volume measured set is the one being used as blood transfusion set in
Newborn.
7.4 For newborn cases that need fresh frozen plasma transfusion, it is being delivered
via perfusion
pump and regulated per doctors order.
7.5 Contraindications:
7.5.1 Platelet Transfusion:
7.5.1.1 Disseminated intravascular disorder.
7.5.1.2 Idiopathic thrombocytopenic purpura disorders causing rapid platelet
destruction.
7.5.2 Albumin Transfusion:
8
7.5.2.1 Severe anemia because of risk of cellular dehydration. (Should be
administered
cautiously in cardiac and pulmonary disease because of the risk of congestive
heart
failure from circulatory overload)
7.5.3 Gamma Globulin Transfusion:
7.5.3.1 Known hypersensitivity to it or an anti immunoglobulin antibody (IgA).
REFERENCE:
8.1 Fundamentals of Nursing concepts, process, and practice 7 th Edition
Barbara Kozier, Glenora Erb, Audrey Berman,
142 Shirlee Snyder
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Care of the Unconscious Client
CONTENTS: This General Ward policy and procedure discusses the procedures on how to
provide care to
the unconscious client.
1 DEFINITION:
1.1 Unconsciousness is a condition in which a patient is unresponsive to and unaware of
environmental stimuli.
1.2 Classification
1.2.1 Coma - is a clinical state of unconsciousness in which the patient is unaware of
self or
environment for prolonged periods. (days to months or even years.)
1.2.2 Akinetic Mutism - is a state of unresponsiveness to the environment in which
patient
makes no movement or sounds but sometimes open the eyes.
1.2.3 Persistent Vegetative State - is a condition in which the patient is described as
wakeful
but devoid of conscious content, without cognitive or affective mental function.
1.3 Causes
1.3.1 Neurologic - (Evaluated by Glasgow Coma Scale)
1.3.1.1 Head injury
1.3.1.2 Stroke
1.3.2 Toxicologic
1.3.2.1 Drug overdose
1.3.2.2 Alcohol Intoxication
1.3.3 Metabolic
1.3.3.1 Hepatic failure
1.3.3.2 Renal Failure
1.3.3.3 Diabetic Ketoacidosis
2 PURPOSES:
2.1 To maintain clear airway.
2.2 To protect from injury.
2.3 To maintain fluid and electrolyte balance.
2.4 To achieve intact oral mucous membrane.
2.5 To maintain normal skin integrity.
2.6 To prevent corneal irritation.
2.7 To attain normal body temperature.
2.8 To promote urinary elimination.
2.9 To promote normal bowel function.
3
2.10To prevent complications of prolong bedridden like pneumonia, DVT and pulmonary
3.1 Oxygen with complete administering
embolism
device
by appropriate physiotherapy.
3.2 Suction apparatus
3.3 Suction catheter of different size
3.4 Disposable gloves/sterile gloves
3.5 Mask
3.6 Gauze 10 x 10 / Gauze 4 x 4
143
Republic of
Yemen 48Modern
Hospital
48
3.7 Eye lubricant, eye pad

3.8 Ear swab
3.9 NGT tube of different sizes
3.10Condom catheter, foley catheter, urine bag
3.11Powder and lotions
3.12Air mattress
3.13Soap and shampoo
3.14Betadine mouthwash/Vaseline
3.15Artery forceps
3.16Intubation kit
3.17Adhesive tape
3.18IV cannula, IV tubings
3.19Blue sheets, tuckables and diapers
3.20Glucometer
3.21Nail cutter
3.22BP apparatus (sphygmomanometer and
stethoscope)
3.23IVAC machine with cover
POLICIES:
4.1 Infection control policy should be followed.
4.2 Patients rights and dignity must be upheld and
respected.
4.3 Safety measure should be observed.
PROCEDURES:
5
5.1 Maintenance of clear airway.
5.1.1 Place the patient in lateral positions or semi-sitting position to prevent tongue
from
obstructing the airway.
5.1.2 Keep the airway free of secretions with efficient suctioning as needed.
5.1.2.1 Apply airway if necessary.
5.1.2.2 Prepare for insertion of cuffed endotracheal tube.
5.1.2.3 Give oxygen as prescribed.
5.1.3 Check pulse rate and blood pressure to evaluate circulatory
adequacy/inadequacy.
5.1.4 Maintain circulation by keeping blood pressure at normal level and treat lifethreatening
cardiac dysrrhythmias.
5.2 Protection from injury
5.2.1 Provide safety measures such as keeping the siderails always up.
5.2.2 Identify potential sources of injury (example: tight dressings, environmental
irritants,
damp bedding or dressing, tubes and drains) and do necessary measures.
5.3 Maintenance of fluid and electrolyte balance:
5.3.1 Assess mucous membranes and skin turgor for hydration status.
5.3.2 Administer and monitor IV fluids carefully.
5.3.3 Give parenteral and enteral feeding as ordered.
5.4 Achieving intact oral mucous membrane:
5.4.1 Remove dentures if present. Inspect patients mouth for dryness, inflammation
and
presence of crusting.
5.4.2 Do oral care every 2 hours with betadine mouthwash.
5.4.3 Apply vaseline lip emollient to prevent from dryness and cracking.
5.5 Maintenance of Skin Integrity
5.5.1 Keep the patient skin clean, dry and free of pressures. Give complete bed bath
twice daily.
144
5.5.2 Trim the patients nails carefully to prevent excoriation.
5.5.3 Turn the patient side to side on a schedule basis to relieve pressure areas.
5.5.4 Apply air mattress, and prevent wrinkles in the bed linens.
Republic of
Yemen 48Modern
Hospital
48
5.5.5 Passive limb exercise 3 times daily and AVI (Arteriovenous Impulses)
stimulation every 8
hours for 1 hour by physiotherapist.
5.6 Maintenance of Corneal Integrity
5.6.1 Assess the eyes daily for corneal irritation or ulceration.
5.6.2 Irrigate eyes with saline to remove discharge and debris. Instill opthalmic
ointment on
both eyes to prevent glazing or corneal ulceration. Cover with eye pads if
necessary.
5.7 Maintenance of Normal Body Temperature
5.7.1 Check body temperature every 4 hours and record.
5.7.2 Look for possible sites of infection if patient has fever. Apply cooling measures
such as
giving cold sponge, cold IV fluids, cold enema, cold NGT feeding, keeping IV
tubing
cold, reducing room temperature, removing excess linens, applying ice packs.
5.7.3 For hypothermic patients, apply warming blanket and other linens.
5.8 Promotion of Urinary Elimination
5.8.1 Palpate the bladder at intervals to detect urinary retention and an over
distended bladder.
5.8.2 Monitor for fever and urine amount, color and turbidity. Inspect the urethral
orifice for
suppurative discharges.
5.8.3 Change foley catheter every 7-10 days. Inject 3ml H 2O + one drop paraffin oil in
the valve
and aspirate it back once daily in the morning during catheter care.
5.8.4 Inform if oliguria, polyuria and anuria is observed. Maintain strict intake and
output
record.
5.8.5 If patient has condom catheter, check the penis regularly for skin irritation and
bruises. Do
not apply condom catheter too tightly and should be changed daily.
5.9 Promotion of Normal Bowel Elimination
5.9.1 Auscultate for bowel sounds. Palpate lower abdomen for distention. Measure
abdominal
girth.
5.9.2 Observe for constipation (from immobility and lack of dietary fiber).
5.9.2.1 Perform a rectal examination.
5.9.2.2 Stool softener maybe prescribed and to be given with tube feeding.
5.9.2.3 Glycerine suppository maybe prescribed to stimulate bowel emptying.
5.9.3 Monitor for diarrhea (from infection, antibiotics, hyperosmolar fluids, and fecal
impaction).
5.9.3.1 Perform a rectal examination if fecal impaction is suspected.
5.9.3.2 Do meticulous skin care if patient has fecal incontinence.
5.10Prevention
of Complication
6
5.10.1
Monitor
for signsto
and
symptoms
of potential complications such as pneumonia,
6.1 Help family members
cope
with crisis.
aspiration,
6.1.1 Verbalize fears and concerns.
respiratory
thrombosis,
embolism
andand
bedsore.
6.1.2
Encouragedistress,
them to contractures,
provide sensory
stimulation
by talking
touching
5.10.2
Closely monitor vital signs and respiratory function.
their
patient.
5.10.3 Blood sampling to be done daily as per doctors order. If infection is
suspected, send
sample for culture.
5.10.4 Monitor CVP every 4-6 hours, as ordered.
145
5.10.5 Chest physiotherapy.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Cast Application

CONTENTS: This General Ward policy and procedure deals with the procedures of cast
application.
1 DEFINITION:
1.1 Cast - is an immobilizing device made up of layers of plaster or Fiberglass (water
activated
polyurethane resin) bandages molded to the body part that it encases.
2 PURPOSES:
2.1 To immobilize and hold bone fragments in reduction.
2.2 To apply uniform compression of soft tissues.
2.3 To permit early mobilization.
2.4 To support and stabilize weak joints.
2.5 To prevent and correct deformities.
2.6 To promote healing after general or plastic surgery, amputation or nerve and vascular
repair.
3.1 If there is a large area of external tissue damage or swelling
3.2 Peripheral vascular disease
3.3 Diabetes mellitus
4.1 Soff ban
4.2 Stockinette
4.3 Disposable gloves, Plastic apron
4.4 Blue sheet
4.5 Splint
4.6 Cast knives scissors
4.7 Tape
4.8 Basin with tap water
4.9 Plaster or synthetic bandages in desired widths
4.10Gauze bandages
4.11Vaseline
5 POLICIES:
5.1 Doctors order should be obtained.
5.2 Identify the correct client.
5.3 Proper assessment of the affected part prior and after casting.
5.4 Cast is applied not too loose or too tight.
5.5 Proper body alignment is obtained and maintained prior and during casting.
PROCEDURES:
6
6.1 Verify doctors order.
6.2 Identify the correct patient.
6.3 Explain the procedure to the patient.
6.4 Give clear information as to what the patient should expect during the
procedure.
6.5 Assemble all necessary equipment at patients bedside.
6.6 Assess for the following:
146
Republic of
Yemen 48Modern
Hospital
48
Neurovascular status of the injured area, which includes skin color, skin
temperature,
capillary refill, pulses, movement and sensation.
6.6.1
6.6.2 Skin that will be soon inaccessible under the cast. Note any bruising, abrasions,
incisions
or skin conditions that might contribute to discomfort, infection, and drainage
or skin
breakdown after the cast is applied.
6.6.3 Patient ability to communicate during the procedure.
6.7 Place patient in proper position, expose the part to be casted.
6.8 Protect the bed and patient from water and casting residue. Apply blue sheets.
6.9 Wash hands, wear gloves and apron.
6.10Assist the doctor in applying the cast.
6.11After the procedure, elevate cast site with pillow. For plaster cast, leave the cast
uncovered while
it is drying.
6.12Reassess neurovascular status.
6.13Clean the bed and remove casting materials.
6.14Dispose all supplies used.
6.15Prepare patient for X-ray as ordered.
6.16Remove apron, gloves and wash hands.
6.17.1 Type of cast and site where it was applied.
6.17.2 Time and date of application.
6.17.3 Specific aids used after casting such as crutches or slings.
6.17.4 Neurovascular status before and after casting.
6.17.5
Tolerance to procedure, and any pain medication, if given.
Special
Considerations:
7
6.17.6
Health
given.
7.1 A window
orteachings
opening may
be done in the cast to relieve pressure or to monitor the
6.18Charge
skin
at that the procedure and all supplies used.
location under the cast.
7.2 The time required for the cast to become rigid varies with the material used.
7.3 There should be no movement of the extremity while the cast is being applied and
set.
7.4 Instruct the patient to report immediately if there is:
7.4.1 Numbness and tingling of the casted extremity.
7.4.2 Excessive edema of the extremity above or below the cast.
7.4.3 Decreased movement of the casted extremity.
7.4.4 Paleness or blueness of the casted extremity.
7.4.5 Increased pain or burning under the cast.
7.4.6 Foul odor from the cast.
7.4.7 Change in temperature of the extremity from warm to cold.
7.4.8 Chest pain or shortness of breath.
7.4.9 Nausea, vomiting or abdominal pain when the patient is in a body spica cast.
7.5 The following health teaching should be given to patient:
7.5.1 Inspect the skin around the edges daily. If rough edges occur, place adhesive
tape over
the edge.
7.5.2 Notify the physician:
7.5.2.1 If the cast is rubbing and irritating the skin. Do not cut the cast.
7.5.2.2 If the cast cracks or breaks.
7.5.3 Do not put anything down the cast to scratch an itchy area. Articles dropped
into a cast
can cause infection and loss of skin.
7.5.4 Avoid getting the cast wet. If the physician
147 permits, a plastic bag or cast cover
can be
taped over the extremity so a shower can be taken.
7.5.5 Elevate the casted extremity when sitting or lying.
Republic of
Yemen 48Modern
48
Hospital
7.5.6
If in a body cast, turn every few hours to prevent respiratory congestion
and skin
pressure
areas.
7.5.7 Exercise joints not in the cast to maintain strength and mobility.
7.5.8 Exercise casted extremity as directed by physician.
7.5.9 Eat a balanced diet with emphasis on fiber to prevent constipation.
7.5.10 Drink extra water to prevent constipation.
7.6 Observe for complications of improper cast application
7.6.1 Palsy, paresthesia, ischemia
7.6.2 Ischemic myositis
7.6.3 Pressure necrosis
7.6.4 Misalignment or non-union of fracture bones.
148
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Cast Removal

CONTENTS: This General Ward policy and procedure deals with the procedures of removing
cast.
1 DEFINITION:
1.1 Cast Removal removing of cast with the aid of a cast cutter, thus releasing and
gradually
mobilizing the body part.
2 PURPOSES:
2.1 When the purpose of applying a cast has been achieved already.
2.2 When complications arise.
3.1 Patient who is restless and uncooperative.
4.1 Cast cutter
4.2 Scissors with blunt ends
4.3 Cast spreader
4.4 Blue sheet
4.5 Basin with water
4.6 Soap
4.7 Bandage scissor
4.9 Mask
4.10Dressing set (optional)
5 POLICIES:
5.2 If done under GA:
5.2.1 Consent to be taken
5.2.2 OR request to be sent
5.2.3 Pre-op evaluation to be done.
6
PROCEDURES:
6.3 Prepare all equipments to be used. Check electric cutter if working properly.
6.4 Explain the procedure and provide privacy.
6.5 Wash hands, wear gloves, mask and plastic apron.
6.6 Place blue sheet under affected part.
6.7 Assess vascular status prior to procedure.
6.8 Assist the doctor in performing the procedure and anticipate the needs.
6.9 After cast is removed, assess the skin underneath the cast.
6.10Assess for the neurovascular status.
6.11Gently clean the skin with warm water. Do not rub or use friction.
6.12Evaluate strength and range of motion of affected extremities.
6.13Assist patient in comfortable position, and instruct about limitation of function of
affected
extremity.
6.14After care of supplies used.
149
Republic of
Yemen 48Modern
48
Hospital
6.15Remove gloves, wash hands.

6.16.1 Date and time the cast has been removed
6.16.2 Patients tolerance to procedure
6.16.3 Assessment made
6.16.4 Any instructions given
6.16.5 Any specific aids that the patient used after removal of cast such as crutches,
arm sling or
walker.
6.17Charge the supplies used.
7
7.1 Elderly patient may take longer to attain maximum muscle function.
7.2 Children maybe more afraid of cast cutter and needs extra support, explanation and
psychological
diversion.
150
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Cleaning a Sutured Wound and Applying a Sterile
Dressing
CONTENTS: This General Ward policy and procedure deals with the guidelines in doing
wound
dressing.
1 DEFINITION:
1.1 Sutured Wound wound that has been surgically sutured.
1.2 Wound Dressing - a procedure done under aseptic technique where a material is
applied to the
surface of a wound to provide and maintain an environment in which healing can take
place at
maximum rate.
1.3 Types of Dressing:
1.3.1 Dry-to-dry dressing used primarily for wound closing by primary intention.
1.3.2 Wet-to-dry dressing used for untidy or infected wounds that must be debrided
and
closed by secondary intention.
1.3.3 Wet-to-wet dressing used on clean open wound or on granulating surfaces.
2 PURPOSES:
2.1 To prevent, eliminate, and control infection.
2.2 To absorb drainage or secretion.
2.3 To provide physical, psychological and aesthetic comfort.
2.4 To protect the wound from further injury.
2.5 To protect the skin surrounding the wound.
2.6 To maintain moist wound and environment.
2.7 To remove necrotic tissue.
2.8 To promote hemostasis as in pressure dressings.
3 INDICATIONS:
3.1 Surgical incision.
3.2 Insertion of central line or other invasive procedure.
4
3.3 Wounds with drain.
4.1 Bath blanket (if necessary)
4.2 Moisture-proof bag
4.3 Mask (optional)
4.4 Acetone or another solution (if necessary to loosen adhesive)
4.4.1 Disposable gloves
4.4.2 Sterile gloves
4.5 Sterile dressing set; if none is available, gather the following sterile items:
4.5.1 Drape or towel
4.5.2 Gauze squares
4.5.3 Container for the cleaning solution
4.5.4 Two pairs of forceps
4.5.5 Gauze dressings and surgipads
4.5.6 Applicators or tongue blades, to apply ointments
4.5.7 Additional supplies required for the particular dressing
4.5.8 Tape, tie tapes, or binder
4.5.9 Hydrocolloid dressing at least 34 cm (1.5 in) larger than wound on all
four sides
151
Republic of
Yemen 48Modern
48
Hospital
Skin barrier or skin prep
(optional)
Wound barrier dressing
Scissors
Paper tape
4.5.10
4.5.11
4.5.12
4.5.13
5
POLICIES:
5.1 Hospital Infection Control Policy is observed.
5.2 Privacy should be maintained.
5.3 Dressing should be done by the doctor assisted by a nurse.
5.4 Wound culture, if needed, should be taken prior to dressing.
5.5 Dressing trolley should be checked for completeness of items at the start of each
shift.
5.6 Solutions, ointment and spray should be labeled as to date of opening.
5.7 During wound dressing, the upper level of trolley should be kept free and the
surface should be
disinfected before and after.
5.8 Counting/Checking of dressing instruments before and after used.
5.9 All items must be charged.
6
PREPARATIONS:
6.1 Assess:
6.1.1 Client allergies to wound cleaning agents
6.1.2 The appearance and size of the wound
6.1.3 The amount and character of exudates
6.1.4 Client complaints of discomfort
6.1.5 The time of the last pain medication
6.1.6 Signs of systemic infection
6.2 Determine:
6.2.1 Any specific orders about the wound or dressing
6.4 Prepare the client and assemble the equipment.
6.4.1 Acquire assistance for changing a dressing on a restless or confused adult.
6.4.2 Assist the client to a comfortable position in which the wound can be readily
exposed.
Expose only the wound area.
6.4.3 Make a cuff on the moisture-proof bag for disposal of the soiled dressings, and
place the
bag within reach.
6.4.4 It can be taped to the bedclothes or bedside table.
6.4.5 Put on a facemask, if required.
7
PROCEDURES:
cooperate.
7.4 Remove binders and tape.
7.4.1 Remove binders, if used, and place them aside. Untie tie tapes, if used.
7.4.2 If adhesive tape was used, remove it by holding down the skin and pulling the
tape
gently but firmly toward the wound.
7.4.3 Use a solvent to loosen tape, if required.
7.5 Remove and dispose of soiled dressings appropriately.
7.5.1 Put on clean disposable gloves, and remove the outer abdominal dressing or
surgipad.
7.5.2 Lift the outer dressing so that the underside is away from the clients face.
7.5.3 Place the soiled dressing in the moisture-proof bag without touching the
152
outside of the
bag.
7.5.4 Remove the under dressings, taking care not to dislodge any drains.
Republic of
If the gauze sticks to the drain, support the drain with one hand and remove the
Yemen
48Modern
48
gauze
Hospital
with
the other.
7.5.6 Assess the location, type, and odor of wound drainage, and the number of
gauzes
saturated or the diameter of drainage collected on the dressings.
7.5.7 Discard the soiled dressings in the bag as before.
7.5.5
7.5.8 Remove gloves, dispose of them in the moisture-proof bag, and wash hands.
7.6 Set up the sterile supplies.
7.6.1 Open the sterile dressing set, using surgical aseptic technique.
7.6.2 Place the sterile drape beside the wound.
7.6.3 Open the sterile cleaning solution, and pour it over the gauze sponges in the
plastic
container.
7.6.4 Put on sterile gloves.
7.7 Clean the wound, if indicated.
7.7.1 Clean the wound, using your gloved hands or forceps and gauze swabs
moistened with
cleaning solution.
7.7.2 If using forceps, keep the forceps tips lower than the handles at all times.
7.7.3 Use the cleaning methods described, or one recommended by agency protocol.
7.7.4 Use a separate swab for each stroke, and discard each swab after use.
7.7.5 If a drain is present, clean it next, taking care to avoid reaching across the
cleaned
incision.
7.7.6 Clean the skin around the drain site by swabbing in half or full circles from
around the
drain site outward, using separate swabs for each wipe.
7.7.7 Support and hold the drain erect while cleaning around it.
7.7.8 Clean as many times as necessary to remove the drainage.
7.7.9 Dry the surrounding skin with dry gauze swabs, as required.
7.7.10 Do not dry the incision or wound itself. Moisture facilitates wound healing.
7.8 Apply dressings to the drain site and the incision.
7.8.1 Place a precut 4 x 4 gauze snugly around the drain, or open a 4 x 4 gauze to
4 x 8,
fold it lengthwise to 2 x 8, and place the 2 x 8 gauze around the drain so
that the ends
overlap.
7.8.2 Apply the sterile dressings one at a time over the drain and the incision.
7.8.3 Place the bulk of the dressings over the drain area and below the drain,
depending on the
clients usual position.
7.8.4 Apply the final surgipad, remove gloves, and dispose of them.
7.8.5 Secure the dressing with tape or ties.
7.9 Applying a Hydrocolloid Dressing
7.9.1 Thoroughly clean the skin area around the wound.
7.9.1.1 Wash hands and put on clean gloves.
7.9.1.2 Clean the skin well but gently with normal saline or a mild cleansing
agent. Always
rinse the adjacent skin well before applying a dressing.
7.9.1.3 Clip the hair about 5 cm (2 in) around the wound area, if indicated
7.9.1.4 Leave the residue that is difficult to remove on the skin.
7.9.1.5 Remove gloves, and dispose of them in the moisture-proof bag.
7.9.2 Clean the wound, if indicated. Put on clean or sterile gloves.
7.9.2.1 Clean the wound with the prescribed solution.
7.9.2.2 Dry the surrounding skin with dry gauze.
7.9.3 Assess the wound.
7.9.3.1 Apply the dressing. Follow the manufacturers instructions.
7.9.3.2 Hold the dressing in place for about one minute with your hand.
7.9.3.3 Remove and dispose of the gloves.
153 Optional: Apply tape to window
frame the
edges of the dressing.
7.9.4 Assess and change the dressing as indicated.
Republic of
Yemen 48Modern
48
Hospital
7.9.4.1 Inspect the dressing at least daily for leakage, dislodgement, odor, and
wrinkling.
7.9.4.2 Change the dressing if any of these signs are present.
7.9.5 Document:
7.9.5.1 Dressing change
7.9.6 Clients response
7.10Applying a Transparent Wound Barrier
7.10.1 Clean the wound, if indicated.
7.10.1.1 Put on clean or sterile gloves in accordance with agency practice.
7.10.1.2 Clean the wound with the prescribed solution.
7.10.1.3Dry the surrounding skin with dry gauze.
7.10.1.4Assess the wound.
7.10.2 Apply the wound barrier.
7.10.2.1Review the instructions on the barrier package. Remove part of the paper
backing
on the dressing.
7.10.2.2Apply the dressing at one edge of the wound site, allowing at least 2.5 cm
(1 in) of
coverage of the skin surrounding the wound.
7.10.2.3Gently lay or press the barrier over the wound. Keep it free of wrinkles,
but avoid
stretching it too tightly.
7.10.2.4Remove and dispose of gloves appropriately.
7.10.3 Reinforce the dressing only if absolutely needed.
7.10.3.1Apply paper or other porous tape to window frame the edges of the
dressing.
7.10.4 Assess the wound at least daily.
7.10.4.1Determine the extent of serous fluid accumulation under the dressing;
wound
healing, and the need to repair the dressing.
7.10.4.2If the dressing
is leaking, remove it and apply another dressing.
8
REFERENCE:
7.10.5 Document: 8.1 Fundamentals of Nursing concepts, process, and practice 7 th
7.10.5.1Dressing
change
Edition
7.10.5.2Wound status
7.10.5.3Clients response
154
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Cold Compress

CONTENTS: This General Ward policy and procedure serves as a guideline in performing cold
compress.
1 DEFINITION:
1.1 Cold Compress - a procedure/measure of applying ice or cold substance to body
surface using
different devices according to method and type of application, depending on patients
condition
with the intention of lowering body temperature or giving therapeutic effect.
1.2 Types of Application:
1.2.1 Ice bag
1.2.2 Cold compress
1.2.3 Cold pack
1.2.4 Chemical cold pack
1.3 General Cold Application:
1.3.1 Cold sponging
2 PURPOSES:
2.1 To stimulate vasoconstriction.
2.2 To inhibit local circulation, suppuration, and tissue metabolism.
2.3 To reduces body temperature and acts as a temporary anesthetic.
2.4 To relieve congestion, slows bacterial activity in infections.
2.5 To prevent gangrene because it decreases the effects of tissue anoxia and thereby
delays the tissue
necrosis.
2.6 To control hemorrhage.
3.1 Cold application should not be applied on the following conditions:
3.1.1 Those who are in the state of shock and collapse.
3.1.2 When there is edema.
3.1.3 On diseases or disorders associated with impaired circulation e.g. patients with
diabetes,
arteriosclerosis and neurological disorder.
3.1.4 When there is muscle spasm.
3.1.5 When there is shivering or having a very low temperature.
3.1.6 For elderly, arthritic or very young patient unless ordered.
4.1 bag depending on the treatment chosen.
4.2 Ice
4.3 Gauze/ Towel
4.4 Cover
4.5 Underpad
5
POLICIES:
4.6 Thermometer 5.1 Doctors order should be obtained.
4.7 Sphygmomanometer
and Stethoscope
5.2 Identify
correct client.
5.3 Application should not be more than 20 minutes at a
temperature of 15oC.
155
Republic of
Yemen 48Modern
48
Hospital
5.4 Ensure patients safety by observing possible complications. Call bell should be
within reach.
5.5 Method of application varies according to patients age and condition, type of
devices to be used
and area involved.
PROCEDURES:
6
6.1 Check for the doctors order.
6.2 Prepare the items/supplies to be used.
6.3 Wash hands before and after the procedure.
6.5 Take vital signs as baseline to assess the condition of patient.
6.6 Determine method of application to be used, and place underpad under the area.
6.7 Expose the area to be treated. Provide privacy and make sure that room is warm.
6.8 Start cold application and take note of the time it started.
6.9 Observe patients condition. Discontinue if any untoward reaction is observed and
notify the
treating doctor immediately.
6.10Aftercare of equipment and supplies.
6.11Record the procedure as to date, time and duration; type of device; and site of
application.
7
7.1 When applying cold to an open wound or to a lesion that may open during
treatment, use sterile
technique.
7.2 Maintain sterile technique during eye treatment.
7.3 Warn the patient against placing ice directly on skin, because extreme cold can
cause burns.
7.4 Extreme external cooling with ice water baths is usually contra-indicated because
this measure
does not treat the cause of the fever.
7.5 Sponging should not be performed until 30 minutes after the administration of an
antipyretic so
that the hypothalamic temperature set point will be lowered, otherwise, the body will
resist the
cooling attempt and shivering can occur.
156
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Colostomy Care

CONTENTS: This General Ward policy and procedure serves as a guideline in performing
colostomy
care.
1 DEFINITION:
1.1 Stoma - a surgical operation in which an artificial opening of a part of the colon is
brought above
the abdominal wall in a colostomy.
1.2 Colostomy - is the surgical creation of an opening into the colon in order to drain or
decompress
the intestine.
1.2.1 Temporary - eventually being closed to restore continuity.
1.2.2 Permanent - usually when the rectum or lower colon has been removed.
2 PURPOSES:
2.1 For cure or palliation of cancer as a part of an abdominal perineal resection.
2.2 As palliative treatment when unresectable malignancy is present.
2.3 To divert fecal stream during radiation or other therapy.
2.4 A temporary measure to protect an anastomosis, such as after abdominal trauma.
3 POLICIES:
3.1 Infection control policy should be observed.
3.2 Colostomy care should be rendered frequently every time colostomy bag is changed.
3.3 Provide privacy all throughout the procedure.
4.2 Mask
4.3 Sterile gauze 10x10
4.4 Warm tap water
4.5 Scissors
PREPARATIONS:
5
Pen or pencil
5.14.6
Assess:
4.7
Colostomy
appliance with skin barrier
5.1.1
Stoma color
5.1.2 Stoma size and shape
5.1.3 Stomal bleeding
5.1.4 Any redness and irritation of the peristomal skin
5.1.5 Amount and type of feces
5.1.6 Complaints
5.1.7 The clients and family members learning needs regarding the ostomy and
selfcare
5.1.8 The clients emotional status, especially strategies used to cope with the
ostomy
5.1.9 The used appliance for leakage of effluent
5.2 Determine:
5.2.1 The need for an appliance change
5.2.2 The kind of ostomy and its placement on the abdomen
5.2.3 The type and size of appliance currently used, and the special barrier substance
157
applied to
the skin
Republic of
Yemen 48Modern
Hospital
48
5.2.4 Taoe allergy

5.2.5 If client has any discomfort at or around the stoma
5.2.6 The fullness of the pouch
5.2.7 If there is pouch leakage or discomfort at or around the stoma, change the
appliance.
5.3.2 Electric or safety razor
5.3.3 Bedpan
5.3.4 Solvent
5.3.5 Moisture-proof bag
5.3.6 Cleaning materials, including issues, warm water, mild soap optional),
washcloth or
cotton balls, and towel
5.3.7 Tissue or gauze pad
5.3.8 Skin barrier
5.3.9 Stoma measuring guide
5.3.10 Pen or pencil and scissors
5.3.11 Clean ostomy appliance, with optional belt
5.3.12 Tail closure clamp
5.3.13 Special adhesive, if needed
5.3.14 Stoma guide strip, if needed
5.3.15 Deodorant (liquid or tablet) for a nonodor-proof colostomy bag
5.4 Select an appropriate time to change the appliance:
5.4.1 Avoid times close to meal or visiting hours.
5.4.2 Avoid times immediately after meals or the administration of any medications
that
may
6
PROCEDURES:
stimulate
6.1 Explain
to thebowel
clientevacuation.
what you are going to do, why it is necessary, and how she can
cooperate.
6.2 Wash hands and observe other appropriate infection control procedures. Apply clean
gloves.
6.4 Assist the client to a comfortable sitting or lying position in bed or, preferably, a
sitting or
standing position in the bathroom.
6.5 Unfasten the belt, if the client is wearing one.
6.6 Shave the peristomal skin of well-established ostomies, as needed. Use an electric
or safety razor
on a regular basis, to remove excessive hair.
6.7 Empty and remove the ostomy appliance.
6.7.1 Empty the contents of the pouch through the bottom opening into a bedpan.
6.7.2 Assess the consistency and the amount of effluent.
6.7.3 Peel the bag off slowly while holding the clients skin taut.
6.7.4 If the appliance is disposable, discard it in a moisture-proof bag.
6.8 Clean and dry the peristomal skin and stoma.
6.8.1 Use toilet tissue to remove excess stool.
6.8.2 Use warm water, mild soap (optional), and cotton balls or a washcloth and towel
to clean
the skin and stoma.
6.8.3 Use a special skin cleanser to remove dried, hard stool.
6.8.4 Dry the area thoroughly by patting with a towel or cotton balls.
6.9 Assess the stoma and peristomal skin.
6.9.1 Inspect the stoma for color, size, shape, and bleeding.
6.9.2 Inspect the peristomal skin for any redness, ulceration, or irritation.
158the stoma, and change it as needed.
6.9.3 Place a piece of tissue or gauze pad over
6.10Apply paste-type skin barrier, if needed.
6.10.1 Fill in abdominal creases or dimples with paste.
Republic of
Yemen 48Modern
Hospital
48
6.10.2 Allow the paste to dry for 1 to 2 minutes, or as recommended by the

manufacturer.
6.10.3 Prepare and apply the skin barrier (peristomal seal).
6.11For a Solid Water or Disc Skin Barrier
6.11.1 Use the guide to measure the size of the stoma.
6.11.2 On the backing of the skin barrier, trace a circle the same size as the stomal
opening.
6.11.3 Cut out the traced stoma pattern to make an opening in the skin barrier.
6.11.4 Make the opening no more than 0.30.4 cm (1/81/6 in) larger than the stoma.
6.11.5 Remove the backing to expose the sticky adhesive side.
6.11.6 Center the skin barrier over the stoma, and gently press it onto the clients
skin,
smoothing out any wrinkles or bubbles.
6.12For Liquid Skin Sealant
6.12.1 Either wipe or apply the product evenly around the peristomal skin to form a
thin layer of
the liquid plastic coating to the same area.
6.12.2 Allow the skin sealant to dry until it no longer feels tacky.
6.13Fill in any exposed skin around an irregularly shaped stoma.
6.13.1 Apply paste to any exposed skin areas. Use a nonalcoholic-based product if the
skin is
excoriated. Or:
6.13.2 Sprinkle peristomal powder on the skin, wipe off the excess, and dab the
powder with
slightly moist gauze or with an applicator moistened with a liquid skin barrier.
6.14Prepare and apply the clean appliance.
6.14.1 Remove the tissue over the stoma before applying the pouch.
6.15For a Disposable Pouch with Adhesive Square
6.15.1 If the appliance does not have a precut opening, trace a circle 0.30.4 cm (1/8
1/6 in)
larger than the stoma size on the appliances adhesive square.
6.15.2 Cut out a circle in the adhesive.
6.15.3 Peel off the backing from the adhesive seal.
6.15.4 Center the opening of the pouch over the clients stoma, and apply it directly
onto the skin
barrier.
6.15.5 Gently press the adhesive backing onto the skin, and smooth out any wrinkles,
working
from the stoma outward.
6.15.6 Remove the air from the pouch.
6.15.7 Place a deodorant on the pouch (optional).
6.15.8 Close the pouch by turning up the bottom a few times, fanfolding its end
lengthwise, and
securing it with a tail closure clamp.
6.16For a Reusable Pouch with Faceplate Attached
6.16.1 Apply either adhesive cement or a double-faced adhesive disc to the faceplate
6.17Variation:
Applying a Reusable Pouch with Detachable Faceplate
of
the
6.17.1appliance.
Apply a skin sealant to the faceplate before attaching the adhesive disc.
6.17.1.1Remove
the
protective
paper(15strip
one
side
the double-faced
6.16.2
Insert a coiled
paper
guide strip
cmfrom
[6-in]
strip
ofof
1.3-cm[_ in] wide
adhesive
disc.
paper) into the
6.17.1.2Apply
the sticky side to the back of the faceplate.
faceplate opening.
6.17.1.3
Remove
theprotrude
remaining
protective
strip from
other
of the
6.16.3
The strip
should
slightly
from paper
the opening
and the
expand
toside
fit it.
adhesive
6.16.4 Using the guide strip, center the faceplate over the stoma.
disc. press the adhesive seal to the 159
6.16.5 Firmly
peristomal skin.
6.16.6 Place a deodorant in the bag, if the bag is not odor-proof.
6.16.7 Close the end of the pouch with the designated clamp.
6.16.8 Attach the pouch belt, and fasten it around the clients waist (optional).
Republic of
Yemen 48Modern
Hospital
48
6.17.1.4Center the faceplate over the stoma and skin barrier, then press and hold
the
faceplate against the clients skin for a few minutes, to secure the seal.
6.17.1.5Press the adhesive around the circumference of the adhesive disc.
6.17.1.6 Tape the faceplate to the clients abdomen using four or eight 7.5-cm (3in) strips of
hypoallergenic tape.
6.17.1.7 Place the strips around the faceplate in a picture-framing manner, one
strip down
each side, one across the top, and one across the bottom.
6.17.1.8 The additional four strips can be placed diagonally over the other tapes
to secure the
seal.
6.17.1.9 Stretch the opening on the back of the pouch, and position it over the
base of the
faceplate. Ease it over the faceplate flange.
6.17.1.10 Place the lock ring between the pouch and the faceplate flange, to seal
the pouch
against the faceplate.
6.17.1.11 Close the base of the pouch with the appropriate clamp.
6.17.1.12 Attach the pouch belt, and fasten it around the clients waist (optional).
6.17.2 Dispose of equipment, or clean reusable equipment.
6.17.2.1 Discard a disposable bag in a plastic bag before placing in the waste
container.
6.17.2.2 If feces are liquid, measure the volume. Note the feces character,
consistency, and
color before emptying the feces into a toilet or hopper.
6.17.2.3 Wash reusable bags with cool water and mild soap, rinse, and dry.
6.17.2.4 Wash a soiled belt with warm water and mild soap, rinse, and dry.
6.17.2.5 Remove and discard gloves.
6.17.3 Variation: Applying the Skin Barrier and Appliance as One Unit
6.17.3.1Prepare the skin barrier by measuring the size of the stoma, tracing a
circle on the
backing of the skin barrier, and cutting out the traced stoma pattern to make
an
opening in the skin barrier.
6.17.3.1.1 Prepare the appliance by cutting an opening 0.30.4 cm (1/81/6 in)
larger
than the stoma size (if not already present) and peeling off the backing
from
the adhesive seal.
6.17.3.1.2 Center the opening of the pouch over the skin barrier.
6.17.3.1.3 Remove the skin barrier backing to expose the sticky adhesive side.
6.17.3.1.4 Center the skin barrier and appliance over the stoma, and press it
onto the
clients skin.
7
6.18
7.1 The
Document
colostomy
the bag
procedure
is emptied
in the
orclients
changed
record.
when Report
it is one-fourth
and record:
to one-third full so
that
6.18.1
the weight
Pertinent assessments and interventions
6.18.2
of its contents
Any increase
does in
not
stoma
causesize
the pouch to separate from the adhesive disk and spill
the6.18.3
contents.
Change in color indicative of circulatory impairment
7.26.18.4
Irrigation
Presence
of colostomy
of skin irritation
is initiated
or when
erosion
bowel function has resumed usually 5 th-6th
day6.18.5
post- Discoloration of the stoma
6.18.6
operatively.
Appearance
The main
of the
purpose
peristomal
of colostomy
skin
irrigation is to empty the colon of gas,
mucus,
6.18.7
and
Amount and type of drainage
160
6.18.8
feces so
Clients
that the
experience
patient can
with
gothe
about
ostomy
with social and business activities without fear
of fecal
6.18.9 Skills learned by the client
6.18.10Client
drainage.
reaction to the procedure
Republic of
Yemen 48Modern
48
Hospital
7.3 For some patients, colostomy bags are not always necessary. As soon as the patient
has learned a
routine for evacuation, bags may be dispensed with a simple dressing of disposable
tissue, held in
place by an elastic belt.
7.4 Promote the patients acceptance of the colostomy by building up self-esteem.
Encourage the
family to assist the patient during period of adjustment.
7.5 Health Teaching:
7.5.1 Instruct the patient to assess the stoma and surrounding skin frequently.
7.5.2 Explain that the pouch should be changed when 1/4 - 1/3 full. Teach the patient
how to
perform self-care of colostomy.
7.6 Diet Management
7.6.1 Avoid overeating and eating irregularly. Chew the food well.
7.6.2 Encourage to eat a well balanced diet to avoid diarrhea and constipation.
7.6.3 Explain to the patient to avoid foods known to cause odors such as onions,
cabbage, eggs,
fish and beans. Fecal odors are lessened with youghurt, juice and milk.
7.6.4 Most gas is due to swallowed air (often takes in while chewing a gum), highly
spiced
foods, and carbonated beverages, including beer. Gas forming foods such as
beans,
cabbage, onions,
radishes, cucumbers and highly seasoned foods must be 8
REFERENCE:
avoided.
7.6.5 Participation
any type of sport or activity is possible.
7thin
Edition
7.7 Approximately 10-12%
of males
with
colostomy
of sexual
function
Barbara
Kozier,
Glenora
Erb, suffer
Audreyimpairment
Berman, Shirlee
Snyder
and
potency. In women, a colostomy does not preclude successful pregnancy. Close
medical care is
required.
161
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Condom Catheter Application

CONTENTS: This General Ward policy and procedure serves as a guideline in applying
condom catheter.
1 DEFINITION:
1.1 Condom catheter is an external drainage system to collect urine from male patients
who have
incontinence.
2 PURPOSES:
2.1 To allow less contact of the skin with urine than a diaper or blue pad.
2.2 To serve as an alternative to an indwelling catheter.
2.3 To collect spontaneous voiding in male patient with reflux or total incontinence.
2.4 To avoid risk associated with catheter inserted through urethra.
2.5 Suitable for unconscious male patient who still have complete and spontaneous
bladder emptying.
3.1 Condom catheter kit with adhesive strip
3.2 Urinary drainage bag
3.4 Basin with warm water and soap
3.5 Towel and washcloth
3.6 Blue pads
3.7 Razor, if needed.
4 POLICIES:
4.1 Follow infection control measures.
4.2 Ensure correct size to avoid leaks.
4.3 Safety measures to maintain skin integrity is observed at all times.
PROCEDURES:
5
4.4 Respect cultural tradition, male nurse to do the application, if possible.
5.1
Check
the
doctors
order,
and
identify
the
correct
patient.
4.5 Obtain doctors order.
5.4 Place patient in supine position.
5.5 Place underpad under the buttocks and expose the genital area.
5.6 Wash hands and wear gloves.
5.7 Assess the patients penis for any signs of redness, irritation, or skin breakdown.
5.8 Follow perineal care procedure.
5.9 Shave any excess pubic hair, if needed.
5.10Wash, rinse and dry the area.
5.11With non-dominant hand, grasp penis along shaft. With dominant hand, hold
condom sheath at
tip of penis and smoothly roll sheath unto penis.
5.12Allow 2.5 to 5cm. of space between tip of glans penis and end of condom catheter.
5.13Apply the adhesive strip around the base of patients penis in spiral position. The
strip is applied
1 from the proximal end of the penis. Apply snugly, but not tightly.
162
5.14Attach the drainage bag tubing to the catheter. Avoid kinking or twisting of the
tubing.
Republic of
Yemen 48Modern
48
Hospital
5.15Make sure tubing lay over the patients leg and not under. Secure the drainage bag
to the side of
the bed below the level of patients bladder.
5.16Cover patient, place in comfortable position.
5.17Dispose used supplies, remove gloves and wash hands.
5.18Measure patients urinary output and record every 4 hours.
5.19Change the condom catheter once a day to clean the area and assess the skin for
any signs of
impaired skin integrity.
5.19.1 In removing condom catheter, remove the adhesive strip first then gently roll
out the
condom catheter and pull it out.
5.20Record the date and time of application and removal, skin condition, and patients
response.
6
SPECIAL
CONSIDERATIONS:
5.21Aftercare
of
equipment.
6.1 Inspect the condom catheter for twist which can result in displacement of catheter.
5.22Charge
the procedure
and supplies
used.
6.2
If the patient
gets an erection,
assure
him that it is usual when applying a condom
catheter. Your
calm reassurance and matter-of-fact attitude will help decrease the patients
embarrassment and
provide guidance to his coping response.
163
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Crash Cart

CONTENTS: This General Ward policy and procedure discusses about the use and contents of
a crash
cart.
1 DEFINITION:
1.1 Crash Cart - is a life-saving medical trolley equipped with all the necessary items and
vital
components of cardio-pulmonary resuscitation such as:
1.1.1 Supplies - refer to crash cart checklist
1.1.2 Medicines - refer to crash cart checklist
1.1.3 Machines
1.1.4 ECG monitor
1.1.5 Defibrillator
1.1.6 SPO2
1.1.7 Transcutaneous Pacemaker
2 PURPOSES:
2.1 To provide the necessary items needed for cardio-pulmonary resuscitation.
EQUIPMENTS/SUPPLIES:(Please refer to Standard Crash Cart Checklist Form
3
M5212)
3.1 First Drawer -CPR
3.1.1 Atropine sulphate 1mg/10ml pre-loaded syringe /amp
3.1.2 Calcium chloride 10% 10ml injectables
3.1.3 Epinephrine 1 mg/10ml (1:10000) DS /amp
3.1.4 Lidocaine 100mg/5ml (2%) DS
3.1.5 Sodium bicarbonate 8.4% 50ml
3.1.6 NSS 10ml
3.1.7 Ampoule file
3.2 Second Drawer Emergency Drug Checklist
3.2.1 Adrenaline 1:1000mg/ml
3.2.2 Atropine sulphate 0.5mg/ml
3.2.3 Amniophylline (Euphyllin) 250mg/10ml amp
3.2.4 Bretylium 500mg/10ml amp
3.2.5 Calcium gluconate 10% (1mg/10ml) amp
3.2.6 Dexamethasone (Decadron) 4mg/ml
3.2.7 Diazoxide 30mg/20ml amp
3.2.8 Digoxin (Lanoxin) 0.5mg/5ml amp
3.2.9 Disopyramide (Rhythmodan)50mg/5ml amp
3.2.10 Dobutamine (Dobutrex) 250mg/20ml amp
3.2.11 Phenytoin (Epanutin) 250mg/5ml amp
3.2.12 Ephedrine 30mg/ml
3.2.13 Furosemide (Lasix) 20mg/2ml amp
3.2.14 Heparin sodium 5000IU vial
3.2.15 Hydralazine (Apresoline) 20mg
3.2.16 Hydrocortisone 100mg/2ml amp
3.2.17 Intropine (Dopamine) 200mg/2ml
164amp
Republic of
Yemen 48Modern
48
Hospital
3.2.18 Isopretenol (Isuprel) 0.2mg/ml

3.2.19 Magnesium sulphate 1gm/10ml amp
3.2.20 Methylprednisolone succinate (Solu-medrol) 500mg
vial
3.2.21 Succinate (Scholine) 500mg vial
3.2.22 Naloxone (Narcan) 0.4mg/ml amp
3.2.23 Nitroglycerine (Tridil) 50mg/10ml amp
3.2.24 Noradrenaline (Levophed) 4mg/4ml amp
3.2.25 Potassium chloride 15% 2meq/ml x 10ml amp
3.2.26 Procainamide (Pronestyl) 1000mg/10ml vial
3.2.27 Propanolol (Inderal) 1mg/ml amp
3.2.28 Verapamil (Isoptin) 5mg/2ml amp
3.2.29 Plasma protein 250ml
3.2.30 Water for injection 10ml
3.2.31 Xylocard 20%
3.2.32 Dextrose 50% 50ml
3.3 Third Drawer-Left
3.3.1 Needles #18,20,22
3.3.2 Goggles
3.3.3 Alcohol pads
3.3.4 Opsite, alcohol spray
3.3.5 Adhesive tape / roll gauze #7.5 x 4
3.3.6 Middle suction catheter Fr 8,10,12,14,16
3.3.7 Oxygen mask with connector
3.3.8 Oxygen nasal cannula
3.3.9 Mepore 9x10, 9x15
3.4 Third Drawer Right
3.4.1 Foley catheter Fr 8,10,12,14,16,18
3.4.2 Feeding tube Adult Fr 14,16,18
3.4.3 Feeding tube Pedia F8, 10
3.4.4 Urine bag
3.4.5 Sterile gloves size #7,8
3.4.6 Sterile gauze size # 2x2, 4x4
3.4.7 Sterile kidney basin
3.5 Fourth Drawer Left
3.5.1 Intrafix
3.5.2 Infusomat
3.5.3 Dosifix (Soluset)
3.5.4 IV with connector
3.5.5 3-way stopcock, IV lock
3.5.6 Blood set
3.6 Fourth Drawer Right
3.6.1 Syringes of different sizes (3cc, 5cc, 10cc, 200cc)
3.6.2 IV cannula size #14,16,18,20,22,24
3.6.3 Needle different sizes 25,23,22,18
3.6.4 Secalon
3.7 Fifth Drawer
3.7.1 LR 500 ml
3.7.2 NSS .9%
3.7.3 D5 NSS 500ml
3.7.4 Ringers solution 500ml
3.7.5 Mannitol 20% 500ml
3.8 Sixth Drawer Left
165
Republic of
Yemen 48Modern
Hospital
48
3.8.1 Laryngoscope adult & pedia

3.8.2 Laryngoscope battery size C
3.8.3 Magil forceps
3.8.4 Stylet adult & pedia
3.8.5 Airway: adult size # 1,2,3,4 pedia size
3.9 Sixth Drawer Right
3.9.1 Endotracheal tubes (adult) sizes 7, 7.5, 8, 8.5
3.9.2 Endotracheal tubes (pedia) sizes 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5,
6, 6.5
3.9.3 Penlight with 2 batteries siza AA
3.10Front Surface
3.10.1 Defibrillator
3.10.2 Electrode adult/pedia
3.10.3 Gel
3.10.4 Connecting leads set
3.10.5 Cavafix size 45cm/70cm
3.10.6 Ambubag
3.11Side Left
3.11.1 Sharps disposal container (small)
3.12Side Right
3.12.1 Oxygen tank (small)
3.13Back Surface
3.13.1 Cardiac board
4
POLICIES:
4.1 Crash cart should be kept locked at all times; integrity of locks to be checked during
crash cart
checks and documented with lock number.
4.2 Crash cart contents must always be complete and should be checked weekly every
Saturday and
immediately after a Code Blue procedure.
4.3 All staff in the unit should be well oriented with the contents and use of crash cart.
4.4 Availability of adequate supply of emergency drugs, equipment and medical supplies
is a must
according to standard list.
4.5 Ensure all medicines should be returned within 3 months before expiry dates.
4.6 All supplies and medicines must be used only for emergency cases.
4.7 All equipments and medical supplies should be in proper order and functioning
properly.
4.8 Defibrillator should always be plugged in AC Power (except when checking for the
battery
wherein it should be unplugged from AC power) and test load to be done every shift.
PROCEDURES:
4.9 Portable oxygen tank located in the crash cart will be checked for the amount of5
5.1
Using the
Crash Cart Daily Checklist Form, list of items should be checked at the
available
oxygen
startatofthe
each
beginning of each shift and after each use.
shift.
4.10Preventive
maintenance should be maintained.
5.1.1 units
Crashwill
carthave
serial
number
4.11All
crash
cart placed in an easily accessible location.
5.1.2 Lock security number
5.1.3 Date changed
5.1.4 Defibrillator fully functional with accessories attached (electrodes, paper, pad)
and the
battery by unplugging it from the power supply before checking.
5.1.5 Clip board with recording sheet and checklist
5.1.6 Suction unit and tubing
5.1.7 Oxygen cylinder full tank with regulator,
166 wrench, and flow meter
5.1.8 Ambubag and reservoir
Republic of
Yemen 48Modern
48
Hospital
5.1.9 Drug calculation chart

5.1.10 Sharps container
5.2 Crash cart and its content should be checked on a regular weekly basis and
immediately after use
(during Code Blue) using the Standard Crash Cart Checklist Form (M5212).
5.3 Update Crash Cart of the required medicines. All expiring medicines should be
returned to the
pharmacy 3 months prior to its expiry date.
5.4 Any medicines or item not available in the Crash Cart must be endorsed to the head
nurse for
immediate requisition and replacement.
5.5 Keep the Crash Cart clean and in usual order. Locations of medicines and life saving
items should
not be interchanged to avoid misguiding the staff and to locate easily when needed.
5.6 Clean and disinfect instruments and equipments after each use.
REVISIONS:
5.7
Use medicines, IVF, supplies strictly for emergency purposes only.
6.1
checking
every
shift has
revised
and approved
5.8Previous
Keep thepolicy
Crashof
Cart
in place
accessible
forbeen
all and
could as
berecommended
taken easily without
any
by
the Code
interference
Blue
Committee.
or difficulty.
6.2 Arrangements and contents of the crash cart have also been modified in accordance
with MOH
requirements.
7 REFERENCES:
7.1 2004 MOH Guidelines on Standard Emergency Drug and Crash Cart Contents
167
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Diabetic Foot Care

CONTENTS: This General Ward policy and procedure serves as a guideline in performing foot
care
routine and diabetic foot care.
1 DEFINITION:
1.1 Foot Care a routine care for the feet for hygienic purposes and to improve
circulation to the feet.
1.2 Diabetic Foot Care - a systematic way of providing physical care of the feet
specifically for
diabetic patient to prevent any complication that may lead to foot amputation and/or
death.
2 PURPOSES:
2.1 To prevent circulatory complications often accompanying diabetes.
2.2 To decrease the incidence of infection.
2.3 To promote comfort and feeling of well-being.
2.4 To increase circulation to lower extremities.
2.5 Provides regular inspection of the lower extremities.
3.1 Toenail trimming is contraindicated in patients with toe infection, diabetes mellitus,
and peripheral
vascular disease unless performed by a doctor or podiatrist.
4.1 Washbasin containing warm water
4.2 Pillow
4.3 Moisture-resistant disposable pad
4.4 Towels
4.5 Soap
4.6 Washcloth
4.7 Toenail-cleaning and trimming equipment
4.8 Lotion or foot powder
5 POLICIES:
5.1 Soaking of feet should not be more than five (5) minutes.
5.2 Obtain a written doctors order.
6 PREPARATIONS:
6.1 Assess:
6.1.1 Skin surfaces for cleanliness, odor, dryness, and intactness
6.1.2 Each foot and toe for shape, size, presence of lesions, areas of tenderness, and
ankle
edema
6.1.3 Skin temperatures of the two feet for circulatory status and the dorsalis pedis
pulses
6.1.4 Self-care abilities
6.2 Determine:
6.2.1 History of any problems with foot odor; foot discomfort; foot mobility;
circulatory
168
problems
6.2.2 Usual foot care practices
Republic of
Yemen 48Modern
48
Hospital
7
PROCEDURES:
7.1 Explain to the client what you are going to do, why it is necessary, and how he can
cooperate.
7.4 Prepare the equipment and the client.
7.4.1 Fill the washbasin with warm water at about 4043C (105110F).
7.4.2 Assist the ambulatory client to a sitting position in a chair, or the bed client to a
supine or
semi-Fowlers position.
7.4.3 Place a pillow under the bed clients knees.
7.4.4 Place the washbasin on the moisture resistant pad at the foot of the bed for a
bed client, or
on the floor in front of the chair for an ambulatory client.
7.4.5 For a bed client, pad the rim of the washbasin with a towel.
7.5 Wash the foot and soak it.
7.5.1 Place one of the clients feet in the basin and wash it with soap.
7.5.2 Rinse the foot well to remove soap.
7.5.3 Rub callused areas of the foot with the washcloth.
7.5.4 If the nails are brittle or thick, and require trimming, replace the water and
allow the foot
to soak for 1020 minutes.
7.5.5 Clean the nails as required with an orange stick.
7.5.6 Remove the foot from the basin and place it on the towel.
7.5.7 Repeat for second foot.
7.6 Dry the foot thoroughly and apply lotion or foot powder.
7.6.1 Blot the foot gently with the towel to dry it thoroughly, particularly between the
toes.
7.6.2 Apply lotion or lanolin cream.
7.6.3 Apply foot powder, if applicable.
7.6.4 Repeat for second foot.
7.7 If agency policy permits, trim the nails of the first foot while the second foot is
soaking.
7.8 Give health-teachings on the following:
7.8.1 Active and passive exercises.
7.8.2 To wear properly fitted shoes and clean socks daily.
7.8.3 To consult a podiatrist for treatment of corns and calluses.
7.8.4 If feet are cold, wear socks or slippers and to use extra blanket. (Avoid using
heating pad
or hot water bottle.)
7.8.5 Regularly check the feet for infection or complications.
7.8.6 Wearing tight fitting garments and elastic garters, walking barefoot, sitting
with knees
REFERENCE:
8
crossed should 8.1
be avoided.
Fundamentals of Nursing concepts, process, and practice
7.8.7 Check worn shoes
frequently for rough spots in the lining.
7th Edition
7.9 Aftercare of equipment.Barbara Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder
7.10Document the procedure, observations, and health-teachings given.
7.11Charge the procedure and supplies used, in the Inpatient Charging Form.
169
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Enema Administration
CONTENTS: This General Ward policy and procedure serves as a guideline in administering
enema.
1 DEFINITION:
1.1 Enema - an instillation of a fluid preparation into the rectum and sigmoid colon
producing a bowel
action.
1.2 Types:
1.2.1 Cleansing - solution introduced into the rectum or lower colon with the intention
of being
expelled, along with fecal matter or flatus.
1.2.2 Retention - with the intention of being retained for a specified period of time.
2 PURPOSES:
2.1 To promote defecation by stimulating peristalsis.
2.2 To relieve constipation, distention, or fecal impaction.
2.3 To prepare the bowel for x-ray or surgical procedures.
2.4 To instill medication.
2.5 To help establish regular bowel function during a bowel training program.
2.6 To reduce temperature.
2.7 To stimulate uterine contraction and to hasten childbirth.
3.1 Bowel obstruction, inflammation, or infection of the abdomen.
3.2 Recent rectal or anal surgery.
3.3 Myocardial infarction or arrhythmia.
3.4 Appendicitis or low sodium tolerance.
3.5 Paralytic ileus.
4.1 Disposable gloves, gown, mask
4.2 Solution as ordered.
4.3 Blue pads, bed pan
4.4 Commode, as needed
4.5 IV pole
4.6 Water soluble lubricant
4.7 Enema set
4.8 Thermometer
4.10Sterile gauze
5 POLICIES:
5.2 Appropriate size of catheter and amount of solution should be used.
5.3 Follow hospital infection control policy.
5.4 Not more than 3 enemas in a day should be given to the patient unless ordered by
physician.
5.5 Proper assessment like vital signs, patients condition, last bowel movement, normal
bowel
170
patterns, presence of hemorrhoids, mobility, and external sphincter control.
5.6 Infusion time varies with volume of solution administered e.g. 1 litre in 10 minutes.
Republic of
Yemen 48Modern
Hospital
48
PREPARATIONS:
6
6.1 Assess:
6.1.1 When the client last had a bowel movement, and the amount, color, and
consistency of the
feces
6.1.2 Presence of abdominal distention
6.1.3 Whether the client has sphincter control
6.1.4 Whether the client can use a toilet or commode or must remain in bed and use a
bedpan
6.2 Determine:
6.2.1 Whether a physicians order is required
6.2.2 The presence of kidney or cardiac disease that contraindicates the use of a
hypotonic
solution
6.3.1 Disposable linen-saver pad
6.3.2 Bath blanket
6.3.3 Bedpan or commode
6.3.4 Clean gloves
6.3.5 Water-soluble lubricant if tubing not prelubricated
6.3.6 Paper towel
6.3.7 Large-volume enema
6.3.7.1 Solution container, with tubing f correct size and tubing clamp
PROCEDURES:
6.3.7.2 Correct solution, amount, and temperature
7.1 Explain
client what you are going to do, why it is necessary, and how he can
6.3.7.3to
IVthe
pole
cooperate.
6.3.8 Small-volume enema
7.2 Wash
hands
and observe
other appropriate
infection
control
procedures.
6.3.8.1
Prepackaged
container
of enema solution
with
lubricated
tip
7.3 Provide
for
client
privacy.
6.3.8.2 Lubricate about 5 cm (2 in) of the rectal tube.
7as
7.4 Assist
the
adult
client
to a left
lateral
position,
withtubing
the right
leg
as acutely
6.3.8.3
Run
some
solution
through
the
connecting
of a
large
volumeflexed
enema
possible
and
set
and the
the linen-saver
pad to
under
the
buttocks.
rectal tube,
expel
any
air in the tubing; then close the clamp.
7.5 Insert the rectal tube.
7.5.1 For clients in the left lateral position, lift the upper buttock.
7.5.2 Insert the tube smoothly and slowly into the rectum, directing it toward the
umbilicus.
7.5.3 Insert the tube 710 cm (34 in).
7.5.4 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.
7.5.5 Never force tube or solution entry. If instilling a small amount of solution does
not permit
the tube to be advanced, or the solution to freely flow, withdraw the tube.
7.5.6 Check for any stool that may have blocked the tube during insertion. If present,
flush it
and retry the procedure. You may also perform a digital rectal examination, to
determine if
there is an impaction or other mechanical blockage.
7.5.7 If resistance persists, end the procedure and report the resistance to the
physician and
nurse in charge.
7.6 Slowly administer the enema solution.
7.6.1 Raise the solution container, and open the clamp to allow fluid flow. Or:
7.6.2 Compress a pliable container by hand. 171
7.6.3 During most low enemas, hold or hang the solution container no higher than 30
cm (12
in) above the rectum.
Republic of
Yemen 48Modern
48
Hospital
During a high enema, hang the solution container about 45 cm (18 in).
7.6.4
Administer the fluid slowly. If the client complains of fullness or pain,7.6.5
use the
clamp to
stop the flow for 30 seconds, and then restart the flow at a slower rate.
7.6.6 If you are using a plastic commercial container, roll it up as the fluid is instilled.
7.6.7 After all the solution has been instilled, or when the client cannot hold any more
and feels
the desire to defecate, close the clamp, and remove the rectal tube from the
anus.
7.6.8 Place the rectal tube in a disposable towel as you withdraw it.
7.7 Encourage the client to retain the enema.
7.7.1 Ask the client to remain lying down.
7.7.2 Request that the client retain the solution for the appropriate amount of time
for
example, 510 minutes for a cleansing enema, or at least 30 minutes for a
retention enema.
7.8 Assist the client to defecate.
7.8.1 Variation:
Assist the Administering
client to a sitting
position
bedpan, commode,
or toilet.
7.8.4
an Enema
toon
anthe
Incontinent
Client
7.8.2
Ask
the
client
who
is
using
the
toilet
not
to
flush
it.
The
nurse
needs
observe
7.8.4.1 After the rectal tube is inserted, have the client assume a supinetoposition
the
feces.
on a bedpan.
7.8.3
If a specimen
is required,
ask theslightly,
client toto
use
bedpanifornecessary,
commode.
7.8.4.2
The head of
of feces
the bed
can be elevated
30 adegrees
for easier
breathing, and use pillows to support t clients had and back.
7.8.5 Variation: Administering a Return-Flow Enema
7.8.5.1 For a return-flow enema, the solution is instilled into the clients rectum
and sigmoid
colon.
7.8.5.2 Then the solution container is lowered so that the fluid flows back out
through the
rectal tube into the container, pulling the flatus with it.
7.8.5.3 The inflow outflow process is repeated five or six times, and the solution is
replaced
several times during the procedure, if it becomes thick with feces.
7.9 Document the procedure.
7.9.1 Document
the type of solution; length of time solution was retained; the
SPECIAL
CONSIDERATIONS:
8
amount,
color,
8.1 Patient
with salt-retention disorders such as congestive heart failure, may absorb
and consistency
of the returns; and the relief of flatus and abdominal distention
sodium from
the
in the
saline enema solution. It should be administered with caution and electrolyte status
client record.
should be
monitored.
8.2 Schedule retention enema before meals, since a full stomach may stimulate
peristalsis and make
retention difficult.
8.3 Dont give enema to a patient who is in sitting position unless absolutely necessary.
9
REFERENCE:
7th Edition
172
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Electrocardiography
CONTENTS: This General Ward policy and procedure deals with the guidelines in performing
electrocardiography.
1 DEFINITION:
1.1 Electrocardiography - a non-invasive procedure that is used to ascertain information
about the
electrophysiology of the heart.
2 PURPOSES:
2.1 Useful tool in the diagnosis of those conditions that may cause aberrations in the
electrical activity
of the heart:
2.1.1 MI and other types of coronary artery disease such as angina.
2.1.2 Cardiac rhythm changes or cardiac dysrhythmias.
2.1.3 Electrolyte disturbances especially in calcium and potassium levels.
2.1.4 Drug effects.
2.2 A part of elective investigations prior to various interventions such as surgery and
anti-cancer
therapy.
3 CONTRAINDICATION:
3.1 Uncooperative patient.
4.1 ECG machine with cables, leads and graph paper.
4.2 Chest electrodes (rubber)
4.3 Alcohol swab
4.4 ECG conducting gel
4.5 Tissue paper
4.6 Plastic clamp for limb leads
4.7 Razor
5 POLICIES:
5.1 Observe Hospital Infection Control Policy.
5.2 Under ordinary circumstances, obtain doctors order. If patient complains of chest
pain ECG is
done immediately.
6
PROCEDURES:
5.3 As part of pre-operative investigation, ECG result should be ready prior to pre6.1 Check doctors order.
anesthesia
6.2 Identify correct patient.
evaluation.
6.3 Explain the procedure.
6.6 Remove patients jewelries such as watch, rings and bracelets to minimize or
prevent artifacts in
the recordings.
6.7 Place the patient in supine position. Drape properly.
6.8 Clean the limbs and the site where electrodes will be applied to ensure good
placement and lessen
electrical artifacts.
173 apply the electrodes as follows:
6.9 Apply electrodes gel on the placement site and
Republic of
Yemen 48Modern
48
Hospital
6.9.1 Bipolar Limb Leads

6.9.1.1 Red color lead - Right hand
6.9.1.2 Yellow color lead - Left hand
6.9.1.3 Black color lead - Right leg
6.9.1.4 Green color lead - Left led
6.9.2 Unipolar Chest Leads
6.9.2.1 V1 - 4th ICS at right margin of the sternum
6.9.2.2 V2 - 4th ICS at left margin of the sternum
6.9.2.3 V3 - Midway between the position of V2 and V4
6.9.2.4 V4 - 5th ICS at the junction of midclavicular line
6.9.2.5 V5 - At the horizontal level position of V 4 at left anterior axillary line
6.9.2.6 V6 - At the horizontal level of position V 4 at left mid-axillary line.
6.10Attach the ten leads for the ECG machine to the electrodes.
6.11Check that the leads are connected properly to the relevant electrodes to get the
correct ECG
recording.
6.12Ask the patient to relax and refrain from movement.
6.13Check that calibration is 10mm/mv to ensure standard recording to aid
interpretation.
6.14Commence 12 lead recording, in case of artifact, check and counter check
electrodes and
connections.
6.15Remove electrodes and wipe the site to get rid of excess gel.
6.17Attach the ECG print -out in the ECG paper (Form M5021) properly filled up.
6.18Send to cardiologist for reading.
6.19If there are findings, inform to anesthesiologist on duty once patient is for
operation and to
attending physician or resident on duty for appropriate action.
6.20.1 Date and time procedure was done
6.20.2 Condition of the patient and complaints made prior to the procedure
6.20.3 ECG result and if findings is noted, appropriate action taken
6.20.4 Name of the cardiologist who read the ECG
7
SPECIAL
CONSIDERATIONS:
6.21Charge
the procedure and supplies used.
7.1 If the patients skin is exceptionally oily, scaly or diaphoretic, rub the electrode site
with alcohol
and dry it with gauze before applying the electrode.
7.2 If ever ECG result is not ready during pre-anesthesia evaluation of OR patients, any
ECG findings
once noted should be informed immediately to anesthesiologist on duty for necessary
action.
174
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Eye Dressing
CONTENTS: This General Ward policy and procedure serves as a guideline in performing eye
dressing.
1 DEFINITION:
1.1 Eye Patch - is a method of covering or protecting the affected eyes by applying an
eyepad or
gauze.
1.2 Eye Shield - is a hard plastic non-metallic material cover to support an eye patch in
place or
protect eye from further injury.
1.3 Pressure Dressing - is a method of using an eye cover (eye patch and eye shield) with
intent of
applying pressure on the affected eye for medical reason.
2 PURPOSES:
2.1 To keep eyes at rest (eye patch).
2.2 To prevent patient from touching his/her eye (patch, shield, & pressure dressing).
2.3 To absorb tears and secretions (patch, pressure dressing).
2.4 To protect eyes from light, dust, and further injury.
2.5 To control or lessen edema.
2.6 To prevent blinking that promotes healing.
3.1 Eye patch is contraindicated, if there is infection.
3.2 Pressure dressing is contraindicated to glaucoma.
4.1 Eye patch:
4.1.1 Eye medication, as ordered
4.1.2 Eye patch (sterile)
4.1.3 Hypoallergenic tape
4.2 Eye shield and Eye dressing:
4.2.1 Eye shield (plastic)
4.2.2 Sterile eye patch
4.2.3 Transparent tape
4.3 Sterile gloves
5 POLICIES:
5.2 Protect patient from accident and further injury.
5.3 Orient patient to his surroundings.
5.4 Effective verbal communication is a must.
PROCEDURES:
6.1 Identify correct patient and explain the procedure.
6.2 Arrange supplies and provide privacy.
6.4 Place patient in sitting or lying position.
6.5 Instruct patient to close both eyes.
6.6 Perform procedure as follows:
175
Republic of
6.6.1 Eye Patch:

Yemen
48Modern
6.6.1.1
Ensure
affected eye is cleansed thoroughly.
Hospital
176
48
Republic of
Yemen 48Modern
48
Hospital
6.6.1.1.1 If medication is indicated, apply first.

6.6.1.1.2 For unconscious patient, moisten the eye patch so as not to irritate
cornea.
6.6.1.2 Apply flat 1 or 2 eye patches (depending on face contour) on the affected
eye with
seam side turned outside.
6.6.1.3 Stick hypoallergenic tape on top of eye patch forming an eye shape with
small tape
overlapped on eye patch edges to hold the tape intact.
6.6.2 Eye Shield (Plastic):
6.6.2.1 Apply eye shield over an affected eye (with or without patch/dressing).
6.6.2.2 Fasten with two strips of transparent tape.
6.6.3 Eye Pressure Dressing:
6.6.3.1 Prepare 8-10 adhesive strips by cutting 2.5cm. (1) in width and 35cm.
(9) length.
6.6.3.2 Apply 2 eye patches to affected eye to prevent skin excoriation.
6.6.3.3 Apply strips from forehead over unpatched eye across dressing to the
cheekbone
(maxillary prominence) to increase bulk pressure while permitting freedom to
move
the head.
6.7 Aftercare of equipment.
6.8 Remove gloves and wash hands.
6.9 Document the following:
6.9.1 date and time of application
6.9.2 observations made
6.9.3 patients tolerance
6.10Charge the procedure and supplies used in the Inpatient Charging Form.
177
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Fall Precautions

CONTENTS: This General Ward policy and procedure serves as a guideline in observing fall
precautions.
1 DEFINITION:
1.1 Fall Precautions - Safety measures observed to protect and prevent patient from
sustaining
accidental fall.
2 PURPOSES:
2.1 To prevent and avoid accidental falls.
2.2 To protect and prevent from further injury.
2.3 To make all staff and family members aware of the enforced precautionary measures.
3 INDICATIONS:
3.1 Conditions stated/mentioned in the Form.
3.1.1 Partial Paralysis
3.1.2 Loss of Limb
3.1.3 Blindness
3.1.4 Deafness
3.1.5 Impaired Mobility
3.1.6 Confusion/Disorientation
3.1.7 Sedation/Anesthesia
3.1.8 Slow Reaction Time
3.1.9 Lack of Coordination
3.1.10 History of Syncope
3.1.11 Convulsion/Seizures
3.1.12 Transient Ischemic Attack (TIA)
3.1.13 Nocturia
3.1.14 70 years or Older
3.1.15 Recent significant blood loss
3.1.16 Previous fall
3.1.17 Other Physical Limitation or Impaired Sensorium
4 POLICIES:
4.1 Every patient is assessed and evaluated immediately upon admission within the
maximum of 3-4
hours after admission.
4.2 Fall/Precautions Sheet Form is filled up and added to patients file as needed.
4.3 Fall/Precautions Remark is written on the Kardex to be known to all staff.
4.4PROCEDURES:
Apply nursing measures as appropriate according to patients condition, indicated
5 in
the Fall
5.1 Admit patient to the room of choice. Assess patients level of consciousness and
Precautions Form.
orientation.
5.2 Orient patient to room facilities, if the condition allows.
5.3 Maintain bedside rails up at all times.
5.4 Ensure that head and footboard of the bed is attached.
5.5 Clip-on call bell cord on bed linen within patients reach.
5.6 Monitor patients activity frequently, as needed.
5.7 Assist patient in ambulation if needed.
178
Republic of
Yemen 48Modern
48
Hospital
5.8 Impose and re-enforce safety nursing measures as indicated and

applicable.
5.9 Proper documentation and endorsement.
5.9.1 Level of consciousness and orientation.
5.9.2 Physical activity status.
5.9.3 Appropriate safety measures applied.
5.9.4 Progress of health condition.
6
6.1 To avoid accidental falls, patients room should be free from clutters.
6.2 Room should be well-lighted during transfers and ambulation.
6.3 Side rails and grab bars must be firmly anchored.
6.4 Clients with orthostatic hypotension should be taught to change position slowly to
allow for blood
7
pressure stabilization.
REFERENCES:
7.1 Fundamentals of Nursing, Human Health and Function, Ruth F. Craven, Constance
Hirnle, pp.
664-665.
179
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Fecal Disimpaction
fecal
disimpaction.
1 DEFINITION:
1.1 Fecal impaction - the retention of hardened feces in the rectum or lower sigmoid
resulting from
prolonged retention and accumulation of stool.
1.2 Disimpaction is a manual (aid of finger) method of evacuating or dislodging hardened
feces in the
rectum.
2 PURPOSE:
2.1 To remove hardened feces in the rectum or lower sigmoid.
3.1 Pregnancy
3.2 After genito-urinary, rectal, perianal, abdominal or gynecological surgery.
3.3 Patients with myocardial infarction, coronary insufficiency, pulmonary embolus,
congestive heart
failure, and heart block.
3.4 Gastro-intestinal or vaginal bleeding.
3.5 Blood dyscrasias.
3.6 Hemorrhoids and rectal polyps.
4.1 Disposable gloves, underpad, apron, mask
4.2 Water soluble lubricant
4.3 Bedpan with cover
4.4 Soap, water, washcloth
4.5 Stethoscope
4.6 Orange bag
4.7 Air freshener (optional)
4.8 Specimen container, if needed
4.9 Thermometer
4.10Sphygmomanometer
5 POLICIES:
5.2 Proper patients identification and vital signs taken as baseline.
5.3 Proper assessment of patients perianal area and auscultation of bowel sound prior
PROCEDURES:
6
to6.1
procedure.
Check doctors order and identify the patient.
5.4Explain
Shouldthe
be done
only ifObtain
extremely
necessary
because of possible complication like
6.2
procedure.
baseline
vital signs.
syncope
and
6.3 Assemble
equipment. Provide privacy.
6.4 tachycardia.
Wash hands. Put on disposable apron, mask, and gloves.
6.5 Position patient on left side with upper knee flexed to permit access to rectum and
lower sigmoid.
6.6 Drape and place underpad under the buttocks.
180
Republic of
Yemen 48Modern
48
Hospital
6.7 Place bedpan near the patient.

6.8 Spray the room with air freshener (optional).
6.9 Lubricate gloved index or middle finger.
6.10Insert gloved finger into the rectum until impaction is felt. Instruct patient to breath
deeply.
6.11Gently remove or break fecal material within reach and put in bedpan.
6.12Manipulate stool mass with your finger breaking the stool into pieces.
6.13Gently stimulate rectal sphincter by making a circular motion once or twice. This
may stimulate
peristalsis and relax the sphincter.
6.14Observe the patient during the procedure for bleeding, pain, and other
complication. If any,
inform the physician.
6.15Offer bedpan to the patient.
6.16Collect specimen, if needed.
6.17Aftercare of equipment.
6.18Remove gloves, mask, and apron and dispose to appropriate receptacle. Wash
hands.
6.19Position patient comfortably and reassess.
6.20.1 Date and time procedure was done.
6.20.2 Significant complication or observations made.
6.20.3 Color, consistency, amount, and odor of stool.
6.20.4 Tolerance to the procedure.
6.21Charge supplies used in the Inpatient Charging Form.
181
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Gastric Lavage

gastric lavage.
1 DEFINITION:
1.1 Gastric Lavage - the method of washing out stomach contents by introducing solution
into the
stomach and withdrawing it back through a nasogastric tube.
2 PURPOSES:
2.1 To empty stomach in case of poisoning.
2.2 To diagnose and arrest gastric hemorrhage.
2.3 To prepare stomach for gastric surgery/endoscopy.
2.4 To relieve persistent vomiting.
2.5 To remove liquid or small particles of material from stomach.
3 INDICATIONS:
3.1 For patient seen within 4 hours of ingesting poison or harmful substance.
3.2 Inadequate gag reflex, (if patient is unconscious and the time of ingestion is
unknown).
3.3 Uncooperative attitude.
3.4 For which vomiting is contraindicated.
3.5 For gastro-intestinal hemorrhage.
4.1 When vomiting can be induced by syrup of Ipecac.
4.2 Ingestion of strong corrosive agents (can cause seizures).
4.3 If there is significant time lapse from ingestion to treatment.
4.4 Excessive fluid more than 300 ml. in adult may result in pushing gastric contents in
duodenum
and increase absorption.
5.1 Gastric tube with large bore
5.2 Tracheal intubation set
5.3 Asepto syringe
5.4 Lavage fluid or other prescribed solution
5.5 O2 tank with O2 devices
5.6 Underpad
5.7 Suction machine and suction catheter
5.8 Container for specimen
5.9 Lubricant (Water - soluble gel)
5.10Gown, gloves, mask and goggles
5.11Cardiac monitor
5.12Stethoscope and sphygmomanometer
5.13Emesis basin
5.14Drainage collection receptacle
5.15Medication as prescribed (usually ATS04)
5.16Connecting tube (Y-connector)
182
5.17Restraints (optional)
5.18Additional pillow
5.19Adhesive tape
Republic of
Yemen 48Modern
Hospital
48
6
POLICIES:
6.1 Obtain physicians order.
6.2 Proper identification of the patient prior to procedure.
6.3 Generally carried out by the doctor and assisted by the nurse except in special area
like ICU, ER
where a registered nurse may carry out the procedure after initial assessment.
6.4 Airway must be secured by intubation prior to procedure, if patient is comatose.
6.5 Ensure patients safety.
6.6 Follow infection control policy.
7
PROCEDURES:
7.1 Explain the procedure to the patient whenever possible.
7.2 Provide privacy, wash hands, wear gloves, gown, and face shield.
7.3 Gather all equipment.
7.3.1 If unconscious, prepare the necessary equipment for intubation at bedside.
7.4 Take vitals signs as baseline, attached to cardiac monitor.
7.5 Remove any dentures, inspect for loose teeth.
7.6 Remove debris or suction vomitus from the buccal cavity.
7.7 Administer medication as prescribed.
7.8 Insert NGT. Refer to Nasogastric Tube Insertion procedure.
7.9 Assist the doctor during the procedure.
7.9.1 Maintain a record of Intake and Output.
7.9.2 Anticipate the needs.
7.9.3 Procedure is done by the doctor until return flow is clear.
7.10Observe the outflow for the color, fragment, and amount.
7.11Suction the buccal cavity throughout the procedure to prevent aspiration.
7.12For ingested poison or drugs, save the specimen for laboratory analysis.
7.12.1 Dilute activated charcoal tablet with saline solution to be administered for
ingested poison
(for absorption of remaining toxic substance).
7.13Observe for complications like:
7.13.1 bradyarrythmias
7.13.2 temperature drop for patient receiving ice saline lavage (gastric bleeding)
7.13.3 aspiration pneumonitis
7.13.4 stomach perforation
7.14Follow procedure for removal of nasogastric tube.
7.16Remove gloves, gown, and face shield. Wash hands.
7.17Documentation of the following:
7.17.1 date and time of lavage
7.17.2 size and type of tube inserted
7.17.3 volume and type of irrigating solution used
7.17.4 volume, color, and consistency of gastric contents drained
7.17.5 vital signs and level of consciousness
7.17.6 drugs instilled through the tube or medication given
7.17.7 duration of the procedure
7.17.8 tolerance and other observations made
7.17.9 outcome of the procedure
7.18Charge
the procedure and supplies used in the Inpatient Charging Form.
8
8.1 Continuous blood pressure and cardiac monitoring should be done as vagal
stimulation from the
tube or gastric distention may cause bradycardia, and many ingested substances
affect the blood
pressure and heart rate (if indicated per doctors order).
8.2 To secure small child, place mummy board183
and protective pad under head.
Republic of
Yemen 48Modern
48
Hospital
8.3 Careful assessment is needed. Specific amount and type of poison ingested must be
taken into
consideration prior to performing the procedure.
184
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL
Title: Gastorostomy/Jejunostomy Feeding

nasogastric
tube feeding.
1 DEFINITION:
1.1 Gastrostomy an opening through the abdominal wall into the stomach.
1.2 Percutaneous Endoscopic Gastrostomy (PEG) feeding catheter inserted into the
stomach
through the skin and subcutaneous tissues of the abdomen.
1.3 Percutaneous Endoscopic Jejunostomy feeding catheter inserted into the jejumon
through the
skin and subcutaneous tissues of the abdomen.
2 PURPOSES:
2.1 To maintain optimal nutritional status by providing adequate amount of all nutrients.
2.2 To preserve the normal sequence of intestinal and hepatic metabolism.
2.3 To maintain fat metabolism and lipoprotein synthesis.
3 INDICATIONS:
3.1 Patient who has dysphagia.
3.2 Oral or esophageal obstruction.
3.3 Trauma.
3.4 Unconscious or intubated patient.
3.5 Patient who had undergone gastro-intestinal tract surgery.
4.1 Patient with absent bowel
sounds
5
4.2 Suspected intestinal obstruction
5.1 Correct amount of feeding solution
4.3 Dysfunctional gag reflex
5.2 Graduated container, to hold the feeding
5.3 Large bulb syringe
5.4 Graduated container with 60 Ml of water, to flush the
tubing
5.5 Graduated container, to measure residual formula
5.6 For a tube sutured in place:
5.6.1 4 x 4 gauze squares, to cover the end of the tube
5.6.2 Elastic band
5.7 For tube insertion:
5.7.1 Clean disposable gloves
5.7.2 Moisture-proof bag
5.7.3 Water-soluble lubricant
5.7.4 18 Fr whistle-tip catheter, or other feeding tube
5.7.5 Tubing clamp
5.8 For cleaning the peristomal skin and dressing the stoma:
5.8.1 Mild soap and water
5.8.2 Petrolatum, zinc oxide ointment, or other skin
protectant
5.8.3 Precut 4 x 4 gauze squares
5.8.4 Uncut 4 x185
4 gauze squares
Republic of
Yemen 48Modern
Hospital
48
Abdominal pads
5.8.5
Abdominal binder or Montgomery 5.8.6
straps
POLICIES:
6
6.1 Administer feeding solution at room temperature.
6.3 Only commercially prepared feeding should be used.
6.4 Keep intake and output record.
7
PREPARATIONS:
7.1 Assess:
7.1.1 For any clinical signs of malnutrition or dehydration
7.1.2 For allergies to any food in the feeding
7.1.3 For the presence of bowel sounds
7.1.4 For any problems that suggest lack of tolerance of previous feedings
7.2 Determine:
7.2.1 Type, amount, and frequency of feedings
7.2.2 Tolerance of previous feedings
7.3.1 Correct amount of feeding solution
7.3.2 Graduated container, to hold the feeding
7.3.3 Large bulb syringe
7.3.4 Graduated container with 60 Ml of water, to flush the tubing
7.3.5 Graduated container, to measure residual formula
7.3.6 For a tube sutured in place:
7.3.6.1 4 x 4 gauze squares, to cover the end of the tube
7.3.6.2 Elastic band
7.3.7 For tube insertion:
7.3.7.1 Clean disposable gloves
7.3.7.2 Moisture-proof bag
7.3.7.3 Water-soluble lubricant
7.3.7.4 18 Fr whistle-tip catheter, or other feeding tube
7.3.7.5 Tubing clamp
7.3.8 For cleaning the peristomal skin and dressing the stoma:
7.3.8.1 Mild soap and water
7.3.8.2 Petrolatum, zinc oxide ointment, or other skin protectant
7.3.8.3 Precut 4 x 4 gauze squares
7.3.8.4 Uncut 4 x 4 gauze squares
7.3.8.5 Abdominal pads
7.3.8.6 Abdominal binder or Montgomery straps
7.3.9 Assist the client to a Fowlers position in bed, or a sitting position in a chair.
7.3.9.1 If a sitting position is contraindicated, a slightly elevated right side-lying
position is
acceptable.
PROCEDURES:
8
cooperate.
8.4 Assess tube placement. Attach the syringe to the open end of the tube, and aspirate
alimentary
secretions. Check the pH.
8.4.1 Allow 1 hour to elapse before testing the pH, if the client has received a
medication.
8.4.2 Use a pH meter rather than pH paper, 186
if the client is receiving a continuous
feeding or if
food coloring has been added to the formula.
Republic of
Yemen 48Modern
Hospital
48
8.5 Insert a feeding tube, if one is not already in place.

8.5.1 Wearing gloves, remove the ostomy dressing. Then discard the dressing and
gloves in the
moisture-proof bag.
8.5.2 Lubricate the end of the tube, and insert it into the ostomy opening 1015 cm
(46 in).
8.6 Check the patency of a tube that is sutured or secured in place.
8.6.1 Determine correct placement of the tube by aspirating secretions and checking
the pH.
8.6.2 Pour 1530 mL of water into the syringe, remove the tube clamp, and allow the
water to
flow into the tube.
8.6.3 If the water does not flow freely, notify the nurse in charge and/or physician.
8.7 Check for residual formula.
8.7.1 Attach the bulb to the syringe, and compress the bulb.
8.7.2 Attach the syringe to the end of the feeding tube, and withdraw and measure
the stomach
or jejunal contents.
8.7.3 Follow agency practice if there is no more than 50 mL of undigested formula.
Hold the
feeding if there is more than 150 mL, and recheck in 34 hours or according to
agency
policy.
8.7.4 For continuous feedings, check the residual every 46 hours, and hold feedings,
according
to agency policy.
8.8 Administer the feeding.
8.8.1 Hold the barrel of the syringe 715 cm (36 in) above the ostomy opening.
8.8.2 Slowly pour the solution into the syringe, and allow it to flow through the tube
by gravity.
8.8.3 Just before all the formula has run through and the syringe is empty, add 30 mL
of water.
8.8.4 If the tube is sutured in place, hold it upright, remove the syringe, and then
clamp or plug
the tube, to prevent leakage.
8.8.5 Cover the end of the tube with a 4 x 4 gauze, and secure the gauze with a
rubber band Percutaneous Endoscopic Gastrostomy (PEG)
8.10Variation:
8.8.6
If a catheter
was
inserted
for the
feeding,
remove
it.
8.10.1
Clean
the stoma
daily
with soap
and
water, using
a cotton
swab or small piece
8.9
Ensure
client
comfort
and
safety.
of gauze in
8.9.1
After the
feeding, ask the client to remain in the sitting position or a slightly
a circular
motion.
elevated
right
8.10.2 Rotate the bolster and clean the skin under it.
lateralthe
position
for
30between
minutes.
8.10.3 Rotate
tube in
a at
fullleast
circle
the thumb and forefinger daily.
8.9.2
Assess
status
of
peristomal
skin.
8.10.4 After cleaning, allow the skin to airdry.
8.9.3
Checkany
orders
about
cleaningpain,
the peristomal
skin, applying
a skin to
protectant,
8.10.5
Report
signs
of redness,
soreness, swelling,
or drainage
the health
and applying
care
appropriate dressings.
provider.
8.9.4
Observe
for acommon
feedings:
aspiration,
8.10.6
Do
not apply
dressingcomplications
over the PEG.ofAenteral
dressing
and tape
may result in skin
hyperglycemia,
excoriation
SPECIAL
CONSIDERATIONS:
9
distention,
diarrhea, and fecal impaction.
andabdominal
breakdown.
9.1assessments
Feeding
is instilled
at an
angle
of 45o so that
air does
enter
8.9.5
When appropriate,
teach
the
how
to administer
feedings
andnot
when
to
8.10.7
Document
all
andclient
interventions.
the stomach.
notify the
health care provider concerning problems.
187
Republic of
Yemen 48Modern
48
Hospital
9.2 Evaluate patients tolerance from tube feeding by checking amount of aspirated
residual every 4
hours, because gastric and intestinal contents can cause injury and necrosis at stoma
site.
10 REFERENCE:
10.1Fundamentals of Nursing concepts, process, and practice 7th
Edition
188
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Glucotest
glucotest.
1 DEFINITION:
1.1 Glucotest - a method or procedure to obtain a blood sample for random blood sugar
using a
glucometer machine.
2 PURPOSES:
2.1 To detect or monitor elevated blood glucose level in-patient with diabetes.
2.2 To obtain quick result of serum glucose level.
2.3 To specify the suitable and effective treatment.
3.1 A tray containing:
3.1.1 Glucometer
3.1.2 Glucostrip
3.1.3 Penlet sampler
3.1.4 Sterile lancet
3.1.5 Small sharp disposable container
3.1.7 Alcohol swabs
3.1.8 Small band aid
3.1.9 Sterile gauze 2 x 2
4 POLICY:
4.1 Follow standard infection control policy.
PROCEDURES:
5
5.1 Verify physicians order.
5.2 Identify correct client.
5.3 Prepare all equipment.
5.4 Set-up the lancet device.
5.4.1 Snap off the clear cap on the lancing device (as if breaking a cracker in half).
5.4.2 Insert a new lancet firmly into the lancet-holder.
5.4.3 Replace the cap until it snaps or clicks into place. Be careful not to touch the
exposed
needle on the lancet.
5.4.4 Look in the window of the lancing device and turn the setting dial to set the
depth level.
Start at 3.
5.4.5 Cock device, by pushing in until clicking sound is heard. You may have already
cocked
the device when you inserted the lancet. Set lancing device aside, proceed to
the next
step.
5.5 Prepare for puncture site.
5.5.1 To bring fresh blood to the surface of the test site, rub the site vigorously for a
few
seconds, until you feel it getting warm.
5.6 Prepare glucometer device.
189 on.
5.6.1 Insert the test strip. The meter will turn
5.6.2 Wait until you see the APPLY SAMPLE message on the meter display screen
BEFORE
Republic of
Yemen 48Modern
48
Hospital
lancing your test site. Set Meter aside proceeds to the next step.
5.7 Fill the Test Strip with Blood
5.7.1 Bring the test strip to the blood sample at a slight angle.
5.7.2 Gently touch only one edge of the test strip to the blood sample on your test
site. The
strip acts like a sponge and pulls the blood into the edge of the test strip.
5.7.3 Do not lift the strip up until you hear the beep or see arrows moving clockwise
on your
meter screen. This means you have enough blood and the meter is reading your
glucose.
5.7.4 The test result is complete when you hear one beep. Your blood glucose test
result is
shown on the display screen.
5.7.5 Inform client his/her blood sugar reading and relay to physician and document
in the file.
5.7.6 Dispose the used lancet in the sharp container. Do after care of the
equipments used.
SPECIAL
6
5.7.7 CONSIDERATIONS:
Remove gloves and wash hands.
6.1
DO
NOT
press
the
test
strip
against
the
test
site.
5.8 Charge the procedure and the supplies used.
6.2 DO NOT scrape the blood.
6.3 DO NOT use the flat side of the test strip.
6.4 The range of the glucometer device is 0-500 mg/dl. Above this range the meter
reads HI.
6.5 Test results below 50 mg/dl indicate low blood glucose. Test results greater than
240 mg/dl
indicate high blood glucose. If the obtained results is below 60 mg/dl or above 240
mg/dl and no
symptoms match the test result, recheck blood sugar. If there are symptoms that
match said result
or if same results were repeatedly obtained, notify the physician.
6.6 Do not use test strips that have passed the expiration date on the package since
they may cause
false results.
6.7 For the above mentioned conditions, RBS is taken in the following interval according
to doctors
order:
6.7.1 Every hour
6.7.2 Every 3 hours
6.7.3 Every 6 hours
6.7.4 Every 12 hours
6.7.5 Every 24 hours
6.8 Test strips automatically pull the sample into the strip.
6.9 Confirmation beep helps eliminate wasted test strips and short sampling.
6.10With clean, dry hands you may gently touch the test strip anywhere.
6.11Target areas are easily identified for clear, hassle-free sample application.
6.12Test strip code is included inside the box.
6.13For clients on hemodialysis, test is done before and after dialysis through the
arterial port of the
extracorporeal circuit.
190
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Hair Care (Routine)

routine
haircare.
1 DEFINITION:
1.1 Hair care is a part of personal hygiene that can be rendered for or by the patient,
which
includes combing, brushing, and shampooing.
2 PURPOSES:
2.1 To stimulate scalp circulation, remove dead cells and debris.
2.2 To distribute hair oil to produce healthy shine.
2.3 To remove dirt, hair oil, and prevent scalp irritation.
2.4 To promote comfort and sense of well-being.
3.1 Patient with cranial injury, recent craniotomy, skull fractures.
3.2 Conditions including intra-cranial pressure monitoring.
4 POLICIES:
4.1 Ensure safety by observing infection control policy.
4.2 Providing privacy is a must.
5.1 Comb and brush
5.2 Plastic sheet or pad
5.3 Two bath towels
5.4 Shampoo basin
5.5 Washcloth or pad
5.6 Bath blanket
5.7 Receptacle for the shampoo water
5.8 Cotton balls (optional)
5.9 Pitcher of water
5.10Bath thermometer
5.11Liquid or cream shampoo
5.12Hair dryer
6 PREPARATIONS:
6.1 Assess:
6.1.1 Condition of the hair and scalp
6.1.2 Evenness of hair growth over the scalp
6.1.3 Self-care abilities
6.1.4 Determine routinely used shampoo products
6.1.5 Any scalp problems
6.1.6 Activity tolerance of the client
6.2 Determine:
6.2.1 History of recent chemotherapy, hypothyroidism, radiation of the head,
unexplained hair
loss, and growth of excessive body hair
6.2.2 Usual hair care practices and routinely
191 used hair care products
Republic of
Yemen 48Modern
Hospital
48
7 PROCEDURES:
7.1 Explain to the
client
what wetting
you are the
going
to will
do, make
why ititisdifficult
necessary,
and how can
6.2.3
Whether
hair
to comb
cooperate.
6.2.4 Whether a physicians order is needed before a shampoo can
7.2 Wash hands
and observe other appropriate infection control procedures.
be given
6.2.5 The type of shampoo to be used
7.4 Position and
prepare
the client
appropriately.
6.2.6
The best
time of
day for the shampoo
7.4.1 Assist the client who can sit to move to a chair. If health permits, assist a client
6.3 Assemble equipment and supplies
confined
to a bed to a sitting position by raising the head of the bed. Otherwise, assist the
client to
alternate side-lying positions, and do one side of the head at a time.
7.4.2 If the client remains in bed, place a clean towel over the pillow and the clients
shoulders.
7.4.3 Place it over the sitting clients shoulders.
7.5 Remove any pins or ribbons in the hair.
7.6 Remove any mats or tangles gradually.
7.6.1 Mats can usually be pulled apart with fingers or worked out with repeated
brushings.
7.6.2 If the hair is very tangled, rub alcohol or an oil, such as mineral oil, on the
strands, to
help loosen the tangles.
7.6.3 Comb out tangles in a small section of hair toward the ends.
7.6.4 Stabilize the hair with one hand, and comb towards the ends of the hair with the
other
hand.
7.7 Brush and comb the hair.
7.7.1 For short hair, brush and comb one side at a time. Divide long hair into two
sections by
parting it down the middle from the front to the back.
7.7.2 If he hair is very thick, divide each section into front and back subsections, or
into
several layers.
7.7.3 Arrange the hair as neatly and attractively as possible, according to the
individuals
desires.
7.8 Document assessments and special nursing interventions.
7.9 Hair Shampoo
7.9.1 Arrange the equipment.
7.9.2 Put the plastic sheet or pad on the bed under the head.
7.9.3 Remove the pillow from under the clients head, and place it under the
shoulders, unless
there is some underlying condition.
7.9.4 Tuck a bath towel around the clients shoulders.
7.9.5 Place the shampoo basin under the head, putting a folded washcloth or pad
where the
clients neck rests on the edge of the basin.
7.9.6 If the client is on a stretcher, the neck can rest on the edge of the sink, with the
washcloth
as padding.
7.9.7 Fanfold the top bedding down to the waist, and cover the upper part of the
client with the
bath blanket.
7.9.8 Place the receiving receptacle on a table or chair at the bedside.
7.9.9 Put the spout of the shampoo basin over the receptacle.
7.10Protect the clients eyes and ears.
7.10.1 Place a damp washcloth over the clients
eyes.
192
7.10.2 Place cotton balls in the clients ears, if indicated.
7.11Shampoo the hair.
7.11.1 Wet the hair thoroughly with the water.
Republic of
Yemen 48Modern
48
Hospital
7.11.2 Apply shampoo to the scalp. Make a good lather with the shampoo while
massaging the
scalp with the pads of your fingertips.
7.11.3 Rinse the hair briefly, and apply shampoo again.
7.11.4 Make a good lather and massage the scalp as before.
7.11.5 Rinse the hair thoroughly this time to remove all the shampoo.
7.11.6 Squeeze as much water as possible out of the hair with your hands.
7.12Dry the hair thoroughly.
7.12.1 Rub the clients hair with a heavy towel.
7.12.2 Dry the hair with the dryer. Set the temperature at warm.
7.12.3 Continually move the dryer to prevent burning the clients scalp.
7.13Ensure client comfort.
7.13.1 Assist the person confined to bed to a comfortable position.
7.13.2 Arrange the hair using a clean brush and comb.
7.14Document the shampoo and any assessments.
8 REFERENCE:
Edition
193
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Handling of Narcotics and Controlled Drugs
CONTENTS: This General Ward policy and procedure serves as a guideline in handling
narcotics and
controlled drugs.
1 DEFINITION:
1.1 Narcotic - is a drug derived from opium or opium-like compounds, with potent
analgesic effects
associated with significant alteration of mood and behavior with potential for
dependence and
tolerance following repeated administration such as Pethidine, Morphine, Fentanyl.
1.2 Controlled drugs are potentially addictive or habit-forming wherein their
manufacture, sale, or
supply is prohibited except in accordance with regulations made under the law.
1.2.1 Example given : Dormicum, Valium, Nubain, Fortal, Tramal, Duragesic and other
drugs ( Xanax, Lexotanil, Ativan, Revotril ) presently calssified by the Saudi
Arabian
Ministry of Health.
1.2.2 These drugs can either be in :
1.2.2.1 Injectable form for IV or IM, intra-spinal, subcutaneous use.
1.2.2.2 Tablet or liquid for oral use and rectal preparation.
2 PURPOSES:
2.1 To prevent misuse and abuse of narcotic and controlled drugs.
POLICIES:
2.2All
To nursing
regulatestations
system must
of issuance
and own
replenishment.
4.1
have their
stock to meet the existing needs of the
2.3 To follow
individual
unit.the standard requirements of MOH in handling narcotics and controlled drugs.
Quantity in stock is documented in the Narcotic/Controlled book.
3.1Narcotic/controlled
Narcotic safety vault
4.2
drugs should not be moved from one unit to another without proper
4
3.2 Logbook
authorization
of Narcotic
designated
narcotic/controlled
drug nurse (assigned by Nursing Director) and
3.3
prescription
(Form M5043)
designated
3.4 Controlled prescription (Form M5043A)
responsible
Pharmacist.
3.5
Information
for Controlled Drugs (Form M1071)
4.3 The storage cabinet is safe, secure, made of steel and with double locks.
4.4 The head nurse (or charge nurse/team leader during HN absence) has full control and
authority of all
stocks of narcotic/controlled drugs kept in her unit.
4.4.1 Only the unit head or charge nurse/team leader on duty should handle
Narcotic/controlled
drug vault key.
4.4.2 The unit Head nurse regulates replacement of the used drugs (as per pharmacy
schedule)
and prepares all prescriptions and empty ampoules ready for collection from
the
Pharmacy.
4.5 All ampoules should be kept safe and fully accounted for (tallying contents inside
the vault
against the logbook record).
194
4.5.1 At the end of each shift, outgoing Charge Nurse must endorse to incoming
Charge
Nurse:
4.5.1.1 Both will physically count the contents of the vault.

4.5.1.2 Any missing ampoule should be informed immediately to Head Nurse,
Nursing
Supervisor, and Narcotic/Controlled Drug Nurse who will inform the
Republic
of
Pharmacist
in
charge.
Yemen
48Modern
48
4.5.1.3 Incident Report must be written on the spot for missing ampoule.
Hospital
4.6 In the event of breakage of ampoule:

4.6.1 Inform immediately the Head Nurse, Nursing Supervisor and Pharmacist in
charge.
4.6.2 Collect broken pieces in a small plastic bag or container in the presence of the
witnesses.
4.6.3 Write an Incident Report signed by Nursing Supervisor on duty and submit to
Pharmacist
in charge.
4.7 In case no stock is available in the vault, the drug is requested through the
computer:
4.7.1 The Head nurse, or in her absence, the charge nurse/team leader will be the
one to collect
them from the pharmacy.
4.7.2 In case none of them is available, the Nursing Supervisor on duty should be
informed to
collect them from the Pharmacy.
4.8 These drugs can only be ordered by a Physician or dentist:
4.8.1 Who are staffs of SGHG and by non-Resident physicians who have the status of
external
doctor to practice medicine within 48 MODERN HOSPITAL.
4.8.2 Having a valid doctors license issued by Ministry of Health, Saudi Arabia.
4.9 Follow standard policies for medication preparation and administration.
4.9.1 The assigned nurse in the presence of Head Nurse or Charge Nurse/Team
Leader should
prepare narcotic/controlled drug after proper checking the doctors order.
4.9.2 Before the drug is given, the nurse who will administer should fill the
Information for
Controlled Drugs (Form M1071) to be given to the Head or Charge nurse, who in
turn
will issue the drug after it is being recorded in the logbook.
4.9.3 Excess medicine from the ampoule should be discarded (to be flushed in the
sink)
witnessed by head or charge nurse/team leader on duty, documented in the
Narcotic/Controlled drug logbook.
4.9.4 Any drug refused by the patient should be reported to the head nurse and
recorded as
Refused in Medication Sheet, Nurses Notes, and Narcotic logbook, then
discard.
4.10Follow rules in filling up Narcotic/Controlled Drug Prescription (Form
M5043/M5043A):
4.10.1 Narcotic/Controlled drug prescription (Form M5043) should be filled up only
by the
head nurse on the same day.
4.10.2 Required information is completely and properly filled up basing on the data
available in
Form M1071. Any missing data makes the form invalid.
4.10.3 No correction/alteration is permitted in the Narcotic/Controlled Drug
prescription
4.10.4 All entries should be written with the same pen and ink color, preferably
black.
4.10.5 Patients full name should be written (at least 3 names), Iqama number/ID
number, place
and date of issuance.
PROCEDURES:
5
4.10.6
oforder
the prescription
as per distribution list mentioned in the
5.1 Check Copies
doctors
and identifyare
thegiven
patient.
form.
5.2
Fill up Information Controlled Drug (Form M1071) and hand-over to the head nurse
4.10.7 A copy is kept by the head nurse attaching empty ampoules to be collected
or charge
bynurse/team
Narcotic
leader, who in turn will record it 195
in the Narcotic Control Logbook and
Nurse for replacement.
issue theControlled
drug.
4.10.8 Prescriptions should be stamped and signed by the prescribing doctor within
24 hours.
4.11In case a controlled drug is prescribed as take home medication, it should be:
4.11.1 Written on the discharge summary
Republic of
Yemen 48Modern
48
Hospital
5.3 Prepare the desired amount of medicine and discard the remaining quantity in the
presence of
head nurse or charge nurse/team leader.
5.4 Hand over the empty ampoules to the head nurse or charge nurse/team leader.
5.5 Have the head nurse or charge nurse/team leader witness the administration of
drug.
5.6 Follow procedures of medication administration.
5.7 Document the following in the nurses notes and medication sheet:
5.7.1 Name of the drug and dose.
5.7.2 Date and time given.
5.7.3 Any adverse reaction observed.
5.7.4 Refusal, if any.
5.8 Charge narcotic/controlled drug used in the Inpatient Charging Form.
5.9 Head nurse (or charge nurse in her absence) shall fill up the form:
5.9.1 Re-check all information for completeness and accuracy of data written in
Form M1071.
5.9.2 Transfer the data from Form M1071 to the Prescription Form M5043 or Form
M5043A.
5.9.3 Use only same pen and ink color, preferably black.
5.9.4 Write neatly and legibly, if possible in block letters.
5.9.5 Get the signature and stamp of the
Prescribing Doctor within 24 hours. 6
REFERENCES:
6.1 Medication Administration, p. 520-521
Craven and Hirnle Fundamentals of Nursing
Human Health and Function, Fourth Edition
6.2 Karrin Johnson, RN

Managing Controlled Substances p. 637-643
Delmars Fundamentals and Advanced Nursing
Skills
196
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Health Assessment
CONTENTS: This General Ward policy and procedure serves as guidelines in performing the
clients
health assessment.
1 DEFINITION:
1.1 Assessment the method of appraising the clients condition that can aid in the
formulation of
nursing diagnosis and patient care planning.
2 PURPOSES:
2.1 To utilize the four methods of physical assessment and health examination.
2.2 To identify the expected outcomes of health assessments.
2.3 To utilize variations in examination techniques appropriate for clients of different
ages.
3 POLICIES:
3.1 Unit staffs should conduct health assessments to all patients admitted in the unit.
3.2 Four (4) methods of examination should be employed inspection, palpation,
percussion, and
auscultation.
3.3
Assessment results are used as the bases in the identification of nursing problems
4 PREPARATIONS:
and4.1
in the
Assessing Appearance and Mental Status
formulation
of to
nursing
carewhat
plan.you are going to do, why it is necessary, and how he
4.1.1 Explain
the client
can
cooperate
4.1.2 Wash hands and observe appropriate infection control procedures.
4.1.3 Provide for client privacy.
4.2 Assessing the Hair
4.2.1 Assemble equipment and supplies:
4.2.2 Clean gloves
4.3 Assessing the Skull and Face
4.3.1 Explain to the client what you are going to do, why it is necessary, and how he
can
cooperate.
4.3.2 Wash hands and observe other appropriate infection control procedures.
4.3.4 Determine clients history of the following:
4.3.5 Any past problems with lumps or bumps, itching, scaling, or dandruff
4.3.6 Any history of loss of consciousness, dizziness, seizures, headache, facial pain,
or injury
4.3.7 When and how any lumps occurred
4.3.8 Length of time any other problem existed
4.3.9 Any known cause of problem
4.3.10 Associated symptoms, treatment, and recurrences
4.4 Assessing the Eye Structure and Visual Acuity
4.4.2 Cotton tip applicator
4.4.3 Examination gloves
4.4.4 Millimeter ruler
197
4.4.5 Penlight
Republic of
Yemen 48Modern
48
Hospital
4.4.6 Snellens or E chart

4.4.7 Opaque card
4.5 Assessing the Ears and Hearing
4.5.2 Otoscope with several sizes or ear specula
4.6 Assessing the Mouth and Oropharynx
4.6.3 Tongue depressor
4.6.4 2 x 2 gauze pads
4.6.5 Flashlight or penlight
4.7 Assessing the Nose and Sinuses
4.7.2 Nasal speculum
4.7.3 Flashlight/penlight
4.8 Assessing the Neck
4.8.1 Explain to the client what you are going to do, why it is necessary, and how
she can
cooperate.
4.8.5 Any problems with neck lumps
4.8.6 Neck pain or stiffness
4.8.7 When and how any lumps occurred
4.8.8 Any previous diagnoses of thyroid problems
4.8.9 Any treatments such as surgery or radiation
4.9 Assessing the Breast and Axillae
4.9.2 Centimeter ruler
4.10Assessing the Abdomen
4.10.2 Examining light
4.10.3 Tape measure (metal or unstretchable cloth)
4.10.4 Water-soluble skin-marking pencil
4.10.5 Stethoscope
4.11Assessing the Nails
4.11.1 Determine client history of the following:
4.11.2 Diabetes mellitus
4.11.3 Peripheral circulatory disease
4.11.4 Previous injury
4.11.5 Severe illness
4.12Assessing the Skin
4.12.2 Millimeter ruler
4.12.4 Magnifying glass
4.13Assessing the Heart and Central Vessels
4.13.2 Stethoscope
4.14Assessing the Thorax and Lungs
198
Republic of
Yemen 48Modern
Hospital
48
4.14.2 Stethoscope
4.14.3 Skin marker/pencil
4.14.6 Family history of illness, including cancer
4.14.7 Allergies
4.14.8 Tuberculosis
4.14.9 Smoking and occupational hazards
4.14.10Any medications being taken
4.14.11Current problems such as swellings, coughs, wheezing, pain
4.15Assessing the Female Genitals and Inguinal Area
4.15.3 Drape
4.15.4 Supplemental lighting, if needed
4.16Assessing the Male Genitals and Inguinal Area
4.17Assessing the Rectum and Anus
4.18Assessing the Musculoskeletal System
4.18.2 Goniometer
4.19Assessing the Peripheral Vascular System
4.19.2 Past history of heart disorders, varicosities, arterial disease, and
hypertension
4.19.3 Lifestyle patterns, specifically exercise patterns, activity patterns,
and tolerance
4.19.4 Smoking habits and use of alcohol
5 PROCEDURES:
5.1 Assessing Appearance and Mental Status
5.1.1 Observe body build, height, and weight in relation to the clients age, lifestyle,
and
health.
5.1.2 Observe the clients posture and gait, standing, sitting, and walking.
5.1.3 Observe the clients overall hygiene and grooming. Relate these to the persons
activities
prior to the assessment.
5.1.4 Note body and breath odor in relation to activity level.
5.1.5 Observe for signs of distress in posture or facial expression.
5.1.6 Note obvious signs of health or illness.
5.1.7 Assess the clients attitude.
5.1.8 Note the clients affect/mood; assess the appropriateness of the clients
responses.
5.1.9 Listen for quantity, quality, and organization of speech.
5.1.10 Listen for relevance and organization of thoughts.
5.1.11 Document findings in the client record.
5.2 Assessing The Hair
can
cooperate.
199
Republic of
Yemen 48Modern
Hospital
48
5.2.5 Recent use of hair dyes, rinses, or curling or straightening preparations

5.2.6 Recent chemotherapy
5.2.7 Presence of disease
5.3 Assessment
5.3.1 Inspect the evenness of growth over the scalp.
5.3.2 Inspect hair thickness or thinness.
5.3.3 Inspect hair texture and oiliness.
5.3.4 Note presence of infections or infestations by parting the hair in several areas
and
checking behind the ears and along the hairline at the neck.
5.3.5 Inspect amount of body hair.
5.4 Assessing the Skull and Face
5.4.1 Inspect the skull for size, shape, and symmetry.
5.4.2 Palpate the skull for nodules or masses and depressions.
5.4.3 Inspect the facial features.
5.4.4 Inspect the eyes for edema and hollowness.
5.4.5 Note symmetry of facial movements.
5.4.6 Ask the client to elevate the eyebrows, frown, or lower the eyebrows, close the
eyes
tightly, puff the cheeks, and smile and show the teeth.
5.5 Assessing the Eye Structure and Visual Acuity
5.5.1 Explain to the client what you are going to do, why it is necessary, and how she
can
cooperate.
5.5.5 Family history of diabetes, hypertension, or blood dyscrasias
5.5.6 Eye disease, injury, or surgery
5.5.7 Last visit to an ophthalmologist
5.5.8 Current use of eye medications
5.5.9 Use of contact lenses or eyeglasses
5.5.10 Hygienic practices for corrective lenses
5.5.11 Current symptoms of eye problems
5.6 External Eye Structures
5.6.1 Inspect the eyebrows for hair distribution and alignment and for skin quality
and
movement.
5.6.2 Inspect the eyelashes for evenness of distribution and direction of curl.
5.6.3 Inspect the eyelids for surface characteristics, position in relation to the
cornea, ability to
blink, and frequency of blinking. Inspect the lower eyelids while the clients eyes
are
closed.
5.6.4 Inspect the bulbar conjunctiva for color, texture, and the presence of lesions.
5.6.5 Inspect the palpebral conjunctiva by everting the lids.
5.6.6 Evert the upper lids if a problem is suspected.
5.6.7 Inspect and palpate the lacrimal gland.
5.6.8 Inspect and palpate the lacrimal sac and nasolacrimal duct.
5.7 Inspect the cornea for clarity and texture.
5.7.1 Ask the client to look straight ahead.
5.7.2 Hold a penlight at an oblique angle to the eye, and move the light slowly
across the
corneal surface.
5.7.3 Perform the corneal sensitivity (reflex)
200 test to determine the function of the
fifth
(trigeminal) cranial nerve.
5.7.4 Ask the client to keep both eyes open and look straight ahead.
Republic of
Yemen
48Modern
48
Approach from behind and beside the client, and lightly touch the cornea
with a
Hospital
corner of
the gauze.
5.7.6 Inspect the anterior chamber for transparency and depth. Use the same
oblique lighting
used when testing the cornea.
5.7.7 Inspect the pupils for color, shape, and symmetry of size.
5.7.5
5.7.8 Assess each pupils direct and consensual reaction to light.
5.7.9 Assess each pupils reaction to accommodation.
5.8 Assessing the Ears and Hearing
can
cooperate.
5.8.5 Family history of hearing problems or loss
5.8.6 Presence of any ear problems
5.8.7 Medication history, especially if there are complaints of ringing in ears
5.8.8 Any hearing difficulty: its onset, factors contributing to it, and how it interferes
with
activities of daily living
5.8.9 Use of a corrective hearing device: when and from whom it was obtained
5.8.10 Position the client comfortably, seated if possible
5.9 Auricles
5.9.1 Inspect the auricles for color, symmetry of size, and position.
5.9.2 Palpate the auricles for texture, elasticity, and areas of tenderness.
5.9.3 External Ear Canal and Tympanic Membrane
5.9.4 Using an otoscope, inspect the external ear canal for cerumen, skin lesions,
pus, and
blood.
5.9.5 Inspect the tympanic membrane for color and gloss.
5.10Gross Hearing Acuity Tests
5.10.1 Assess clients response to normal voice tones. If client has difficulty hearing
the normal
voice, proceed with the following tests.
5.11Perform the watch tick test.
5.11.1 Have the client occlude one ear. Out of the clients sight, place a ticking
watch 23 cm
(12 in) from the unoccluded ear.
5.11.2 Ask what the client can hear. Repeat with the other ear.
5.12Assessing the Mouth and Oropharynx
5.12.2 Routine pattern of dental care
5.12.3 Last visit to dentist
5.12.4 Length of time ulcers or other lesions have been present
5.12.5 Any denture discomfort
5.12.6 Any medications client is receiving
5.12.7 Position the client comfortably, seated if possible.
5.13Lips and Buccal Mucosa
5.13.1 Inspect the outer lips for symmetry of contour, color, and texture.
5.13.2 Ask client to purse the lips as if to whistle.
5.13.3 Inspect and palpate the inner lips and buccal mucosa for color, moisture,
texture, and the
presence of lesions.
5.14Teeth and Gums
5.14.1 Inspect the teeth and gums while examining the inner lips and buccal
mucosa.
5.14.2 Inspect the dentures.
201
5.14.3 Ask client to remove complete or partial dentures. Inspect their condition,
noting in
particular broken or worn areas.
Republic of
Yemen 48Modern
48
Hospital
5.15Tongue/Floor
of the Mouth
5.15.1 Inspect the surface of the tongue for position, color, and texture.
5.15.2 Ask the client to protrude the tongue.
5.15.3 Inspect tongue movement.
5.15.4 Ask the client to roll the tongue upward and move it from side to side.
5.15.5 Inspect the base of the tongue, the mouth floor, and the frenulum.
5.15.6 Ask the client to place the tip of his tongue against the roof of the mouth.
5.15.7 Palpate the tongue and floor of the mouth for any nodules, lumps, or
excoriated areas.
5.15.8 Use a piece of gauze to grasp the tip of the tongue and, with the index finger
of your
other hand, palpate the back of the tongue, its borders, and its base.
5.16Salivary Glands
5.16.1 Inspect salivary duct openings for any swelling or redness.
5.17Palates and Uvula
5.17.1 Inspect the hard and soft palate for color, shape, texture, and the presence of
bony
prominences.
5.17.2 Ask the client to open his mouth wide and tilt his head backward.
5.17.3 Then, depress tongue with a tongue blade as necessary, and use a penlight for
appropriate
visualization.
5.17.4 Inspect the uvula for position and mobility while examining the palates.
5.17.5 To observe the uvula, ask the client to say ah so that the soft palate rises.
5.18Oropharynx and Tonsils
5.18.1 Inspect the oropharynx for color and texture.
5.18.2 Inspect one side at a time to avoid eliciting the gag reflex. To expose one side
of the
oropharynx, press a tongue blade against the tongue on the same side about
halfway back
while the client tilts his head back and opens the mouth wide. Use a penlight for
illumination, if needed.
5.18.3 Inspect the tonsils for color, discharge, and size.
5.18.4 Elicit the gag reflex by pressing the posterior tongue with a tongue depressor.
5.19Assessing the Nose and Sinuses
5.19.2 Allergies
5.19.3 Difficulty breathing through the nose
5.19.4 Sinus infections
5.19.5 Injuries to nose or face
5.19.6 Nosebleeds
5.19.7 Any medications taken
5.19.8 Any changes in sense of smell
5.20Nose
5.20.1 Inspect the external nose for any deviations in shape, size, or color and
flaring, or
discharge from the nares.
5.20.2 Lightly palpate the external nose to determine any areas of tenderness,
masses, and
displacements of bone and cartilage.
5.20.3 Determine patency of both nasal cavities.
5.20.4 Ask the client to close the mouth, exert pressure on one naris, and breathe
through the
opposite naris.
5.20.5 Repeat the procedure to assess patency of the opposite naris.
5.20.6 Inspect the nasal cavities using a flashlight or a nasal speculum.
5.20.7 Observe for the presence of redness,
202swelling, growths, and discharge.
5.20.8 Inspect the nasal septum between the nasal chambers.
5.21Facial Sinuses
5.21.1 Palpate the maxillary and frontal sinuses for tenderness.
Republic of

Yemen 48Modern
48
5.22Assessing the Neck
Hospital
5.22.1 Neck
Muscles
5.22.2 Inspect the neck muscles (sternocleidomastoid and trapezius) for abnormal
swellings or
masses.
5.22.3 Ask the client to hold her head erect.
5.23Observe head movement.
5.23.1 Ask client to:
5.23.2 Move her chin to the chest (determines function of the sternocleidomastoid
muscle).
5.23.3 Move her head back so that the chin points upward (determines function of
the trapezius
muscle).
5.23.4 Move her head so that the ear is moved toward the shoulder on each side
(determines
function of the sternocleidomastoid muscle).
5.23.5 Turn her head to the right and to the left (determines function of the
sternocleidomastoid
muscle).
5.23.6 Assess muscle strength.
5.23.7 Ask the client to:
5.23.8 Turn her head to one side against the resistance of your hand.
5.23.9 Repeat with the other side.
5.23.10 Shrug her shoulders against the resistance of your hands.
5.24Lymph Nodes
5.24.1 Palpate the entire neck for enlarged lymph nodes.
5.25Trachea
5.25.1 Palpate the trachea for lateral deviation.
5.25.2 Place your fingertip or thumb on the trachea in the suprasternal notch, and
then move
your finger laterally to the left and the right in spaces bordered by the clavicle,
the
anterior aspect of the sternocleidomastoid muscle, and the trachea.
5.26Thyroid Gland
5.26.1 Inspect the thyroid gland.
5.26.2 Stand in front of the client.
5.26.3 Observe the lower half of the neck overlying the thyroid gland for symmetry
and visible
masses.
5.26.4 Ask the client to hyperextend her head and swallow. If necessary, offer a glass
of water
to make it easier for the client to swallow.
5.26.5 Palpate the thyroid gland for smoothness.
5.26.6 Note any areas of enlargement, masses, or nodules.
5.26.7 If enlargement of the gland is suspected:
5.26.8 Auscultate over the thyroid area for a bruit.
5.26.9 Use the bell-shaped diaphragm of the stethoscope.
5.26.10Document findings in the client record.
5.27Assessing the Breast and Axillae
5.27.1.1Breast self-examination; technique used and when performed in relation
to the
menstrual cycle
5.27.1.2Breast masses, and what was done about them
5.27.1.3Any pain or tenderness in the breasts and relation to the womans
menstrual cycle
5.27.1.4Any discharge from the nipple
5.27.1.5Medication history
5.27.1.6Estrogen replacement therapy 203
5.27.1.7Alcohol consumption
5.27.1.8High-fat diet
5.27.1.9Obesity
5.27.1.10Use
Republic
of oral
ofcontraceptive
5.27.1.11Menarche before age 12
Yemen 48Modern
48
5.27.1.12Menopause after age 55
Hospital
5.27.1.13Pregnancy
after age 30
5.27.2 Inspect the breasts for size, symmetry, and contour or shape while the client
is in a sitting
position.
5.27.3 Inspect the skin of the breast for localized discolorations or
hyperpigmentation, retraction
or dimpling, localized hypervascular areas, swelling, or edema.
5.27.4 Emphasize any retraction by having the client:
5.27.5 Raise the arms above the head
5.27.6 Push the hands together, with elbows flexed
5.27.7 Press the hands down on the hips
5.27.8 Inspect the areola area for size, shape, symmetry, color, surface
characteristics, and any
masses or lesions.
5.27.9 Inspect the nipples for size, shape, position, color, discharge, and lesions.
5.27.10Palpate the axillary, subclavicular, and supraclavicular lymph nodes.
5.27.11The client is seated with the arms abducted and supported on the nurses
forearm.
5.27.12Use the flat surfaces of all fingertips to palpate the four areas of the axilla:
5.27.12.1The edge of the greater pectoral muscle along the anterior axillary line
5.27.12.2The thoracic wall in the midaxillary area
5.27.12.3The upper part of the humerus
5.27.13The anterior edge of the latissimus dorsi muscle along the posterior axillary
line
5.27.14Palpate the breast for masses, tenderness, and any discharge from the
nipples.
5.27.15Palpate the areola and the nipples for masses.
5.27.16Compress each nipple to determine the presence of any discharge.
5.27.17If discharge is present, milk the breast along its radius to identify the
dischargeproducing lobe.
5.27.18Assess any discharge for amount, color, consistency, and odor.
5.27.19 Note any tenderness on palpation.
5.27.20Teach the client the technique of breast self-examination.
5.28Assessing the Abdomen
5.28.1.1Incidence of abdominal pain: its location, onset, sequence, and
chronology; its
quality (description); its frequency; associated symptoms
5.28.1.2Bowel habits
5.28.1.3Incidence of constipation or diarrhea
5.28.1.4Change in appetite
5.28.1.5Food intolerances
5.28.1.6Foods ingested in last 24 hours
5.28.1.7Specific signs and symptoms
5.28.1.8Previous problems and treatment
5.28.2 Assist the client to a supine position, with the arms placed comfortably at the
sides.
5.28.3 Place small pillows beneath the knees and the head to reduce tension in the
abdominal
muscles.
5.28.4 Expose only the clients abdomen from chest line to the pubic area to avoid
chilling and
shivering, which can tense the abdominal muscles.
5.28.5 Inspection of the Abdomen
5.28.6 Inspect the abdomen for skin integrity.
5.28.7 Inspect the abdomen for contour and 204
symmetry.
5.28.8 Observe the abdominal contour while standing at the clients side when the
client is
supine.
Republic of
Yemen 48Modern
48
5.28.9 AskHospital
the client to take a deep breath and to hold it.
5.28.10Assess the symmetry of contour while standing at the foot of the bed.
5.28.11 If distention is present, measure the abdominal girth by placing a tape
around the
abdomen at the level of the umbilicus.
5.28.12Observe abdominal movements associated with respiration, peristalsis, or
aortic
pulsations.
5.28.13Observe the vascular pattern.
5.28.14Auscultation of the Abdomen
5.28.15Auscultate the abdomen for bowel sounds, vascular sounds, and peritoneal
friction rubs.
5.28.16Percussion of the Abdomen
5.28.17Percuss several areas in each of the four quadrants to determine presence of
tympany and
dullness.
5.28.18Use a systematic pattern: Begin in the lower left quadrant, then proceed to
the lower right
quadrant, the upper right quadrant, and the upper left quadrant.
5.28.19Percussion of the Liver
5.28.19.1Percuss the liver to determine its size.
5.28.20Palpation of the Abdomen
5.28.20.1Perform light palpation first to detect areas of tenderness and/or muscle
guarding.
5.28.20.2Systematically explore all four quadrants.
5.28.20.3Perform deep palpation over all four quadrants.
5.28.21Palpation of the Liver
5.28.21.1Palpate the liver to detect enlargement and tenderness.
5.28.22Palpation of the Bladder
5.28.22.1Palpate the area above the pubic symphysis if the clients history
indicates possible
urinary retention.
5.29Assessing the Nails
5.29.1 Assessment
5.29.2 Inspect fingernail plate shape to determine its curvature and angle.
5.29.3 Inspect fingernail and toenail texture.
5.29.4 Inspect fingernail and toenail bed color.
5.29.5 Inspect tissues surrounding nails.
5.29.6 Perform blanch test of capillary refill.
5.30Assessing the Skin
5.30.1.1Pain or itching
5.30.1.2Presence and spread of any lesions, bruises, abrasions, or pigmented
spots
5.30.1.3Previous experience with skin problems
5.30.1.4Associated clinical signs
5.30.1.5History of problems in other family members
5.30.1.6Related systemic conditions
5.30.1.7Use of medications, lotions, home remedies
5.30.1.8Excessively dry or moist feel to the skin
5.30.1.9Tendency to bruise easily
5.30.1.10Any association of the problem to season of year
5.30.2 Inspect skin color.
5.30.3Inspect uniformity of skin color.
5.30.4 Assess edema, if present
5.30.5 Inspect, palpate, and describe skin lesions. Apply gloves if lesions are open or
draining.
205
5.30.6 Observe and palpate skin moisture.
5.30.7 Palpate skin temperature.
5.30.8 Compare the two feet and the two hands, using the backs of your fingers.
5.30.9 Note skin turgor.

5.30.10Document findings in the client record. Draw location of skin lesions on body
surface
diagrams.
Republic
of and Central Vessels
5.31Assessing
the Heart
5.31.1
Determine
clients history of the following:
Yemen
48Modern
48
5.31.1.1Family history of incidence and age of heart disease, high cholesterol
Hospital
levels, high
blood pressure, stroke, obesity, congenital heart disease, arterial disease,
hypertension, and rheumatic fever
5.31.1.2Clients past history of rheumatic fever, heart murmur, heart attack,
varicosities, or
heart failure
5.31.1.3Present symptoms indicative of heart disease
5.31.1.4Presence of diseases that affect heart
5.31.1.5Lifestyle habits that are risk factors for cardiac disease
5.31.2 Simultaneously inspect and palpate the precordium for the presence of
abnormal
pulsations, lifts, or heaves.
5.31.3 Inspect and palpate the aortic and pulmonic areas, observing them at an angle
and to the
side, to note the presence or absence of pulsations.
5.31.4 Inspect and palpate the tricuspid area for pulsations and heaves or lifts.
5.31.5 Inspect and palpate the apical area for pulsation, noting its specific location (it
may be
displaced laterally or lower) and diameter.
5.31.6 If displaced laterally, record the distance between the apex and the MCL in
centimeters.
5.31.7 Inspect and palpate the epigastric area at the base of the sternum for
abdominal aortic
pulsations.
5.31.8 Auscultate the heart in all four anatomic sites: aortic, pulmonic, ricuspid, and
apical
(mitral).
5.31.9 Carotid Arteries
5.31.9.1Palpate the carotid artery.
5.31.9.2Use extreme caution.
5.31.9.3Auscultate the carotid artery.
5.31.10Jugular Veins
5.31.10.1Inspect the jugular veins for distention.
5.31.10.2The client is placed in a semi- Fowlers position, with the head supported
on a
small pillow.
5.31.10.3If jugular distention is present, assess the jugular venous pressure (JVP).
5.31.10.4Locate the highest visible point of distention of the internal jugular vein.
5.31.10.5 Measure the vertical height of this point in centimeters from the sternal
angle.
5.31.10.6 Repeat the steps above on the other side.
5.31.10.7Document findings in the client record.
5.32Assessing the Thorax and Lungs
5.32.1 Posterior Thorax
5.32.1.1Inspect the shape and symmetry of the thorax from posterior and lateral
views.
5.32.1.2Inspect the spinal alignment for deformities.
5.32.1.3Have the client stand. From a lateral position, observe the three normal
curvatures:
cervical, thoracic, and lumbar.
5.32.1.4 To assess for lateral deviation of spine (scoliosis), observe the standing
client from
the rear. Have the client bend forward at the waist and observe from behind.
5.32.1.5Palpate the posterior thorax.
5.32.1.6For clients who have no respiratory complaints, rapidly assess the
temperature and
integrity of all chest skin.
206 complaints, palpate all chest areas for
5.32.1.7For clients who do have respiratory
bulges,
tenderness, or abnormal movements.
5.32.1.8Avoid deep palpation for painful areas, especially if a fractured rib is
suspected.
5.32.1.9Palpate the posterior chest for respiratory excursion.

5.32.1.10Place
Republicthe
ofpalms of both your hands over the lower thorax, with your
thumbs
Yemen
48Modern
48
adjacent to the spine and your fingers stretched laterally.
Hospital
of
5.32.1.11Ask
the client to take a deep breath while you observe the movement
your
hands and any lag in movement.
5.32.1.12Palpate the chest for vocal (tactile) fremitus.
5.32.1.13Place the palmar surfaces of your fingertips or the ulnar aspect of your
hand or
closed fist on the posterior chest, starting near the apex of the lungs.
5.32.1.14Ask the client to repeat such words as blue moon or one, two, three.
5.32.1.15 Repeat the two steps, moving your hands sequentially to the base of the
lungs.
Compare the fremitus on both lungs and between the apex and the base of
each lung,
either 1) using one hand and moving it from one side of the client to the
corresponding area on the other side or 2) using two hands that are placed
simultaneously on the corresponding areas of each side of the chest.
5.32.1.16Percuss the thorax.
5.32.1.17Percuss for diaphragmatic excursion.
5.32.1.18Auscultate the chest using the flatdisc diaphragm of the stethoscope.
5.32.1.19Use the systematic zigzag procedure used in percussion.
5.32.1.20Ask the client to take slow, deep breaths through the mouth.
5.32.1.21Listen at each point to the breath sounds during a complete inspiration
and
expiration.
5.32.1.22Compare findings at each point with the corresponding point on the
opposite side
of the chest.
5.32.2 Anterior Thorax
5.32.2.1Inspect breathing patterns.
5.32.2.2Inspect the costal angle and the angle at which the ribs enter the spine.
5.32.2.3Palpate the anterior chest.
5.32.2.4Palpate the anterior chest for respiratory excursion.
5.32.2.5Place the palms of both your hands on the lower thorax, with your fingers
laterally
along the lower rib cage and your thumbs along the costal margins.
5.32.2.6Ask the client to take a deep breath while you observe the movement of
your hands.
5.32.2.7Palpate tactile fremitus in the same manner as for the posterior chest.
5.32.2.8If the breasts are large and cannot be retracted adequately for palpation,
this part of
the examination is usually omitted.
5.32.2.9Percuss the anterior chest systematically.
5.32.2.10Begin above the clavicles in the supraclavicular space, and proceed
downward to
the diaphragm.
5.32.2.11Compare one side of the lung to the other.
5.32.2.12 Displace female breasts for proper examination.
5.32.2.13Auscultate the trachea.
5.32.2.14Auscultate the anterior chest.
5.32.2.15Use the sequence used in percussion, beginning over the bronchi
between the
sternum and the clavicles.
5.33Assessing the Female Genitals and Inguinal Area
5.33.1.1Determine clients history of the following:
5.33.1.2Age at onset of menstruation
5.33.1.3Last menstrual period (LMP)
5.33.1.4Regularity of cycle, duration, amount of daily flow, and whether
menstruation is
207
painful
5.33.1.5Incidence of pain during intercourse
5.33.1.6Vaginal discharge
5.33.1.7Number of pregnancies
5.33.1.8Number of live births
5.33.1.9Labor
Republicorof
delivery complications
5.33.1.10Urgency and frequency of urination at night
Yemen
48Modern
48
5.33.1.11Blood in urine
Hospital urination
5.33.1.12Painful
5.33.1.13Incontinence
5.33.1.14History of sexually transmitted disease, past and present
5.33.1.15Position the client supine with feet elevated on the stirrups of an
examination
table.
5.33.1.16Alternately, assist the client into the dorsal recumbent position with
knees flexed
and thighs externally rotated.
5.33.2 Inspect the distribution, amount, and characteristics of pubic hair.
5.33.3 Inspect the skin of the pubic area for parasites, inflammation, swelling, and
lesions.
5.33.4 To assess pubic skin adequately, separate the labia majora and labia minora.
5.33.5 Inspect the clitoris, urethral orifice, and vaginal orifice when separating the
labia minora.
5.33.6 Palpate the inguinal lymph nodes.
5.34Assessing the Male Genitals and Inguinal Area
5.34.1.1Usual voiding patterns and any changes, bladder control, urinary
incontinence,
frequency, or urgency
5.34.1.2Abdominal pain
5.34.1.3Any symptoms of sexually transmitted disease
5.34.1.4Any swellings that could indicate presence of hernia
5.34.1.5Family history of nephritis, malignancy of the prostate, or malignancy of
the
kidney.
5.34.2 Pubic Hair
5.34.2.1Inspect the distribution, amount, and characteristics of pubic hair.
5.34.3 Penis
5.34.3.1Inspect the penile shaft and glans penis for lesions, nodules, swellings,
and
inflammation.
5.34.3.2Inspect the urethral meatus for swelling, inflammation, and discharge.
5.34.3.3Compress or ask the client to compress the glans slightly to open the
urethral
meatus to inspect it for discharge.
5.34.3.4 If the client has reported a discharge, instruct the client to strip the penis
from the
base to the urethra.
5.34.3.5Palpate the penis for tenderness, thickening, and nodules.
5.34.3.6Use your thumb and first two fingers.
5.34.4 Scrotum
5.34.4.1Inspect the scrotum for appearance, general size, and symmetry.
5.34.4.2To facilitate inspection of the scrotum during a physical examination, ask
the client
to hold the penis out of the way.
5.34.4.3Inspect all skin surfaces by spreading the rugated surface skin and lifting
the
scrotum as needed to observe posterior surfaces.
5.34.4.4Palpate the scrotum to assess status of underlying testes, epididymis,
and spermatic
cord. Palpate both testes simultaneously for comparative purposes.
5.34.5 Inguinal Area
5.34.5.1Inspect both inguinal areas for bulges while the client is standing, if
possible.
5.34.5.2First, have the client remain at 208
rest.
5.34.5.3Next, have the client hold his breath and strain or bear down, as though
having a
bowel movement.
or
5.34.5.4Palpate
Republic hernias.
of
Yemen 48Modern
48
5.34.6 Assessing the Rectum and Anus
Hospital
5.34.6.1Determine
clients history of the following:
5.34.6.2History of bright blood in stools, tarry black stools, diarrhea, constipation,
abdominal pain, excessive gas, hemorrhoids, or rectal pain
5.34.6.3Family history of colorectal cancer
5.34.6.4When last stool specimen for occult blood was performed, and the results
5.34.6.5For males, if not obtained during the genitourinary examination, any signs
symptoms of prostate
5.34.7 Position the client.
5.34.8 In adults, a left lateral or Sims position with the upper leg acutely flexed is
required for
the examination.
5.34.9 For females: a dorsal recumbent position with hips externally rotated and
knees flexed or
a lithotomy position may be used.
5.34.10For males: a standing position while the client bends over the examining
table may also
be used.
5.34.11Inspect the anus and surrounding tissue for color, integrity, and skin lesions
5.34.12Then, ask the client to bear down as though defecating.
5.34.13Describe the location of all abnormal findings in terms of a clock, with the12
oclock
position toward the pubic symphysis.
5.34.14Palpate the rectum for anal sphincter tonicity, nodules, masses, and
tenderness.
5.34.15On withdrawing the finger from the rectum and anus, observe it for feces.
5.35Assessing the Musculoskeletal System
5.35.1.1History or presence of muscle pain: onset, location, character, associated
phenomena, and aggravating and alleviating factors
5.35.1.2Any limitations to movement or inability to perform activities of daily
living
5.35.1.3Previous sports injuries
5.35.1.4Any loss of function without pain
5.35.2 Muscles
5.35.2.1Inspect the muscles for size.
5.35.2.2Compare each muscle on one side of the body to the same muscle on the
other side.
5.35.2.3For any apparent discrepancies, measure the muscles with a tape.
5.35.2.4Inspect the muscles and tendons for contractures.
5.35.2.5Inspect the muscles for fasciculations and tremors.
5.35.2.6Inspect any tremors of the hands and arms by having the client hold the
arms out in
front of the body.
5.35.2.7Palpate muscles at rest to determine muscle tonicity.
5.35.2.8Palpate muscles while the client is active and passive for flaccidity,
spasticity, and
smoothness of movement.
5.35.2.9Test muscle strength. Compare the right side with left side.
5.35.3 Bones
5.35.3.1Inspect the skeleton for normal structure and deformities.
5.35.3.2Palpate the bones to locate any areas of edema or tenderness.
5.35.4 Joints
5.35.4.1Inspect the joint for swelling.
5.35.4.2Palpate each joint for tenderness, smoothness of movement, swelling,
crepitation,
and presence of nodule
209
5.35.4.3Assess joint range of motion.
5.35.4.4Ask the client to move selected body parts. If available, use a goniometer
to
Republic of
Yemen 48Modern
48
Hospital
measure the angle of the joint in degrees.

5.36Assessing the Peripheral Vascular System
5.36.1 Peripheral Pulses
5.36.1.1Palpate the peripheral pulses (except the carotid pulse) on both sides of
the clients
body individually, simultaneously, and systematically to determine the
symmetry of
pulse volume.
5.36.1.2If you have difficulty palpating some of the peripheral pulses, use a
Doppler
ultrasound probe.
5.36.2 Peripheral Veins
5.36.2.1Inspect the peripheral veins in the arms and legs for the presence and/ or
appearance
of superficial veins when limbs are dependent and when limbs are elevated.
5.36.2.2Assess the peripheral leg veins for signs of phlebitis.
5.36.3 Peripheral Perfusion
5.36.3.1Inspect the skin of the hands and feet for color, temperature, edema, and
skin
6 REFERENCES:
changes.
5.36.3.2Assess the adequacy of arterial flow if arterial insufficiency is suspected.
Edition
210
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL

Title: Heparin Administration

CONTENTS: This General Ward policy and procedure serves as a guideline in Heparin
administration.
1 DEFINITION:
1.1 Heparin Administration - a therapeutic administration of an anticoagulant that
inhibits the
formation of fibrin.
2 PURPOSES:
2.1 To prevent the development of venous thromboembolism and initiate rapid
anticoagulant action
for the patient undergoing surgery and other invasive procedures.
2.2 It serves as secondary prophylaxis to prevent the expansion of an existing
embolism.
2.3 To minimize the risk of venous thromboembolism for bedridden patient.
3 INDICATIONS:
3.1 Venous thrombosis, thrombophlebitis
3.2 Pulmonary embolism
3.3 Patient susceptible to embolism
3.4 Coronary occlusion with myocardial infarction
3.5 Stroke caused by emboli or cerebral thrombi
3.6 Persistent leg edema secondary to heart failure
3.7 For elderly patients with a hip fracture which may result in lengthy immobilization.=
4.1 Patients with genito-urinary, gastrointestinal or respiratory bleeding.
4.2 Liver and kidney insufficiency diseases.
4.3 For impending surgery of eye, spinal cord, and brain.
4.4 Patients with hemophilia, aneurysm or blood dyscrasias.
4.5 Those who are hypersensitive to heparin.
4.6 Those who are severely hypertensive and those with visceral malignancies.
4.7 Severe diabetes, infection or severe traumatic condition.
4.8 Recent cerebro-vascular hemorrhage.
4.9 Alcoholism.
5
4.10Open ulcerative wounds.
5.1 Subcutaneous:
A tray containing
4.11Patients whose occupation
involves a significant
hazard for injury.
5.1.1 Heparin:
4.12Patients who are not cooperative.
5.1.1.1 Multi-dose vial
5.1.1.2 Pre-filled single dose
5.1.2 Tuberculin or insulin syringe with fine gauge
needle
5.1.3 Alcohol swabs
5.1.4 Band aid
5.1.5 Small sharp container
5.2 Intravenous via Infusion Pump:
5.2.1 Perfusor machine
5.2.2 Perfusor syringe
211
Republic of
Yemen 48Modern
48
Hospital
Perfusor tubing 5.2.3
Disposable gloves5.2.4
5.2.5
Blue pads
Alcohol pad
5.2.6
5.2.7
Syringe with needle
NSS 500cc
5.2.8
5.2.9
IV Tray
6
POLICIES:
6.2 Observe 7 rights of medication administration.
6.3 Follow strict aseptic technique.
6.4 Have a senior nurse double check the prepared dose.
PROCEDURES:
6.5
the site of injection for subcutaneous administration.
7.1 Rotate
Subcutaneous:
6.6 7.1.1
Prior Check
to administration,
clotting
profilesthe
should
be obtained
doctors order
and identify
correct
patient. to detect bleeding
tendencies
and
7.1.2 Assess patients condition. Check vital signs and coagulation profile as
Protamine Sulphate should be available as antidote.
baseline.
7.1.3 Wash hands. Verify medication label (including expiry date) with doctors
7
order and
medication record.
7.1.4 Withdraw the prescribed dose from multi-dose vial after double-checked by a
senior
nurse.
7.1.5 Change needle preferably gauge 25 or according to the amount of underlying
tissues.
7.1.6 Place in the injection tray the prepared medicine, alcohol pad, band aid, and
small sharp
container and bring to patients bedside.
7.1.7 Identify the correct patient by calling his/her name and checking the ID band.
7.1.8 Provide privacy and explain the procedure.
7.1.9 Select and assess the site of injection.
7.1.9.1 Common site is the fatty area anterior to either iliac crest.
7.1.9.2 Other sites:
7.1.9.2.1 Outer posterior aspect of upper arm.
7.1.9.2.2 Abdomen from below the coastal margin to the iliac crest.
7.1.9.2.3 Anterior aspect of the thigh.
7.1.9.2.4 Scapular areas of the upper back.
7.1.9.2.5 Upper ventral or dorsal gluteal area.
7.1.10 Position to expose the site of injection.
7.1.11 Cleanse the area gently with alcohol pad. Do not rub.
7.1.12 Form a fat roll by gently grasping skin at the selected site without pinching
the tissue.
7.1.13 Hold the shaft of the syringe in dart fashion and insert needle directly to the
skin at 4590o angle depending on the amount of tissue grasped (thin tissue 45 o, fatty
tissue 90o).
7.1.14 Move right hand into position to direct plunger without aspirating.
7.1.15 Firmly push plunger down as far as it will go.
7.1.16 After injection, withdraw the needle gently at the same angle at which it
entered
releasing skin roll upon withdrawal of needle.
7.1.17 Press an alcohol pad to the site for 6-10 seconds. Do not rub or massage the
area and
instruct patient not to do the same.
7.1.18 Place patient in comfortable position.
212
7.1.19 Dispose syringe and needle in the sharp container.
7.1.20 Wash hands.
7.1.21 Observe patient for abnormality and notify the treating doctor, if any.
Republic of
Yemen 48Modern
48
Hospital

7.1.22.1date and time
7.1.22.2dose
7.1.22.3site
7.1.22.4observations made
7.1.22.5tolerance to the procedure
7.1.23 Charge the procedure and supplies used in the Charging Form.
7.2 Intravenous via Infusion Pump:
7.2.1 Check doctors order and identify correct patient.
7.2.2 Assess patients condition. Check vital signs and coagulation profile as
baseline.
7.2.3 Verify medication label (including expiry date) with doctors order and
medication
record.
7.2.4 Wash hands.
7.2.5 Prepare the heparin in the perfusor syringe diluted with NSS according to
doctors
order, counter-checked by a senior nurse. Label syringe.
7.2.6 Remove the needle and connect perfusor tubing.
7.2.7 Push the plunger slowly to fill the tubing with heparin and to expel the air.
7.2.8 Program the perfusor machine to the desired rate.
7.2.9 Insert the perfusor syringe to the machine and recheck the pre-programmed
rate.
7.2.10 Bring the machine to patients bedside. Place out of patients reach and plug
to the
electric socket ensuring correct voltage.
7.2.11 Explain the procedure.
7.2.12 Wash hands and put on gloves.
7.2.13 Place blue sheet under the arm with cannula or to the site that will be used
for insertion.
7.2.14 Check for patency of the cannula, if patent, connect the tubing and start the
machine,
calibrate according to doctors order.
7.2.15 If cannula is not patent, remove and insert another cannula. Refer to IV
Cannula
Insertion Procedure (GW-084).
7.2.16 Ensure that the system is working properly, exact dosage, no leak, no kinks
before
leaving the room.
7.2.17 Instruct the patient not to manipulate the machine.
7.2.18 Educate the patient regarding the following:
7.2.18.1Importance of bed rest.
7.2.18.2Elevation of affected extremity.
7.2.18.3Applying elastic stockings.
7.2.18.4To report for any possible signs of bleeding like change in color of urine
and stool
8
or unusual bleeding
fromas
any
part
of the body.
8.1 Be alert
drug
interaction
can alter the effect of anti7.2.19 Remove gloves
and wash hands.
coagulant.
7.2.20 Document the8.2
following:
Notify the physician if patient is pregnant.
7.2.20.1Date and time started
7.2.20.2Dosage
7.2.20.3Health-teachings imparted and observations made
7.2.20.4Tolerance to procedure.
7.3 Charge the procedure and supplies used in the Charging Form.
213
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Height and Weight Measurement

CONTENTS: This General Ward policy and procedure serves as a guideline in taking height
and weight
measurements.
1 DEFINITION:
1.1 Height is the vertical measurement of the patients physical length expressed in feet
or
centimeter.
1.2 Weight is a unit of mass expressed in pound (lb.) or kilogram (kg.).
2 PURPOSES:
2.1 Essential for calculating dosage of drugs, anesthetics, and radio-opaque dyes for xrays.
2.2 Assessing nutritional status.
2.3 Necessary for patient receiving sodium retaining medications or diuretics.
3.1 Standing height and weighing scale
3.2 Electric chair or bed weighing scale
4 POLICIES:
4.1 Ensure correct balanced calibration of the scale.
4.2 Maintain accuracy while measuring.
PROCEDURES:
5
4.3Explain
Take height
and weight
every patient on admission, and as required.
5.1
procedure
to the of
patient.
4.4
It
should
be
measured
at
the
same
time
daily
using
the
same
scale,
if
possible.
5.2 Calibrate and adjust to zero prior to taking weight and height.
5.3 Instruct patient to remove slippers/shoes and other heavy objects to ensure
measurement
accuracy.
5.4 Measure as follows:
5.4.1 Weight
5.4.1.1 Using standing weighing scale:
5.4.1.1.1 Let patient to stand on standing weighing scale.
5.4.1.1.2 Adjust weighing anchor indictor from zero to the last number
where it is
well balanced.
5.4.1.1.3 Note weight measurement where the indicator is pointed when it
attains its
balance.
5.4.1.2 Using electronic chair weighing scale:
5.4.1.2.1 Let patient to sit on electronic chair weighing scale.
5.4.1.2.2 Ensure electric power is on.
5.4.1.2.3 Note weight measurement on the figure shown on the LCD (Liquid
Crystal
Display).
5.4.1.3 Using bed weighing scale for non-ambulatory patient:
5.4.1.3.1 Follow falls precaution to ensure patients safety.
5.4.1.3.2 Place on the canvas of the bed weighing scale.
5.4.1.3.3 Secure and fasten belts. 214
5.4.1.3.4 Ensure electric power is on.
5.4.1.3.5 Elevate bed-weighing scale in a way that the patient is lifted from
bed.
Republic of
Yemen 48Modern
48
Hospital
5.4.1.3.6 Take weight measurement as shown on LCD.

5.4.1.4 Using baby weighing scale:
5.4.1.4.1 Switch on the scale with start button.
5.4.1.4.2 Remove the blanket and clothes of the baby.
5.4.1.4.3 Place the baby gently on the scale - the weight is displayed.
5.4.1.4.4 Press the hold button and the weight is stored.
5.4.1.5 Height
5.4.1.5.1 Let patient stand straight on height scale.
5.4.1.5.2 Extend measuring bar upward until it reaches the top level of
patients
head.
5.4.1.5.3 Note height on the number indicated on the scale.
5.4.1.5.4 Document height and weight measurements.
215
Republic of
Yemen 48Modern
4 POLICIES:
48
Hospital
48 MODERN HOSPITAL
Title: High Risk Medications
CONTENTS: This General Ward policy and procedure deals with the guidelines and
precautionary
measures in the administration of medications that are considered high-risk or
dangerous.
1 DEFINITIONS:
1.1 High-Risk Medications
1.1.1 According to the Drug drugs with low therapeutic index and limited range of
safety;
borderline effect as therapeutic or toxic.
1.1.2 According to the Situation drugs administered during critical or high-risk
situations.
1.1.2.1 cardiac arrest
1.1.2.2 respiratory failure
1.1.2.3 convulsions
1.1.2.4 bronchial asthma
1.1.2.5 hypotension
1.1.2.6 bradycardia
1.1.2.7 hypertensive encephalopathy
1.1.2.8 hypoxia
1.1.2.9 acute coronary syndrome
2 PURPOSES:
2.1 To observe precautionary and safety measures in the administration of drugs
considered high
risks.
2.2 To ensure that the action of the drug does not cause harmful side effects.
3.1 infusion pumps
3.2 syringe pumps
3.3 infusomat
3.4 perfusor syringe
3.5 perfusor tubing
3.6 extension set
3.7 cardiac monitor
3.8 syringes
3.9 needles
3.10alcohol swab
3.11peripheral cannula
3.12central cannula
3.13oximeter
3.14capnograph
3.15pressure gauge for arterial and CVP cannulae
4.1 All medications identified as high risks or dangerous via hospital policy should not be
administered by nurses alone.
216
Republic of
4.1.1 High-risk medications should be administered by the physician.

Yemen
4.1.2
If nurses 48Modern
necessitate to administer the medication, he/she should be 48
under
the strict
Hospital
217
Republic of
supervision of the physician; or
Yemen
48Modern
48
4.1.3 For competent nurses, prior to administration, two (2) nurses, to prevent
commissionHospital
of
errors, should check and double-check with each other for dosage calculation of
the
medication; and both nurses sign.
4.1.4 Infusion pumps or perfusor syringe should be used when administering IV
high-risk
medications to ensure that it is regulated and delivered to the patient
accurately.
4.1.5 All high-risk medications should be labeled.
4.2 Basic safety precautions in medication preparation and administration according to
the hospital
policy should be observed at all times.
4.2.1 Medication storage areas should be locked at all times except when nurses are
preparing
medications.
4.2.2 Medication preparation area should be well lit, clean, and located preferably in
a closed
area to avoid distraction.
4.3 Patients vital signs should be monitored frequently to observe for any adverse
effects of the
drug.
4.3.1 heart rate
4.3.2 respiration
4.3.3 temperature
4.3.4 oxygen saturation
4.3.5 blood pressure, either invasive or non-invasive
4.4 For any manifestation of adverse reaction of the drug, refer to the physician
immediately.
4.5 Medications classified as high risk according to the drug, include the following:
4.5.1 cardiac drugs (examples and has to take precautions)
4.5.1.1 inotropics
4.5.1.1.1 obtain baseline data ( heart rate and rhythm, blood pressure, and
electrolytes)
4.5.1.1.2 take apical-radial pulse for 1 minute
4.5.1.1.2.1 for sudden increase or decrease in pulse rate, pulse deficit,
irregular
beats, and regularization of previously irregular rhythm, check
blood
pressure and obtain a 12-lead ECG.
4.5.1.1.3 monitor for digoxin level 8 hours after the last dose
4.5.1.2 antiarrythmics
4.5.1.2.1 connect patient to the cardiac monitor.
4.5.1.3 antianginals
4.5.1.3.1 avoid mixing with other drugs
4.5.1.3.2 check apical pulse rate before administration
4.5.1.3.2.1 withhold for pulse rate slower than 60beats/minute
4.5.1.3.3 monitor for blood pressure frequently
4.5.1.4 antihypertensives/vasodilators
4.5.1.4.1 frequent monitoring of blood pressure
4.5.2 central nervous system drugs
4.5.2.1 anticonvulsants
4.5.2.1.1 should not be administered for pregnant women
4.5.2.1.2 monitor periodic liver, renal, and hematopoietic functions
4.5.3 respiratory tract drugs as examples
4.5.3.1 bronchodilators
4.5.3.1.1 never administer without dilution
4.5.3.1.1.1 discard unused diluted solution after 24 hours
4.5.3.1.2 do not mix with other drugs
218
4.5.3.1.3 monitor responses to the drug by maintaining the oxygen saturation
4.5.3.2 oxygen therapy
4.5.3.2.1 check oxygen saturation level with the use of an oximeter
Republic of
5 PROCEDURES:
Yemen
48Modern
5.1 Verify
doctors
orders.
Hospital
48
4.5.4 muscle relaxants

4.5.4.1 prepare patient for ventilation support as ventilators, ETT, laryngoscope,
oxygen,
etc.
4.5.5 drugs for fluid and electrolyte balance
4.5.5.1 diuretics
4.5.5.1.1 monitor for fluid intake and output, electrolyte, BUN, and carbon
dioxide
levels frequently.
4.5.5.1.2 monitor glucose levels in diabetic patients
4.5.5.2 potassium infusion
4.5.5.2.1 monitor urine output
4.5.5.2.2 check for serum potassium level daily if IV infusion was given
4.5.6 blood-thinner drugs
4.5.6.1 anticoagulants
4.5.6.1.1 take baseline coagulation parameter prior to therapy
4.5.6.1.2 if bleeding occurs (sign of severe adverse drug reactions) hold the
medication at once and notify the physician
4.5.6.2 thrombolytics
4.5.6.2.1 monitor vital signs and neurologic status carefully
4.5.6.2.2 keep patient on strict bed rest
4.5.6.2.3 have antiarrythmics readily available, monitor ECG carefully
4.5.6.2.4 avoid any invasive procedures during thrombolytic therapy to avoid
undue
bleeding
4.5.6.2.4.1 closely monitor patient for signs of internal bleeding as occult
blood in
stool or hematemesis
4.5.6.2.4.2 check all puncture sites frequently
4.5.7 antineoplastic drugs
4.5.7.1 alkylating/antimetabolite drugs
4.5.7.1.1 treat as hazardous drug
4.5.7.1.2 anticipate for possible blood transfusion during treatment because
of
cumulative anemia
4.5.7.1.3 avoid tumor lysis syndrome as hyperkalemia and renal shutdown,
hemolysis, etc.
4.5.8 anti-infectives
4.5.8.1 special care should be taken for patients with kidney or liver disease;
frequent
investigations needed
4.6 For medications classified as high risk according to the situation, the following
responsibilities
should be observed:
4.6.1 the treating physician should give necessary instructions and guidance
regarding the drug
to be given.
4.6.1.1 name of drug
4.6.1.2 dose
4.6.1.3 route
4.6.1.4 frequency
4.6.2 instructions as to the precautionary measure to be observed
4.6.2.1 necessity to hook patient to a cardiac monitor
4.6.2.2 importance of oxygen administration
219
4.6.2.3 laboratory work-up to determine
electrolytes, blood gas levels, etc. that
will serve as
an essential guide on the adjustment of the drug doses
Republic of
Yemen 48Modern
48
Hospital

5.3 Prepare necessary supplies and equipment.
5.6 Check for baseline vital signs before administering the drug.
5.6.1 blood pressure
5.6.2 pulse
5.6.3 respiration
5.6.4 temperature
5.6.5 oxygen saturation
5.7 Refer any laboratory results to the treating physician.
5.8 Observe hospital policies in medication administrations.
5.8.1 infection control precautions
5.8.2 proper medication preparation and administration according to
the order
5.8.3 observe and document for any adverse reactions
5.8.4 check for any changes in the patients level of consciousness
5.8.5 document the drug administered
220
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Hot Compress
CONTENTS: This General Ward policy and procedure deals with the procedure in hot
compress
application.
1 DEFINITION:
1.1 Hot compress - a procedure/measure of applying external heat to keep body surface
or area of
the body warm rendering therapeutic effect. This dilates blood vessels and increases
the blood
supply.
2 PURPOSES:
2.1 To decrease pain and muscle tone.
2.2 To promote healing and suppuration.
2.3 To relieve deep congestion.
2.4 To soften the exudates.
2.5 To provide warmth and stimulate peristalis.
3.1 Impaired kidney, heart and lung functions
3.2 Acutely inflamed areas i.e. appendicitis and tooth abscess
3.3 Paralysis, weak and debilitated patients
3.4 Open wounds as bleeding may take place
3.5 Edema, headache, high temperature
3.6 Metabolic disorders i.e. diabetis, arteriosclerosis due to increased hazards of tissue
damage
3.7 Very young and old patients because of risk of tissue burn.
4.1 Hot water bag with cover
4.2 Towel (optional)
4.3 Hot water
4.4 Thermometer
5 POLICIES:
5.2 Ensure hot water bag is tightly covered without leak.
PROCEDURES:
6
5.3
Neverthe
apply
hot water
bag and
directly
to the
6.1
Check
physicians
order
purpose
of skin.
the treatment.
5.4
Application
should
not exceed
6.2
Wash
hands and
provide
privacy.more than 20-30 minutes.
6.3 Assemble the equipment near bedside.
6.5 Obtain the baseline vital signs.
6.6 Check the skin for lotion/ointment. Remove, if present.
6.7 Instruct the patient not to lie on the bag.
6.8 Fill the bag only two third (2/3) full, expel air from the bag. Secure the cap, and
turn upside
down to check any leak.
6.9 Cover the bag with protective towel and apply on the affected area.
221
Republic of
Yemen 48Modern
48
Hospital
6.10Assess tolerance. Examine the area at time intervals. Discontinue if skin turns red.
6.11Aftercare of hot water bag. Empty bag, wash with soap. Rinse well and hang to
dry. Keep in
proper place.
6.12Document date and time, site applied and patients reaction.
222
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Manual: General Wards Policies and Procedures
Title: Infection Control Guidelines

CONTENTS: This General Ward policy and procedure discusses in details the specifications
of
infection control guidelines in the nursing department in the conformance with the
hospital-wide
infection control program. This policy also gives guidelines for the needs for staff
vaccination.
1 DEFINITIONS:
1.1 Infection Control the method or the practices of preventing infections from one
patient to
another and from the hospital-acquired due to wrong practices and negligence of the
health care
workers as well as to know the importance of isolation standards in the hospital
settings.
1.2 Infection Control Guidelines a precautionary measures for the prevention of
transmission of
infections and the safe practices for health care workers.
1.3 Immunization / Vaccination Programs - the act of creating immunity by artificial
POLICIES:
means by
3.1 Personnel:
the introduction of vaccine into the body.
3.1.1 Proper hand washing techniques should be followed at all times. (Normal hand
2 PURPOSES:
washing
2.1 To prevent the transfer of infections from patient, staffs, and visitors.
3
10-15
seconds;
forto
hand
scrubbing
3-5 minutes).
2.2 To
minimize,
if not
prevent
infection,
from patients having blood-borne viruses
and 3.1.1.1 Before and after each patient contact.
3.1.1.2 Whenever
the
hands
are soiled.
pathogenic
bacteria
from
recognized
and unrecognized sources.
Before and
after precaution
personal functions
such as
eating,
etc.
2.33.1.1.3
To implement
isolation
for infections
that
are virulent
or communicable
3.1.1.4
Before
starting
the
duty
and
after
finishing.
thence
3.1.1.5 Before
and
after patient-related
procedures
such as IV cannulation,
prevention
of its
transmission
to other patients
is attained.
medication
2.4 To religiously monitor routine serology tests for HBV, HCV, and HIV infections.
preparations,
wound
dressing,
etc.for suspected patient against Hepatitis B
2.5 To establish
guidelines
for
vaccination
3.1.2
Proper
and
safe
nursing
practices
should be done at all times.
virus (possible
3.1.2.1
Proper
and
site
preparation
for
IV cannulation, catheterization, wound
for the health care workers and also in epidemics).
dressing,
specimen collection.
3.1.2.2 Skin preparation for surgery or for the procedures should be done just
before the
procedure to avoid colonization.
3.1.2.3 Invasive days for IV cannula should be 72 hours; urinary catheter 1
week to 1
month, depending on the type of the catheter.
3.1.3 Gloves, masks, and/or gowns should be used in all nursing procedures or
whenever
coming in contact with infected or isolated cases, blood and body fluids, or
with the staff
taking care of the patient.
223
3.2 Unit:
3.2.1 All units should have designated utility room for dirty or contaminated linen
and
Republic of
Yemen 48Modern
Hospital
48
equipment, as well as for the clean ones.

3.2.1.1 Dirty utility room should be kept closed at all times.
3.2.1.2 Persons entering the dirty utility room should wear masks, gloves,
and/or gowns.
3.2.1.3 Dirty utility room should be cleaned daily with detergent and
disinfections to be
done weekly.
3.2.1.4 Dirty equipments such as bedpans and urinals should be washed in the
bed pan
washer; cleaned and disinfected properly.
3.2.1.5 All used linens should be considered contaminated. Hampers should be
kept
covered in sending used linens to the laundry for washing.
3.2.2 Soiled or contaminated linens should be handled appropriately by observing
strict
infection control precautions.
3.2.2.1 Soiled linens shall be handled as little as possible with minimum
agitation to
prevent gross microbial contamination of air and of persons handling the
linen.
3.2.2.2 Linens contaminated with blood and body fluids, secretions, and
excretions should
be placed in the orange bags with proper labeling. Damp linens should be
placed in
water-soluble bags to prevent leakage of fluids.
3.2.2.3 Clean linen shall not be handled more than necessary to minimize its
contamination. Any linen dropped on the floor is considered contaminated.
3.2.3 Instruments should be sent to CSSD for autoclaving immediately after use.
3.2.4 Environmental control should be strictly maintained.
3.2.4.1 Work areas such as treatment and procedure room, dressing room,
medication
preparation area, etc. should be kept clean always.
3.2.4.2 Dressing trolleys should be kept clean and disinfected with alcohol after
each use.
3.2.4.2.1 Contents of the trolley should be checked daily for the expiration of
medications and dressing materials.
3.2.5 Proper waste and sharps disposal should be implemented strictly.
3.2.5.1 Normal waste such as food or tissue paper should be disposed in black
or white
plastic bags.
3.2.5.2 Contaminated or infectious waste, soiled items and dressings should be
disposed in
yellow bags.
4
RESPONSIBILITIES:
3.2.5.3
Pathological
wastes should be disposed in red plastic bags.
4.1 Unit
Head
Nurse:
3.2.5.4
Personnel
handling
infectious
wastes
use appropriate
protective
4.1.1
Ensures
all nursing
staffs
comply with
theshould
established
infection control
barriers.
policies
and
3.2.5.5
Waste container should be closed at all times.
procedures.
3.2.5.6
Sharps
should beorientation,
disposed in and
puncture-resistant
containers,
to be
4.1.2 Provides
information,
continuing education
program
disposed
once
it
is
regarding infection
full.
control
in coordination with the Infection Control Team.
3.2.6
Patients
withadmission
communicable
diseases
or infected
cases
should
be admitted
in
4.1.3 All isolation
or infected
cases
in the unit
should
be reported
to the
the
Infection
Isolation
Unit. If not for
available,
patient
be to
admitted
in a single room
Control
Officer/Nurse
the cases
to beshould
reported
the MOH.
observing
4.1.4 Serves as a resource person for support personnel, patient, and patients
224
isolation precautions according to the case.
family
3.2.6.1
Droplet/airborne
cases
should
be
admitted
in a negative pressure room.
regarding infection control.
3.2.6.2 Immunosupressed cases in a positive pressure room.
Republic of
Yemen 48Modern
48
Hospital
4.1.5 Enforce strict visiting hours for isolation cases with proper precautions for
visitors.
4.2 Unit Staff:
4.2.1 Adheres to infection control policies and procedures for the safe practice for
the staff as
well as the patient.
4.2.2 Observes aseptic technique for all ward procedures.
4.2.2.1 Complies with the nursing service policy on the cleaning and storage of
equipment.
4.2.3 Submits for an annual screening for HBV, HCV, and HIV.
4.2.3.1 Staff records should be maintained in the staff file.
4.2.3.2 Vaccination of the health care workers according to Infection Control APP
IC-9.
4.2.4 Any needle stick injuries should be reported immediately for their
management and the
need for post-exposure prophylaxis.
4.2.5 Proper instructions should be given to the patient or relatives about the selfcollected
specimen (e. g. urine collection).
4.3 Patient:
4.3.1 Adheres to infection control policies and procedures in the unit.
4.3.2 Follow proper instructions in the collection of specimen.
225
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Instillation of Ear Drops

instillation of
eardrops.
1 DEFINITION:
1.1 Ear Instillation is a method of applying topical solution into the ear cavity
2 PURPOSES:
2.1 To soften earwax.
2.2 To produce anesthesia.
2.3 To treat infection or inflammation.
2.4 To facilitate removal of foreign body such as insect.
2.5 To relieve pain.
3.1 Tympanic membrane perforation.
3.2 Eardrop with hydrocortisone is contraindicated to herpes, viral or fungal infection.
4.1 Ear drops
4.2 Cotton tip applicator
4.3 Tissue
4.5 Cotton balls
4.6 Normal saline solution
5 POLICIES:
5.1 Patients should have their own eardrops.
5.2 Follow seven rights in medication administration.
5.3 Follow infection control precautions.
5.4 Obtain doctors order prior to procedure.
5.5 Any eardrop, once opened should be discarded after 7 days.
PROCEDURES:
6
6.1 Check doctors order. Identify correct patient.
6.2 Assess the patients ear for any drainage and history of allergy.
6.4 Wash hands and put gloves.
6.5 Clean the external ear of drainage with cotton balls moistened with NSS solution, as
necessary.
6.6 Warm the solution to be instilled to body temperature to avoid side effects such as
vertigo,
nausea, and pain.
6.7 Place the patient in a side lying position with the affected ear facing up.
6.8 Straighten the ear canal by pulling the pinna:
6.8.1 down and back for children less than 3 years of age
6.8.2 upward and outward in adults and other children.
6.9 Ensure that the tip of the dropper is not in contact to any part of the ear to prevent
infection.
6.10Instill the drops into the ear canal by holding the dropper at least above the ear
226
canal.
6.11After 5 minutes, instill the ear drops to the other ear, if ordered.
6.12Place a cotton ball on the outermost part of the canal, if indicated.
Republic of
Yemen 48Modern
48
Hospital

6.15.1 Date and time
6.15.2 Ear/s treated
6.15.3 Number of ear drops instilled
6.15.4 Observations made during the procedure such as drainage, redness, vertigo,
nausea or
pain
227
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Instillation of Eye Drops/Ointment

instillation of
eyedrops/ointment.
1 DEFINITION:
1.1 Eye instillation - is a topical application of solution/ointment into the eye.
2 PURPOSES:
2.1 To dilate/constrict the pupil.
2.2 To relieve pain and discomfort.
2.3 To act as an antiseptic in cleansing the eye.
2.4 To combat infection.
2.5 To relieve inflammation.
2.6 Used for local anesthesia.
3.1 Small tray containing:
3.1.1 Eye drops/eye ointment (as prescribed)
3.1.3 NSS
3.1.4 Gauze/tissue
4 POLICIES:
4.1 Each patient should have his/her own eye drops/ointment.
4.2 Label according to the date opened and check expiry date.
4.3 Observe seven rights of medication administration.
4.4 Observe for infection precautions.
5
PROCEDURES:
5.2 Identify the right client and explain the procedure.
5.3 Assemble all the items needed.
5.5 Ensure the correct eye to be treated and correct medicine to be instilled.
5.6 Place client on sitting/lying position with head tilted backward.
5.7 Clear the eyelids from all secretions/discharges with cotton balls wet with normal
saline.
5.8 Gently pull down the lower lid to expose the conjunctival sac.
5.9 Hold the dropper or ointment against the clients forehand with a steady hand.
5.10Instill the eye drops into the center of the lower lid according to affected eye. For
eye ointment,
squeeze a small ribbon of ointment on the conjunctival sac from the inner to outer
canthus.
5.11Instruct to close the eyes gently without squeezing.
5.12Multiple eye drops if to be given simultaneously, should be every 5 minutes interval
for each eye
drops.
5.13Remove any excess solution/ointment surrounding
the eye with a gauze.
228
5.14Explain that vision maybe blurred for a while.
5.15.1 Drug name and number of drops
Republic of
Yemen 48Modern
48
Hospital
5.15.2 Eye into which drug was instilled

5.15.3 Time of administration
5.15.4 Observations made and clients
tolerance
6
6.1 Eye medicines once opened should be used for a maximum of 2 weeks
only.
6.2 Do not touch the tip of solution/ointment to any part of the eye.
6.3 If dropper is used, discard any remaining solution before placing back
into the bottle.
229
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Instillation Nasal Drops/Ointment

instillation of
nasal drops/ointment.
1 DEFINITION:
1.1 Nasal instillation - is a method of applying topical solutions/ointment into nasal
cavity.
2 PURPOSES:
2.1 To treat sinusitis or other infections.
2.2 To give local anesthesia.
2.3 To provide astringent effect.
2.4 To relieve inflammation and congestion in case of rhinitis.
3 CONTRAINDICATION:
3.1 Nasal medications, which are nasoconstrictors, are contraindicated for hypertensive
patients.
4.1 Nasal drops
4.2 Kleenex
4.3 Blue pad
4.4 Pillow (optional)
4.5 Emesis basin
5 POLICIES:
5.2 Follow 7 rights of medication administration.
6
PROCEDURES:
5.4 Each patient should have his/her own nasal drops.
6.1
Check
doctors
order
and
identify
correct
patient.
5.5 Label according to the date opened and check expiry date.
6.2 Verify medication label with medication record.
6.4 Gather equipment/supplies to bedside.
6.6 Instruct patient to blow nose unless contraindicated.
6.7 Clean the patients nostrils with tissue/cotton buds, if indicated.
6.8 Assist patient to a supine position and place blue pad under the head.
6.8.1 For sinus of posterior pharynx - tilt head backward.
6.8.2 Ethmoid/sphenoid sinus - tilt head back over edge of bed or place pillow under
shoulder
with head hanging over the edge of bed (Proetz position).
6.8.3 Frontal and maxillary sinus - tilt head back over edge of bed or pillow with head
turned
toward affected side (Parkinson position).
6.9 Support patients head with non-dominant hand.
6.10Instruct patient to breath through the mouth.
6.11Hold dropper 1cm. above nares, ensuring 230
not to touch the sides of nostrils as it may
cause the
patient to sneeze and contaminate dropper.
Republic of
Yemen 48Modern
48
Hospital
6.12Instill prescribed number of drops towards mid-line of ethmoid bone.

6.13Have patient remain in supine position for 5 minutes.
6.14Wipe off with clean tissue any medication that may have escaped from the anterior
nares.
6.15Provide emesis basin to spit medication that have reached the mouth or throat.
6.16Aftercare of equipment and wash hands.
6.17Observe for discomfort or side effects like restlessness, palpitations, etc. for 15-30
minutes after
administration.
6.18.1 Drug name, concentration, and no. of drops
6.18.2 Nostril into which drug was instilled
6.18.3 Time of administration
6.18.4 Observations and patients tolerance
7
7.1 Discard any remaining solution in the dropper before placing back into
the bottle.
231
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Insulin Therapy

CONTENTS: This General Ward policy and procedure deals with the procedure in insulin
therapy.
1 DEFINITION:
1.1 Insulin Therapy - a replacement therapy designed to overcome the deficiency in
endogenous
insulin.
1.2 Insulin is a hormone produced by the pancreas that controls the level of glucose in
the body by
regulating the production and storage of glucose.
2 PURPOSES:
2.1 To prevent ketoacidosis or other severe metabolic aberrations.
2.2 To control symptoms of hyperglycemia.
2.3 To minimize complications.
3.1 Subcutaneous
3.1.1 Medication tray
3.1.2 Insulin syringe with fine gauge needle
3.1.3 Alcohol swab
3.1.5 Sharp disposal container
3.1.6 Insulin vial
3.2 Intramuscular
3.2.1 Medication tray
3.2.2 Alcohol pad
3.2.3 Band aid
3.2.5 Insulin syringe
3.2.6 Insulin vial
3.2.7 Needle g. 23
3.3 Intravenous via perfusor pump
3.3.1 Perfusor machine
3.3.2 Perfusor syringe with needle
3.3.3 Perfusor tubing
3.3.4 Insulin syringe
3.3.5 Alcohol swab
3.3.6 Extension set (optional)
3.3.7 NSS 500cc as diluent solution
4
3.3.8 Insulin vial
POLICIES:
3.6.1. Adhesive tape
4.2 Wash hands before and after administration of
medicine.
4.3 Observe 7 rights of medication administration.
232
Republic of
Yemen 48Modern
48
Hospital
4.5 Rotate the site of injection.

4.6 Keep a daily record of blood sugar
test.
5
PROCEDURES:
5.3 Prepare all equipments needed.
5.4 Identify the patient by:
5.4.1 Asking his/her name
5.4.2 Checking his/her ID band
5.7 Assist the patient in a comfortable position.
5.8 Method of administration:
5.8.1 Subcutaneous: Refer to drug administration procedure for S.C. injection with
prepared
insulin in a syringe as ordered by the physician.
5.8.2 Intramuscular: Refer to drug administration procedure for I.M. injection with
prepared
insulin in a syringe as ordered by the physician.
5.8.3 Intravenous via perfusor pump.
5.8.3.1 Prepare insulin in the perfusor syringe diluted with NSS according to
doctors
order, counter checked by the senior nurse. Label the syringe properly.
5.8.3.2 Remove the needle and connect the perfusor tubing.
5.8.3.3 Prime the tubing with the solution to expel the air.
5.8.3.4 Program the perfusor machine to a desired rate.
5.8.3.5 Insert the perfusor syringe to the perfusor machine and bring to patients
bedside.
5.8.3.6 Place the machine out of reach of patient and plug to the electric socket
ensuring
correct voltage.
5.8.3.7 If patient has cannula, check for patency. If patent, connect the tubing.
5.8.3.8 Start the machine and calibrate according to doctors order.
5.8.3.9 If cannula is not patent, remove and insert another cannula.
5.8.3.10Ensure that the system is working properly, exact dosage, no leaks, no
kinks, before
leaving the room.
5.8.3.11Instruct patient not to manipulate the machine.
5.8.3.12Remove gloves and wash hands.
5.8.3.13Monitor blood sugar regularly per doctors order and record in Diabetic
Worksheet
Form M1026.
5.8.4.1 Date and time given
6
5.8.4.2 Amount administered
6.1 For
patients
on
continuous
insulin
therapy
at
home,
health
education
should
be
5.8.4.3 Type of insulin
focused on the
5.8.4.4 Route and site of administration
following:
5.8.4.5 Name of doctor informed if blood sugar is persistently high
6.1.1 Visit the physician on regular basis.
5.8.4.6 Signs and symptoms of hypoglycemia noted such as sweating, pallor,
6.1.2
tremor
etc.Teach the patient how to use the glucometer and to monitor blood glucose
level.
5.8.5 Charge supplies and procedure.
6.1.3 Member of patients family should also be taught how to administer insulin.
6.1.4 Self-administration of insulin should be taught to the patient.
233
Republic of
Yemen 48Modern
Hospital
48
Instruct patient to bring hard candies and pack of sugar with him/her
always.
6.1.5
Patient and relatives must be aware of the signs and symptoms of insulin
6.1.6
reaction and the
proper intervention.
6.2 Wear identification bracelet or necklace. Carry more detailed information about
insulin in the
wallet.
6.3 Preparation of insulin.
6.3.1 Avoid injection of cold insulin. It can lead to lipodystrophy, reduced rate of
absorption
and local reactions.
6.3.2 Examine vial before preparing dose. Do not use solutions if discolored or
presence of
precipitates is noted.
6.3.3 Insulin should not be mixed unless prescribed by physician. In general, regular
insulin is
drawn up into syringe first to avoid contaminating the bottle with the second
insulin.
6.3.4 Insulin is generally administered 15-30 minutes before a meal so that peak
action will
coincide with postprandial hyperglycemia.
6.3.5 Allow approximately 1 inch. between injection sites and avoid reuse of a site
for 6-8
weeks if possible. Maintain an injection record or chart to assure systematic
site rotation.
6.4 Hypoglycemic reaction is an emergency situation, since prolonged hypoglycemia
can cause
irreversible brain damage. Monitor early signs and symptoms:
6.4.1 sweating
6.4.2 tremor
6.4.3 pallor
6.4.4 tachycardia
6.4.5 palpitation
6.4.6 nervousness
6.4.7 headache & confusion
6.5 Exercise and delayed meals decrease the need for insulin, whereas illness and
emotional stress
increase the need for insulin.
6.6 If patient is engaged in active sports, it is suggested that injection of insulin be
made into the
abdomen rather than into a muscle that will be heavily taxed, since this may speed
up insulin
absorption.
6.7 Presence of acetone without sugar usually signifies insufficient carbohydrate intake.
Acetone
with sugar may indicate onset of ketoacidosis. Notify physician promptly.
6.8 Hypoglycemic reaction is sometimes the first indication of pregnancy in the diabetic
woman.
Patient should report promptly to physician.
6.9 The nurse should know when hypoglycemia is most likely to occur with the type of
insulin that is
being used.
6.10Exercise on a regular basis should be encouraged to diabetic patients because this
234
promotes the
utilization of carbohydrates and enhance the action of insulin.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Intravenous Cannula Insertion

insertion of
intravenous cannula.
1 DEFINITION:
1.1 Intravenous Cannula Insertion - a procedure done under aseptic technique wherein a
cannula is
inserted into the vein.
2 PURPOSES:
2.1 Provides immediate access to the vasculature for rapid delivery of specific amounts
of fluids,
electrolytes, nutrients and medications without time required for absorption for
gastro-intestinal
tract or tissues.
2.2 Allows delivery of blood and its components.
2.3 Provides route for delivery of fluids, electrolytes, nutrients and medication to
persons who
cannot take adequate amount easily due to decrease level of consciousness, inability
to swallow,
gastro-intestinal pathophysiology or therapeutic instruction (NPO) orders.
2.4 To establish access for blood extraction for investigations.
3.1 Cannula - different sizes
3.2 Alcohol swab
3.3 Tourniquet
3.4 IV 3000 transparent dressing
3.5 Cannula locked (optional)
3.6 Underpad
3.7 Syringe 10cc
PROCEDURES:
5
3.8 Needle g # 18 5.1 Verify doctors order as for the purpose of venipuncture.
4 POLICIES:
5.2 Provide privacy, explain the procedure to be done for the
4.1 Observe asepticpatient.
technique on IV cannulation.
4.2 Label the cannula
with
the date
and time
of insertion.
5.3
Gather
all supplies
needed.
4.3 Cannula should be
changed
every
72
hours.
5.4 Wash hands, wear gloves, put blue sheet under the site to be
punctured
5.5 Select the site for venipuncture.
5.5.1 Factors to consider in selecting a vein
5.5.1.1 Patients medical history.
5.5.1.2 Patients age, size and general condition.
5.5.1.3 Conditions of the veins.
5.5.1.4 Type of IV fluids or medication to be infused.
5.5.1.5 Expected duration of IV therapy.
5.5.1.6 Skill of the person who will do the venipuncture.
5.5.2 Sites to avoid
5.5.2.1 Veins below a previous IV infiltration.
235
5.5.2.2 Veins below a phlebitic area.

5.5.2.3 Sclerosed or thrombosed veins.
5.5.2.4 Areas of skin inflammation, diseased, bruising or breakdown.
5.5.2.5 An arm affected by radical mastectomy, edema, blood clot or infection.
Republic
5.5.2.6
An arm of
with arterio - venous shunt or fistula.
5.5.3
Sites
for
venipuncture
Yemen 48Modern
48
5.5.3.1 Large upper cephalic vein - lies above the antecubital space and is often
Hospital
difficult to
visualize and stabilize.
5.5.3.1.1 Gauge 22 - 16 cannula can be used.
5.5.3.1.2 Excellent for a confused patient because her clothing may cover it
and keep
her from noticing it.
5.5.3.2 The accessory cephalic veins - branching off the cephalic vein are located
on the top
of the forearm.
5.5.3.3 Medial veins of the forearm - originate in the palm of the hand, extend
along the
underside of the arm, and empty into the basilic vein or median cubital vein.
5.5.3.4 Median veins - cephalic, cubital and basilic-lie in the antecubital fossa
generally
used to draw blood and to place a midline or peripherally inserted central
catheter.
5.5.3.5 Basilic vein - lies along the medial (little finger) side of the arm.
5.5.3.6 Cephalic Vein - lying along the lateral (thumb) side of the arm, is large and
easy to
access. An excellent choice for infusing chemically irritating solutions.
5.5.3.7 Metacarpal and Dorsal Veins - on top of the hand are good sites to begin
IV therapy
easily visualized.
5.6 Apply tourniquet 4-6 inches above the chosen site, ensure that distal pulse is still
palpable.
5.7 Prepare the site by cleaning with alcohol swab.
5.8 Position the cannula 45 degrees angle to the skin of puncture site and insert
directly to the
selected vein.
5.9 Upon visualization of back flow, lower the cannula almost parallel to the skin and
advance it
slightly to ensure the cannula tip is in the lumen of the vein. While immobilizing the
vein,
advance the cannula completely.
5.10Place a protective pad or sponge under the catheter hub to catch any blood when
stylet is remove.
5.11Release the tourniquet, apply digital pressure beyond the cannula tip, stabilize the
hub.
5.12Remove stylet and flush the cannula with distilled water and NSS, apply
transparent dressing to
visualize insertion site. Label IV dressing the date and time of insertion.
5.13Administer IV meds as ordered or attached the IV line and start infusion at slow
rate.
5.14Use armboard, if necessary, to stabilize the limb.
5.15Dispose all supplies used, remove gloves and wash hands. Dispose all sharps in
sharps container
and contaminated materials in yellow bag.
5.16Check the site frequently for infiltration, phlebitis, bruising, pain and redness. If
observed,
remove cannula immediately and reinsert.
5.17.1 Date and time of insertion
5.17.2 Site of insertion
5.17.3 Size or gauge of cannula
5.17.4 Medications given or IV fluid infused
236
5.17.5 Any observations made
5.17.6 Interventions made in case complication arise
5.18Variation: Inserting a Butterfly (Winged-Tip) Needle
5.18.1 Hold the needle, pointed in the direction of the blood flow, at a 30- degree
angle, with the
6.1 A vein that is suitable for venipuncture should feel round, firm, elastic and engorged
- not hard,
bumpy or flat.
Republic
of and thumb maybe easily visible when tourniquet is placed;
6.2 Veins
in the fingers
however,
they 48Modern
Yemen
48
dont make good sites for infusion. They have smaller diameter which allows little or
Hospital
no blood
flow around catheter. The motion of the finger can lead to infiltration and
subsequently tissue
damage.
6.3 Most adults have many venipuncture sites or both sides of the forearm, using those
5.18.2
veins
is Once the needle is through the skin, lower the needle so that it is almost
parallel
with
theoptions for short term IV therapy because hand and arm mobility are not
usually
good
skin.
restricted.
5.18.3
When blood
backbe
into
the needle,
insert
the needle
to an
itsobese
hub.
6.4
A patients
weightflows
can also
a factor
in the tubing,
choice of
forearm
veins. In
5.18.4 Release the tourniquet, attach the infusion, and initiate flow as quickly as
patient,
possible.
example, you may not be able to see vein in the forearm. You may be able to palpate
5.19Securing
a Butterfly Needle
heavy
vein
5.19.1
Tape the
needle securely by the crisscross (chevron) method.
by knowing
the butterfly
typical locations.
5.19.2
small gauzefossa
square
under
the
needle, if
6.5
VeinsPlace
in thea antecubital
and
above
shouldnt
berequired.
used routinely for insertion of
peripheral
6
catheter. These sites may limit the patients range of motion and interfere with blood
sample and
prevent the use of this vein for midline and PICC (Percutaneous Implanted Cardiac
Catheter)
insertion.
6.6 Starting to a distal site and making subsequent venipunctures proximal to the
previous site is
crucial. When a complication develops at proximal site, you wont be able to use
veins distal to
this site because the fluids or medication will infuse into the damaged site
compounding the
problem.
6.7 Use veins of the palm side or volar aspect of the wrist only if absolutely necessary.
The radial
nerve is very superficial here, and damage to the vein can cause severe pain in some
patients.
6.8 Common reasons for problems during venipuncture:
6.8.1 Improper tourniquet placement - too high, too low, too tight or too loose
(causing
insufficient engorgement).
6.8.2 Failure to release tourniquet promptly when vein is sufficiently cannulated.
intravascular
pressure can cause bleeding outside the vein.
6.8.3 A tentative stop and start technique - often a problem with beginners who
lacks
confidence. A tentative approach can injure the vein causing bruising.
6.8.4 In adequate vein stretching, allowing the stylet to push the vein aside.
6.8.5 Failure to recognize the cannula has gone through the opposite vein wall (as
indicated by
diminished blood return).
6.8.6 Stopping to soon after insertion, so only the stylet - not the cannula enter the
lumen.
6.8.7 Inserting the cannula too deep, below the vein. This is evident when the
cannula wont
move freely because it is embedded in fascia or muscle. The patient may also
complain of
severe discomfort.
6.8.8 Failure to penetrate the vein wall because of improper insertion angle (too
steep or not
steep enough), causing the cannula to ride on top of or below the vein.
6.9 Hematoma formation and leaking from insertion site are problems that might
require stopping of
venipuncture procedure. These problems 237
occur most commonly in the elderly, who
have fragile
vein, and in infants, who have very small ones.
6.10Each nurse should make only two attempts of cannula insertion and if still
unsuccessful get the
Republic of
Yemen 48Modern
48
Hospital
6.11Each attempt should be done with new cannula.

6.12If routine methods fail to dilate the veins sufficiently, apply warm, moist compress
for 3-5
minutes. Veins in lower extremities are avoided because of venous stasis, increased
risk of
thrombosis, and limitations imposed on ambulating patient.
REFERENCE:
7
7th Edition
238
Republic of
Yemen 48Modern
Standard formula
48
Hospital
48 MODERN HOSPITAL
Title: Intravenous Fluid Therapy
CONTENTS: This General Ward policy and procedure deals with the procedure during
intravenous fluid
therapy.
1 DEFINITION:
1.1 Intravenous Fluid Therapy
1.1.1 Introduction of fluid into the body through a vein by gravity.
1.1.2 Means of delivering larger volumes of fluids that could be administered
conveniently by
infusion.
1.2 Principles of Intravenous Fluid Therapy
1.2.1 Tissue cells are surrounded by semi-permeable membrane.
1.2.2 Osmotic pressure is the pulling pressure demonstrated when water moves
from an area
of weaker concentration to stronger concentration of solute. The end result is
dilution of
and equilibrium of intracellular and extracellular compartments.
1.2.3 Extracellular compartment fluids primarily include plasma and interstitial fluid
(are fluids
that surround the cell).
1.3 Types of IV solutions
1.3.1 Isotonic Solution - total electrolyte content is approximately 310 mEq/L. Total
osmolality (the number of particles per unit volume of solution) is close to that of
extracellular fluids and do not cause red blood cells to shrink. Example is .9 NaCl
or NSS.
1.3.2 Hypotonic Solution - total electrolyte content is less than 250 mEq/L. Purposes
of
hypotonic solutions are to replace cellular fluid and to provide force water for
excretion of
body wastes, cells will then expand or swell. Examples are D 5% W and .45% NSS.
1.3.3 Hypertonic Solution - total electrolyte content exceeds 375 mEq/L.
administration of this
fluid increases the solute concentration of plasma, drawing water out of the cells
and into
the extracellular compartment to restore osmotic equilibrium causing cells to
shrink.
Example are D10% W, D5 NSS and D5 LR.
1.4 Formula for computation of IV Flow Rate
FLOW RATE (gtt/min = volume (ml) x drop factor (gtt/ml)
time in minutes
Example - Infuse 500ml of D5W over 5 hours with IV set delivers 15 gtt/ml.
= 500ml x 15gtt/ml
5hr (60min./hr)
= 7500gtt = 25gtt/min.
239
Republic of
300min
Yemen 48Modern
PURPOSES:
48
2.1 To correct hypovolemia,
disturbances of osmolarity or acid-base imbalance.
Hospital
2.2 To dilute toxins in the blood and other body fluids.

2.3 To administer electrolytes, nutrient or drugs.
EQUIPMENTSSUPPLIES:
3.1 IV fluid as ordered and properly labeled
2
3
240
Republic of
Yemen 48Modern
Hospital
48
3.2 IV set
3.3 IV pole
3.5 IV tray (optional)
3.5.1 IV cannula of different sizes
3.5.2 Syringe 5cc
3.5.3 Needle
3.5.4 Transparent dressing
3.5.5 Alcohol swab and dressing
3.5.6 Adhesive tape and tourniquet
3.5.7 10cc of Distilled water or NSS solution
3.5.8 Underpad
3.5.9 Armboard or splint if necessary
4
POLICIES:
4.1 Physicians order should be checked prior to preparation of IV fluid for infusion.
4.2 IV tubing should be changed every 48 hours.
4.3 IV fluid should not hang more than 24 hours.
4.4 Every IV fluid should have label, which include flow rate, additives, date, starting
and finishing
time.
5
4.5 IV Fluid should be recorded in the IV Fluid Therapy Sheet.
PREPARATIONS:
5.1 Assess:
5.1.1 Vital signs for baseline data
5.1.2 Skin turgor
5.1.3 Allergy to tape or iodine
5.1.4 Bleeding tendencies
5.1.5 Disease or injury to extremities
5.1.6 Status of veins to determine appropriate venipuncture site
5.2 Consider:
5.2.1 How long the patient is likely to have the IV
5.2.2 What kinds of fluids will be infused
5.2.3 What medications the patient will be receiving or is likely to receive
5.4 Unless initiating IV therapy is urgent, provide any scheduled care before
establishing the infusion
to minimize movement of the affected limb during the procedure.
5.5 Make sure that the clients clothing or gown can be removed over the IV apparatus if
necessary.
6
PROCEDURES:
6.1 Starting an IV Infusion
6.1.1 Explain to the client what you are going to do, why it is necessary, and how she
can
cooperate.
6.1.4 Open and prepare the infusion set.
6.1.4.1 Remove tubing from the container and straighten it out.
6.1.4.2 Slide the tubing clamp along the tubing until it is just below the drip
chamber to
facilitate its access.
6.1.4.3 Close the clamp.
6.1.4.4 Leave the ends of the tubing covered with the plastic caps until the
infusion is
started.
241
6.1.5 Spike the solution container.
6.1.5.1 Remove the protective cover from the entry site of the bag.
6.1.5.2 Remove the cap from the spike, and insert the spike into the insertion
site of the bag
or bottle.
6.1.5.3 Follow manufacturers instructions.
of label to the solution container if a medication was added.
6.1.6Republic
Apply a medication
6.1.7
Apply a48Modern
timing label on the solution container.
Yemen
48
6.1.7.1 The timing label may be applied at the time the infusion is started.
Hospital
6.1.8 Hang the solution container on the pole.

6.1.8.1 Adjust the pole so that the container is suspended about 1 m (3 ft) above
the clients
head.
6.1.9 Partially fill the drip chamber with solution.
6.1.9.1 Squeeze the chamber gently until it is half full of solution
6.1.10 Prime the tubing.
6.1.10.1Remove the protective cap, and hold the tubing over a container.
6.1.10.2Maintain the sterility of the end of the tubing and the cap.
6.1.10.3Release the clamp, and let the fluid run through the tubing until all
bubbles are
removed.
6.1.10.4Tap the tubing with your fingers if necessary to help the bubbles move.
6.1.10.5Reclamp the tubing, and replace the tubing cap, maintaining sterile
technique.
6.1.10.6For caps with air vents, do not remove the cap when priming this tubing.
6.1.10.7If an infusion control pump, electronic device, or controller is being used,
follow the
manufacturers directions for inserting the tubing and setting the infusion
rate.
6.1.11 Wash your hands.
6.1.12 Select the venipuncture site.
6.1.12.1Unless contraindicated, use the clients nondominant arm.
6.1.12.2Check agency protocol about shaving if the site is very hairy.
6.1.12.3Place a towel or bed protector under the extremity to protect linens.
6.1.13 Dilate the vein.
6.1.13.1Place the extremity in a dependent position.
6.1.13.2Apply a tourniquet firmly 1520 cm (68 in) above the venipuncture site.
6.1.13.3If the vein is not sufficiently dilated:
6.1.13.3.1 Massage or stroke the vein distal to the site and in the direction of
venous
flow toward the heart.
6.1.13.3.2 Encourage the client to clench and unclench the fist.
6.1.13.3.3 Lightly tap the vein with your fingertips.
6.1.13.3.4 If the preceding steps fail to distend the vein so that it is palpable,
remove
the tourniquet and apply heat to the entire extremity for 1015
minutes.
6.1.14 Don clean gloves and clean the venipuncture site.
6.1.14.1Clean the skin at the site of entry with a topical antiseptic swab, 2%
chlorhexidine,
or alcohol.
6.1.14.2Check for allergies to iodine or shellfish before cleansing skin with
Betadine or
iodine products.
6.1.14.3Use a circular motion, moving from the center outward for several
inches.
6.1.14.4 Permit the solution to dry on the skin.
6.1.15 Insert the catheter, and initiate the infusion.
6.1.15.1If desired and permitted by policy, inject 0.05 mL of 1% lidocaine
intradermally
over the site where you plan to insert the IV needle.
6.1.15.2Allow 510 seconds for the anesthetic to take effect.
6.1.15.3Use the nondominant hand to pull the skin taut below the entry site.
6.1.15.4Holding the over-the-needle catheter at a 15- to 30-degree angle with
the bevel up,
insert the catheter through the skin and into the vein in one thrust.
242of the needle or you feel the lack of
6.1.15.5Once blood appears in the lumen
resistance,
reduce the angle of the catheter until it is almost parallel with the skin, and
advance
Republic of
Yemen 48Modern
Hospital
48
the needle and catheter approximately 0.51 cm (about _ inch) further.

6.1.15.6Holding the needle portion steady, advance the catheter until the hub is at
the
venipuncture site.
6.1.15.7Release the tourniquet.
6.1.15.8Remove the protective cap from the distal end of the tubing, and hold it
ready to
attach to the catheter, maintaining the sterility of the end.
6.1.15.9Carefully remove the needle, engage the needle safety device, and attach
the end of
the infusion tubing to the catheter hub.
6.1.15.10Initiate the infusion.
6.1.16 Tape the catheter.
6.1.16.1Tape the catheter by the U method.
6.1.16.2Using three strips of adhesive tape, each about 7.5 cm (3 in) long:
6.1.16.3Place one strip, sticky-side up, under the catheters hub.
6.1.16.4Fold each end over so that the sticky sides are against the skin.
6.1.16.5Place second strip, sticky-side down, over catheter hub.
6.1.16.6Place third strip, sticky-side down, over tubing hub.
6.1.17 Dress and label the venipuncture site and tubing.
6.1.17.1Cover venipuncture site according to policy.
6.1.17.2Remove soiled gloves and discard appropriately.
6.1.17.3Loop the tubing and secure it with tape.
6.1.17.4Label the dressing with the date and time of insertion, type and gauge of
needle or
catheter used, and your initials.
6.1.18 Ensure appropriate infusion flow.
6.1.18.1Apply a padded arm board to splint the joint, as needed.
6.1.18.2Adjust the infusion rate of flow according to the order.
6.1.19 Label the IV tubing.
6.1.19.1Label the tubing with the date and time of attachment and your initials.
6.1.20 Document relevant data. Record:
6.1.20.1The time of the start of the infusion
6.1.20.2The flow rate of the transfusion
6.1.20.3The date and time of the venipuncture
6.1.20.4The amount and type of solution used, including any additives
6.1.20.5The type and gauge of the needle or catheter
6.1.20.6The venipuncture site
6.1.20.7The clients general response
6.2 Monitoring an IV Infusion
6.2.1 Ensure that the correct solution is being infused.
6.2.1.1 If the solution in incorrect, slow the rate of flow to a minimum to maintain
the
patency of the catheter.
6.2.1.2 Change the solution to the correct one. Document and report the error
according to
agency protocol.
6.2.2 Observe the rate of flow every hour.
6.2.2.1 Compare the rate of flow regularlyfor example, every houragainst the
infusion
schedule.
6.2.2.2 If the rate is too fast, slow it so that the infusion will be completed at the
planned
time.
6.2.2.3 If the rate is too slow, check agency practice.
6.2.2.4 If the rate of flow is 150 mL/h or more, check the rate of flow more
frequentlyfor
243
example, every 1530 minutes.
6.2.3 Inspect the patency of the IV tubing and needle.
6.2.3.1 Observe the position of the solution container.
6.2.3.2 If it is less than 1 m (3 ft) above the IV site, readjust it to the correct
height of the
pole.
6.2.3.3 Observe the drip chamber. If it is less than half full, squeeze the chamber
Republic
of
to allow
the
correct
amount of fluid to flow in.
Yemen
48Modern
48
6.2.3.4 Open the drip regulator, and observe for a rapid flow of fluid from the
Hospital
solution
container into the drip chamber.
6.2.3.5 Then partially close the drip regulator to reestablish the prescribed rate
of flow.
6.2.3.6 Inspect the tubing for pinches, kinks, or obstructions to flow.
6.2.3.7 Arrange the tubing so that it is lightly coiled and under no pressure.
6.2.3.8 Observe the position of the tubing. If it is dangling below the
venipuncture, coil it
carefully on the surface of the bed.
6.2.3.9 Lower the solution container below the level of the infusion site, and
observe for a
return flow of blood from the vein.
6.2.3.10Determine whether the bevel of the catheter is blocked against the wall
of the vein.
6.2.3.11 If there is leakage, locate the source.
6.2.3.12 If the leak is at the catheter connection, tighten the tubing into the
catheter. If the
leak cannot be stopped, slow the infusion as much as possible without
stopping it,
and replace the tubing with a new sterile set.
6.2.3.13Estimate the amount of solution lost, if it was substantial.
6.2.4 Inspect the insertion site for fluid infiltration.
6.2.4.1 Assess for infiltration at IV site:
6.2.4.1.1 Swelling
6.2.4.1.2 Coolness
6.2.4.1.3 Pallor
6.2.4.1.4 Discomfort
6.2.4.1.5 If an infiltration is present, stop the infusion and remove the
catheter.
6.2.4.1.6 Restart the infusion at another site.
6.2.4.1.7 Apply a warm compress to the site of the infiltration.
6.2.4.2 If infiltration is not evident but the infusion is not flowing, determine
whether the
needle is dislodged from the vein.
6.2.4.2.1 Gently pinch the IV tubing adjacent to the needle site.
6.2.4.2.2 Use a sterile syringe of saline to withdraw fluid from the port near
the
venipuncture site.
6.2.4.2.3 If blood does not return, discontinue the intravenous solution.
6.2.4.3 Inspect the insertion site for phlebitis.
6.2.4.3.1 Inspect and palpate the site at least every 8 hours.
6.2.4.3.2 If phlebitis is detected, discontinue the infusion, and apply warm
compresses
to the venipuncture site.
6.2.4.3.3 Do not use this injured vein for further infusions.
6.2.4.4 Inspect the intravenous site for bleeding.
6.2.4.4.1 Oozing or bleeding into the surrounding tissues can occur while the
infusion
is flowing freely, but is more likely to occur after the needle has been
removed from the vein.
6.2.4.4.2 Observation of the venipuncture site is extremely important for
clients who
bleed readily, such as those receiving anticoagulants.
6.2.4.5 Teach the client ways to maintain the infusion system. For example:
6.2.4.5.1 Avoid sudden twisting or turning movements of the arm with the
needle or
catheter.
6.2.4.5.2 Avoid stretching or placing 244
tension on the tubing.
6.2.4.5.3 Try to keep the tubing from dangling below the level of the needle.
6.2.4.5.4 Instruct client to notify a nurse if:
6.2.4.5.4.1 The flow rate suddenly changes or the solution stops dripping.
Republic of
6.2.4.5.4.2 The solution container is nearly empty.
Yemen
48Modern
6.2.4.5.4.3 There is blood in the IV tubing.
48
Hospital
6.2.4.5.4.4 Discomfort or swelling is experienced at the IV site.
6.2.4.6 Document all relevant information.

6.3 Discontinuing an IV Infusion
6.3.1 Prepare the equipment.
6.3.1.1 Clamp the infusion tubing.
6.3.1.2 Loosen the tape at the venipuncture site while holding the needle firmly
and applying
countertraction to the skin.
6.3.1.3 Don clean gloves, and hold sterile gauze above the venipuncture site.
6.3.2 Withdraw the needle or catheter from the vein
6.3.2.1 Withdraw the needle or catheter by pulling it out along the line of the
vein.
6.3.2.2 Immediately apply firm pressure to the site, using sterile gauze, for 23
minutes.
6.3.2.3 Hold the clients arm or leg above the body if any bleeding persists.
6.3.3 Examine the catheter removed from the client.
6.3.3.1 Check the catheter to make sure it is intact.
6.3.3.2 Report a broken catheter to the nurse in charge or physician immediately.
6.3.3.3 If the broken piece can be palpated, apply a tourniquet above the
insertion site.
6.3.4 Cover the venipuncture site.
6.3.4.1 Apply the sterile dressing.
6.3.5 Discard the IV solution container, if infusions are being discontinued, and
discard the
used supplies appropriately.
6.3.6 Document all relevant information.
6.3.6.1 Record the amount of fluid infused on the intake and output record and on
the chart.
6.4 Changing an IV Container, Tubing, and Dressing
6.4.1 Set up the intravenous equipment with the new container, and label them.
6.4.1.1 Apply a timing label to the container.
6.4.1.2 Prime the tubing.
6.4.1.3 Label the tubing.
6.4.2 Prepare the IV needle or catheter tape and the dressing equipment.
6.4.2.1 Prepare strips of tape as needed for the type of needle or catheter.
6.4.2.2 Hang the pieces of tape from the edge of a table.
6.4.2.3 Open all equipment: swabs, dressing and adhesive bandage, and
ointment.
6.4.2.4 Place a towel under the extremity.
6.4.2.5 Don gloves.
6.4.3 Remove the soiled dressing and all tape, except the tape holding the catheter
or IV needle
in place.
6.4.3.1 Remove tape and gauze from the old dressing one layer at a time.
6.4.3.2 Remove adhesive dressings in the direction of the clients hair growth
when
possible.
6.4.3.3 Discard the used dressing materials in the appropriate container.
6.4.4 Assess the IV site.
6.4.4.1 Inspect the IV site for the presence of infiltration or inflammation.
6.4.5 Disconnect the used tubing.
6.4.5.1 Place a sterile swab under the hub of the catheter.
6.4.5.2 Clamp the tubing.
6.4.5.3 Holding the hub of the catheter with the nondominant hand, loosen the
tubing with
the dominant hand, using a twisting, pulling motion.
6.4.5.4 Remove the used IV tubing.
6.4.5.5 Place the end of the tubing in the
245 basin or other receptacle.
6.4.6 Connect the new tubing, and reestablish the infusion.
6.4.6.1 Continue to hold the catheter, and grasp the new tubing with the dominant
hand.
6.4.6.2 Remove the protective tubing cap and, maintaining sterility, insert the
tubing end
securely into the needle hub.
6.4.6.3 Twist it to secure it.
Republic
ofclamp to start the solution flowing.
6.4.6.4
Open the
6.4.7
Remove48Modern
the tape securing the needle or catheter.
Yemen
48
6.4.7.1 When removing this tape, stabilize the needle or catheter hub with one
Hospital
hand.
6.4.8 Clean the IV site.
6.4.8.1 Start with adhesive remover to remove adhesive residue.
6.4.8.2 Then, using chlorhexidine swabs or alcohol and povidone-iodine swabs,
clean the
site, beginning at the catheter or needle and cleaning outward in a 2-inch
diameter.
6.4.9 Retape the needle or catheter.
6.4.9.1 For a butterfly needle, apply strips of tape to the wings of the butterfly
using the
crisscross (chevron) method.
6.4.9.2 For a catheter; apply the tape using the U method.
6.4.10 Apply antiseptic ointment or solution, if indicated, and apply the dressing.
6.4.10.1Place povidone-iodine ointment or solution at the entry site, in
accordance with
agency protocol.
6.4.10.2Apply a sterile gauze or transparent dressing over the site.
6.4.10.3Remove gloves.
6.4.11 Label the dressing, and secure IV tubing.
6.4.11.1Place the date and time of the dressing change and your initials either on
the label
provided or directly over the top of the dressing.
6.4.11.2 Secure IV tubing with additional tape, as required.
6.4.11.3Regulate the rate of flow of the solution according to the order on the
chart.
6.4.12.1Record the change of the solution container, tubing, and/or dressing in
the
appropriate place on the clients chart.
6.4.12.2Record the fluid intake, according to agency practice..
6.4.12.3Record your assessments.
6.5 Changing an IV Catheter to an Intermittent Infusion Lock
6.5.1 Assess the IV site (if visible) and determine the patency of the catheter.
6.5.1.1 If the catheter is not fully patent, or if there is evidence of phlebitis or
infiltration,
discontinue the catheter and establish a new IV site.
6.5.1.2 Expose the IV catheter hub and loosen any tape that is holding the IV
tubing in place
or that will interfere with insertion of the intermittent infusion plug into the
catheter.
6.5.1.3 Clamp the IV tubing to stop the flow of IV fluid.
6.5.1.4 Open the gauze pad and place it under the IV catheter hub.
6.5.1.5 Open the alcohol wipe and intermittent infusion plug, leaving the plug in
its sterile
package.
6.5.2 Remove the IV tubing and insert the intermittent infusion plug into the IV
catheter.
6.5.2.1 Don clean gloves.
6.5.2.2 Stabilize the IV catheter with your nondominant hand and use the little
finger to
place slight pressure on the vein above the end of the catheter.
6.5.2.3 Twist the IV tubing adapter to loosen it from the IV catheter and remove it,
placing
the end of the tubing in a clean emesis basin.
6.5.2.4 Pick up the intermittent infusion plug from its package and remove the
protective
sleeve from the male adapter, maintaining its sterility.
246 twisting it to seat it firmly or engage
6.5.2.5 Insert the plug into the IV catheter,
the Luer
lock.
6.5.3 Instill saline or heparin solution per agency policy.
6.5.4 Tape the intermittent infusion plug in place using a chevron or U method.
Republic of
Yemen 48Modern
48
Hospital
6.5.5.1 Avoid manipulating the catheter or infusion plug, and protect it from
catching on
clothing or bedding.
6.5.5.2 Cover the site with an occlusive dressing when showering; avoid
immersing the site.
6.5.5.3 Flush the catheter with saline or heparin solution as directed.
6.5.5.4 Notify the nurse or primary care provider if the plug or catheter comes
out, if the site
becomes red, inflamed, or painful, or if any drainage or bleeding occurs at
the site.
7
7.1 Uses and Precautions of Common Types of Infusions
7.1.1 Dextrose 5% water
7.1.1.1 Used to replace water losses, supply some caloric intake, administer as
carrying
solution for numerous medications or function as a slow keep-vein-open
infusion.
7.1.1.2 Should not be used as concurrent solution infusion with blood or blood
components.
Cautious use in patients who are hyponatremic and has syndrome of
inappropriate
antidiuretic hormone release.
7.1.2 Normal Saline
7.1.2.1 Used to replace saline losses, administer with blood components or treat
patients in
hemodynamic shock.
7.1.2.2 Cautious use in patients with heart failure and renal failure.
7.1.3 Lactated Ringers
7.1.3.1 Used to replace isotonic fluid losses, replenish specific electrolyte losses
and
moderate metabolic acidosis.
8
7.2 Because isotonic solutions expand the intravascular space, patients with
hypertension and
congestive heart failure should be monitored for signs of fluid overload.
7.3 Excessive infusions of hypotonic solutions can lead to intravascular fluid depletion,
decreased
blood pressure, cellular edema and cell damage.
7.4 Rapid administration or large quantity of hypertonic solution can cause
extracellular volume
excess and precipitate circulatory overload and dehydration.
REFERENCE:
247
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Implementing Seizure Precautions
CONTENTS: This General Ward policy and procedure serves as a guideline in implementing
seizure
precautions.
1 DEFINITION:
1.1 Seizure a sudden onset of a convulsion or other paroxysmal motor or sensory
activity.
1.2 Seizure Precautions safety measures taken by the nurse to protect clients from
injury should
they have a seizure.
2 PURPOSES:
2.1 To prevent occurrence of seizure.
2.2 To promote patient safety.
3 POLICIES:
3.1 Nurse should perform appropriate assessment and identify patients subject to seizure
precautions.
4 EQUIPMENT:
4.1 Blankets or other linens to pad side rails
4.2 Oral suction equipment
4.3 Oral airway or padded tongue depressor
4.4 Oxygen equipment
5 PREPARATIONS:
PROCEDURES:
5.1 Assess:
6.1 5.1.1
Explain
to theof
client
what you are going to do, why it is necessary, and how he can
History
seizures
6
cooperate.
5.1.2 Last seizure event
6.2 5.1.3
Wash Assemble
hands andequipment
observe appropriate
infection control procedures.
and supplies:
6.3 If the client is actively seizing, apply clean gloves in preparation for performing
respiratory care
measures.
6.5 Pad the bed.
6.6 Secure blankets or other linens around the head, foot, and side rails of the bed.
6.7 Place oral suction equipment in place, and test to confirm that it is functional.
6.8 Tape the tongue depressor that has been wrapped with gauze padding or an oral
airway within
reach of the head of the bed.
6.9 If a seizure occurs:
6.9.1 Remain with the client and call for assistance, if needed.
6.9.2 If the client is not in bed, assist client to the floor and protect the head in your
lap or on a
pillow.
6.9.3 According to policy, insert the airway or tongue depressor between the clients
upper and
lower teeth.
6.9.4 Apply oxygen by mask.
6.9.5 Turn the client to a lateral position, if 248
possible.
6.9.6 Time the seizure duration.
6.9.7 Move items in the environment to ensure the client does not experience an
injury.
Republic of
Yemen 48Modern
48
Hospital
Observe the progression of the seizure, noting the sequence and type of6.9.8
limb
6.9.9
involvement.
6.9.10
Observe skin color.
6.9.11
When the seizure allows, check pulse and respirations.
6.9.12
Administer ordered anticonvulsant medications.
Use equipment to suction the oral airway if the client vomits or has excessive oral
secretions.
6.9.13 When the seizure has finished, assist client to a comfortable position.
6.9.14 Provide hygiene as necessary. Allow the client to verbalize feelings about the
seizure.
REFERENCE:
6.10When the seizure
has subsided, document pertinent information in the client 7
7.1
Fundamentals of Nursing concepts, process, and practice
record.
7th Edition
249
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Management of Burns
CONTENTS: This General Ward policy and procedure deals with the management of burns.
1 DEFINITION:
1.1 Burns - are a form of traumatic injury caused by transfer of energy from a heat source
to the
body.
1.2 Types of Burns
1.2.1 Thermal burns - results from exposure to an explosive flash or flame or from
contact
with a hot object, liquid, semi-liquid, or semi-solid material. This can be sustained
also
from fire or explosive accidents.
1.2.2 Electrical burns - results from the heat that the electric current generates as it
passes
through the tissues of the body. Sometimes classified under thermal burns.
1.2.3 Chemical burns - results from tissue or skin contact with strong acid, alkaline or
organic
compounds.
1.2.4 Radiation - results from exposure to radioactive source.
1.3 Classification of Burns according to the Depth of Tissue Destruction.
1.4 Criteria for classifying the extent of burn injury.
1.5 Determination/Calculation of the percent or burns surface area.
1.5.1 Rule of Nines (Adult)
1.5.2 Lund and Browder Method (Infants and Children)
1.6 Phases of Major Burn Injury
1.6.1 Emergent (Resuscitative) phase - begins at the time of injury and concludes with
restoration of capillary permeability, typically 48-72 hours after the major burn
injury.
1.6.2 Acute Phase - begins when the person is hemodynamically stable, when capillary
permeability has been restored,
and when diuresis has begun. This phase begins
PURPOSES:
2
48-72
2.1 Emergent Phase
hours after injury and concludes
discharge
from
the acute care setting.
2.1.1with
To give
first aid
treatment.
1.7 Rehabilitative Phase - begins during
the
acute
hospital
stay,
after the patient
is
2.1.2 To prevent shock and respiratory
distress.
stable, and
2.1.3 To detect and treat concomitant injuries.
continues until efforts to promote,2.1.4
cosmesis
(a concern
in therapeutics, especially in
To stabilize
the patient.
surgical
2.1.5 To perform wound assessment and initial
operations, for the appearance
of the patient), function and adjustment are no longer
care.
required.
2.2 Acute Phase
2.2.1 To perform wound care and closure.
2.2.2 To maintain fluid and electrolyte balance.
2.2.3 To give nutritional support.
2.2.4 To prevent complications.
2.3 Rehabilitative Phase
2.3.1 To attain quality function and cosmesis.
2.3.2 To minimize
hypertrophic scar development
250
Republic of
Yemen 48Modern
48
Hospital
2.3.3 To increase musculoskeletal strength.

2.3.4 To overcome disabilities caused by related injuries, such as fractures,
amputations and
nerve damage.
2.3.5 To promote psychologic recovery
3.1 Immediate Resuscitation
3.1.1 Oxygen with complete O2 administering
devices
3.1.2 Ambu bag (manual resuscitation)
3.1.3 Endotracheal Intubation
3.1.3.1 Laryngoscope
3.1.3.2 syringe 10cc
3.1.3.3 stylet
3.1.3.4 endotracheal tube
3.1.3.5 plaster/roll gauze
3.1.4 ECG machine/Multiparameters
3.1.5 IVAC thermometer
3.2 IV Access
3.2.1 Cannula/central line (large bore)
3.2.2 Alcohol swab/Band aid
3.2.3 Plaster
3.2.4 Transparent dressing
3.2.5 Gauze 10x10
3.2.6 IV set
3.2.7 IV fluid
3.2.8 Vacutainer
3.3 Insertion of Indwelling Catheter
3.3.1 Foley catheter
3.3.2 KY jelly
3.3.3 Distilled H2O
3.3.4 10cc syringe with needle
3.3.5 Urine bag
3.3.6 Gauze 10x10
3.4 Wound Dressing
3.4.1 Disposable/sterile gloves
3.4.2 Mask
3.4.3 Plastic apron
3.4.4 Gauze 10x10
3.4.5 Bandages
3.4.6 Dressing set
3.4.7 Blue pads
3.4.8 Tongue depressor
3.4.9 NSS
3.4.10 Kidney basin
3.4.11 Prescribed ointments
3.4.11.1Flammazine cream
3.4.11.2Mebo ointment
3.4.11.3Sofratulle
3.4.11.4Plaster
POLICIES:
4.1 Observe hospital infection control policy.
4.2 Patient should be monitored closely for the first 48-72 hours
following burns.
251
Republic of
Yemen 48Modern
Hospital
48
4.3 Patient should be kept alone in one room. In severe cases of burns, visitors are not
allowed.
4.4 Nurses who are handling the patient should wear complete apparel - gown, mask,
apron and foot
cover - when going inside the room.
4.5 All linens to be used should be sent to CSSD for sterilization. Linens must be
PROCEDURES:
changed
twice
5.1
Emergent
daily
preferably after wound dressing.
5.1.1 Assess
of the
burns.
Determine
the percentage
of Burns
Surface
Area. 5
4.6 Linens
shouldseverity
not touch
burned
areas. Bed
cradles should
be used
to support
5.1.2 Remove clothing.
the linens.
5.1.3 Check vital signs. Do ECG. Connect to multiparameters.
5.1.4 Assess the ABCs
5.1.4.1 Establish airway.
5.1.4.2 Ensure adequate breathing provide 100% oxygen through facemask for
conscious
patients and assist on endotracheal intubation or manual ventilation for
unconscious
patients.
5.1.4.3 Assess Circulation - monitor peripheral pulses.
5.1.5 Establish intravenous line access for immediate intravenous fluid resuscitation.
Extract
blood sample and send to laboratory for investigation.
5.1.6 Start fluid therapy as ordered:
5.1.6.1 Indications:
5.1.6.1.1 Adults with burns over/greater than 15% - 20 % of body surface area.
5.1.6.1.2 Children with burns involving more than 100% of body surface area.
5.1.6.1.3 Patients with electrical injury, the elderly, or anyone with cardiac or
pulmonary disease and compromised response to burn injury.
5.1.6.2 Guidelines and Formulas for fluid Replacement in Burn Patients (Refer to
Figure
110-4).
5.1.6.3 Monitor the following:
5.1.6.3.1 Level of Consciousness
5.1.6.3.2 Urine output. (Insert indwelling catheter)
5.1.6.3.3 Pulse
5.1.6.3.4 Arterial blood pressure
5.1.6.3.5 Cardiac filling pressures and cardiac index
5.1.6.3.6 Bowel sounds
5.1.6.3.7 Serum electrolytes and hematolegic studies
5.1.7 Keep patient NPO
5.1.8 Do wound care:
5.1.8.1 Chemical Burn
5.1.8.1.1 Immediately after admission, brush off any dry chemical.
5.1.8.1.2 Remove all clothing. It may retain the chemical and continue the
burning
process.
5.1.8.1.3 Do continuous irrigation with water to dilute and remove chemicals.
5.1.8.1.4 Do not use neutralizing agents.
5.1.8.2 Cutaneous Burns
5.1.8.2.1 Cleanse the wound using aseptic technique.
5.1.8.2.2 Debride the wound of all loose, nonviable skin and blisters.
5.1.8.2.3 Examine the wound after cleaning and debridement.
5.1.8.2.4 Apply topical wound treatment as prescribed. Either the exposure
method
252
or closed method of wound care should be used to apply topical
antimicrobial creams.
5.1.9 Check patients weight.
Republic of
Yemen 48Modern
Hospital
48
5.1.10 Do all radiological procedures as ordered.

5.1.11 Prevent complications.
5.1.11.1Acute Respiratory Failure
5.1.11.2Shocks
5.1.11.3Acute Renal Failure
5.1.11.4Compartment Syndrome
5.1.11.5Paralytic Ileus
5.1.11.6Curlings Ulcer
5.2 Acute Phase:
5.2.1 Maintain adequate tissue oxygenation.
5.2.1.1 Continue oxygen inhalation therapy.
5.2.1.2 Assess breath sounds, respiratory rate, rhythm, depth and symmetry.
5.2.1.3 Monitor arterial blood gas values, pulse oximetry reading and carboxy
hemoglobin
levels.
5.2.1.4 Report labored respirations, decreased depth of respirations, or signs of
hypoxia to
physician immediately.
5.2.2 Maintain patent airway and adequate airway clearance.
5.2.2.1 Place the patient in semi-fowlers position.
5.2.2.2 Do suctioning of secretions if necessary.
5.2.2.3 Encourage patient to turn, cough and deep breath. Advise patient to use
incentive
spirometry.
5.2.3 Continue Fluid Therapy:
5.2.3.1 Observe vital signs, central venous pressure, urine output. Be alert for
signs of
hypovolema or fluid overload and report immediately.
5.2.3.2 Monitor intake and output every hour. Weigh patient daily.
5.2.3.3 Maintain IV lines and regulate fluids at prescribed rates.
5.2.4 Start Nutritional Support
5.2.4.1 When bowel sounds return, administer oral fluids and advance diet as
tolerated with
orders from the attending physician.
5.2.4.2 Offer more solid food after 2-3 days post burns as tolerance for food
improves.
Provide high calorie, high protein diet.
5.2.4.3 When caloric requirements cannot be met by enteral feedings, it may be
necessary to
initiate intravenous hyperalimentation, per doctors order.
5.2.4.4 Provide potassium and vitamin supplements.
5.2.5 Prevent Infection.
5.2.5.1 Use aseptic technique in all aspects of patient care:
5.2.5.1.1 meticulous hand washing before and after patient care.
5.2.5.1.2 use clean or sterile gloves for wound care.
5.2.5.1.3 wear isolation gown, mask and protective plastic apron for patient
care.
5.2.5.2 In case of severe burns, visitors are not allowed.
5.2.5.3 Inspect wound for signs of infection purulent drainage or discoloration.
5.2.5.4 Monitor white blood cell count, culture and sensitivity results.
5.2.5.5 Administer antibiotics as prescribed.
5.2.6 Do wound care as prescribed. Prepare the patient for early surgical
intervention if
ordered.
5.2.7 Give pain medications as ordered.
5.2.8 Encourage optimum physical mobility:
5.2.8.1 Position patient carefully to prevent
253 flexed position in burned areas.
5.2.8.2 Implement range of motion exercise several times as ordered.
5.2.8.3 Assist with early sitting and ambulation.
5.2.8.4 Encourage self-care to the extent of the patients ability.
Republic of
Yemen 48Modern
Hospital
48
5.2.8.5 Splint joints to maintain proper joint positioning and help prevent or
correct wound
contractures.
5.2.9 Help facilitate coping:
5.2.9.1 Assess patient for coping abilities, and previous successful coping
strategies.
5.2.9.2 Provide an atmosphere of acceptance, trust and caring. Communicate
your
accessibility to patient.
5.2.9.3 Help patient to identify new coping strategies.
5.2.9.4 Provide positive reinforcement when effective coping strategies are
utilized.
5.2.9.5 Encourage the involvement of family in the coping process if not
contraindicated to
patients condition.
5.2.10 Prevent complications such as:
5.2.10.1Congestive Heart Failure and Pulmonary Edema
5.2.10.2Sepsis
5.2.10.3Acute Respiratory Failure/Acute Respiratory Distress Syndrome.
5.2.10.4Visceral Damage
5.3 Rehabilitative Phase
5.3.1 Monitor and manage potential complications:
5.3.1.1 Contractures:
5.3.1.1.1 Work closely with physical therapist to identify physical therapy
needs.
5.3.1.2 Impaired Psychological Adaptation.
5.3.2 Promote Home and Community - Based Care
5.3.3 Give Health Education
5.3.3.1 Benefits of functional and cosmetic reconstruction
5.3.3.2 Assist patient in transition from dependence on the health team to
independence by
helping him develop methods of communicating his needs and functioning
abilities
to others.
5.3.3.3 Guide the patient in thinking positively about himself; promote ability to
redirect
others attention from the scarred body to the self within.
5.3.3.4 Demonstrate and explain wound care procedures to be continued after
discharge.
5.3.3.5 Observe for local signs of wound infection:
5.3.3.5.1 Increased redness of normal skin around burn area.
5.3.3.5.2 Increased cloudy yellow pus or drainage.
6
5.3.3.5.3 Increased pain, foul odor in burn area.
6.1 Inhalation injury results from the inhalation of toxic fumes, gases and particulate
5.3.3.5.4 Elevated body temperature.
matter present in
5.3.3.6 Instruct the patient measures to enhance comfort of healing skin:
smoke. Vapors may also cause inhalation injury.50-60% of fire deaths are secondary
5.3.3.6.1 Cleanse skin with mild soap and rinse well daily.
to
5.3.3.6.2 Wear clean clothing free of irritating dyes.
inhalation injury.
5.3.3.6.3 Take antipruritics as prescribed.
6.2 The following are types of pulmonary injury in burns:
5.3.3.6.4 Protect skin form further trauma including sunburn.
6.2.1 Carbon monoxide poisoning
5.3.3.7 Provide written instructions regarding all care required in discharge.
6.3 Smoke toxicity
6.3.1 Upper airway trauma
6.3.2 Restrictive pulmonary defects
254
6.4 Flexible bronchoscopy allows direct examination of the upper airways and is used
for early
medical diagnosis of inhalation injury.
Republic of
Yemen 48Modern
48
Hospital
6.5 Hydrotherapy is the bathing of burn patients in a tub or tank of water to facilitate
cleaning of the
burn area.
6.6 Skin grafting is indicated if burn wounds are deep or extensive and spontaneous reepithelialization is not possible. The purposes of skin grafting are:
6.6.1 to decrease the risk for infection
6.6.2 to prevent further loss of protein, fluid and electrolytes through the wound
6.6.3 to minimize heat loss through evaporation
255
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Management of Client for Electroconvulsive
Therapy (ECT)
CONTENTS: This General Ward policy and procedure deals with the management of client
during
electroconvulsive therapy (ECT).
1 DEFINITION:
1.1 Electroconvulsive Therapy (ECT) - a procedure performed by psychiatrist wherein a
very
small amount of electric current is delivered to the temporal area to stimulate a
seizure as
treatment.
2 PURPOSE:
2.1 For treating acute psychotic, suicidal depression or severe depression who are
refractory or cannot
tolerate medication.
3.2 Stethoscope
3.3 IVAC machine/ IVAC cover
3.4 Kidney basin
3.5 Suction machine/Suction catheter
3.6 IV pole/O2 tank with O2 devices
3.7 For ER use:
3.7.1 Pulse oximeter
3.7.2 ECT machine
3.7.3 Electroencephalographic/ Electrocardiographic electrodes
3.7.4 Bite black
3.7.5 Sphygmomanometer cuff attached to multiparameter
4 POLICIES:
4.1 Ensure patients safety by observing fall precautions and aspiration precaution.
PROCEDURES:
5
4.2 Doctors order and consent should be obtained.
5.1
Night
Prior
to
Procedure
4.3 Infection control policy should be observed.
5.1.1 Verify doctors order and check for the signed consent.
5.1.2 Instruct or assist patient in shampooing hair to remove hair products that may
interfere
with conduction.
5.1.3 Administer any premeds a night prior to procedure, if there is any.
5.1.4 Keep the patient NPO from 12 midnight. Remove the tray or any food from the
room if
patient is alone.
5.2 Morning of the Procedure
5.2.1 Explain and remind the patient about the procedure to be done.
5.2.2 Assist the patient to change into hospital gown.
5.2.3 Ensure that patient is wearing the correct ID band.
5.2.4 Remove hairpins, hairnets or prosthesis like hearing aids, dentures, and
glasses if any.
256
5.2.5 Encourage the patient to void before the procedure.
5.2.6 Put patient on bed and kept in a comfortable position.
5.2.7 Check vital signs and record.
Republic of
Yemen 48Modern
48
Hospital
5.2.8 Administer pre-op meds, if any.

5.2.9 Put side rails-up, check and complete the pre-op checklist.
5.2.10 Sent to ER/OR per bed with side rails-up with complete documents and
endorse.
5.3 After the Procedure.
5.3.1 Prepare the room prior to the arrival of the patient and keep the following
available:
5.3.1.1 O2 tank with O2 devices
5.3.1.2 Suction machine with suction catheter.
5.3.1.3 Kidney basin
5.3.1.4 Blue sheet
5.3.1.5 IV pole
5.3.2 Received the patient from ER/OR, take note of the level of consciousness.
5.3.3 Received endorsement from ER/OR staff.
5.3.4 Send back to room with side rails up.
5.3.5 Keep the patient in a comfortable position, with side rails up and check for the
IV
patency, keep vein open.
5.3.6 Check and record the vital signs.
5.3.7 Administer O2 suction secretions if indicated.
5.3.8 Instruct the relative not to give any food till further instruction.
5.3.9 Check for return of gag reflex before offering oral medication or food.
5.3.10 Offer analgesia for headache or muscle soreness as ordered.
5.3.11 Reorient the patient as needed.
5.4 Charge the supplies used.
5.5.1 Date and time sent and returned back
5.5.3 Vital signs prior and after the procedure
5.5.4 Observation made
5.5.5 Tolerance to procedure
257
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Management of Foreign Body Airway Obstruction

management of
foreign body airway obstruction.
1 DEFINITION:
1.1 Heimlich Maneuver - (subdiaphragmatic - abdominal thrusts) a maneuver used to
clear foreignbody airway obstruction.
1.1.1 Partial Airway Obstruction - the victim may be capable of either:
1.1.1.1 Good air exchange - victim remains conscious and can cough forcefully,
although
frequently there is wheezing between coughs.
1.1.1.2 Poor air exchange - indicated by weak, ineffective cough, high-pitched
noise while
inhaling, increased respiratory difficulty and possible cyanosis.
1.1.2 Complete Obstruction - victim is unable to speak, breathe or cough.
2 PURPOSE:
2.1 To relieve foreign-body airway obstruction.
3 CONTRAINDICATION:
PROCEDURES:
(Adult)
3.1 Patient with
partial or incomplete airway obstruction when the patient can maintain
5.1
With
conscious
patient sitting or standing.
adequate
5.1.1
Stand behind
the patient,
wrapbody
yourby
arms
around
his waist and proceed as
ventilation
to dislodge
the foreign
effective
coughing.
4follows:
POLICIES:
5.1.1.1
Make ashould
fist with
hand, placing
the thumb side of the fist against the
4.1 The
maneuver
beone
performed
with caution.
5
patients
4.2 All health personnel should be trained periodically to ensure that proper technique
is employedabdomen in the midline, slightly above the navel and well below the xiphoid
Grasp the fist with the other hand.
duringprocess.
the procedure.
5.1.1.2 Press your fist into the patients abdomen with a quick upward thrust.
Each new
thrust should be a separate and distinct maneuver.
5.2 With unconscious patient lying down.
5.2.1 Position patient supine with face up.
5.2.2 Kneel astride the patients thighs, facing his head.
5.2.3 Place the heel of one hand against the patients abdomen in the midline
slightly above
the navel and well below the tip of the xiphoid, place the second hand directly
on top of
the first.
5.2.4 Press into the abdomen with a quick upward thrust.
5.2.5 Finger sweep.
5.2.5.1 Open patients mouth by grasping both the tongue and lower jaw between
the
thumb and fingers and left mandible (tongue-jaw left)
5.2.5.2 Insert the index finger of the other hand down along the inside of the
cheek and
deeply into the throat to the base of258
the tongue.
5.2.5.3 Use a hooking action to dislodge the foreign body and maneuver it into
the mouth
for removal.
Republic of
Yemen 48Modern
Hospital
48
5.3 Chest thrust with conscious patient standby or sitting - used only in advanced
stages of
pregnancy or in markedly obese person.
5.3.1 Stand behind the patient with arm under his axillae to encircle the patients
chest.
5.3.2 Place thumb side of your fist on middle of patients sternum taking care to
avoid xiphoid
process and rib cage margins.
5.3.3 Grasp your fist with the other hand and perform backward thrusts until the
foreign body
is expelled or patient becomes unconscious.
PROCEDURES:
5.4
Chest thrust(Infant)
with unconscious patient lying.
6.1
Back
blows
cheston
thrust
for conscious
5.4.1
Place
theand
patient
his back
and knee; infants.
close to the side of his body.
6.1.1
Holdthe
theheel
infant
face down,
resting
on the
forearm.
Support the infants head6
5.4.2
Place
of your
hand on
the lower
half
of the sternum.
byDeliver
firmly each chest thrust slowly and distinctly with the intent of relieving the
5.5
holding the jaw. Rest your forearm on your thigh to support the infant. Head
obstruction.
should be
lower than the trunk.
6.1.2 Deliver up to five back blows forcefully between the infants shoulder blades,
using the
heel of the hand.
6.1.3 After delivery the back blows, place your free hand on the infants back,
holding the
infants head. The infant is effectively sandwiched between your two hands and
arms.
One hand supports the head and neck jaw and chest while the other supports
the back.
6.1.4 Turn the infant while the head and neck one carefully position, draped on the
thigh. The
infants head should remain lower than the trunk.
6.1.5 Give up to five quick downward chest thrusts in the same location and manner
as chest
compressions two fingers placed on the lower half of the sternum
approximately one
fingers breadth below the nipples. Steps 6.1.1. - 6.1.5. should be repeated
until the
object is expelled or the infant loses consciousness.
6.2 If the victim is or becomes unconsciousness:
6.2.1 Open the infants airway. If the loss of consciousness is witnessed and foreign
body
obstruction is suspected, lift the chin using a tongue-jaw lift and if you see a
foreign
object, remove it with a finger sweep.
6.2.2 Attempt rescue breathing.
6.2.3 If the first attempt is unsuccessful, reposition the head and reattempt
ventilation.
6.2.4 If ventilation is unsuccessful, give five back blows and five chest thrusts.
6.2.5 Open the mouth using a tongue-jaw lift and remove the foreign object if seen.
7
6.2.6 Repeat steps 6.2.2. - 6.2.4. until ventilation is successful (chest uses)
7.1 Serious internal injury may result due to Heimlich maneuver such as:
7.1.1 Rupture or laceration of abdominal or thoracic viscera secondary to fractured
6.3.1 Date and time of the procedure.
ribs or
6.3.2 Patients activity prior to the onset of the obstruction.
sternum.
6.3.3 Appropriate length of time required to clean the airway.
7.1.2 The Heimlich maneuver should not be used in infants because of the risk of
6.3.4 Type and size of foreign body removed.
259
injury to
6.3.5 Vital signs afterward
abdominal organs especially the liver.
6.3.6 Any complications and the nursing action taken.
Republic of
Yemen 48Modern
48
Hospital
Under no circumstances should, the Heimlich maneuver be practiced on each

7.1.3
other
7.1.4
during CPR training.
The rescuers hands should never be placed on the xiphoid process of the
sternum or on
the lower margins of the rib cage to minimize possible complications of the
maneuver.
260
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL
Title: Managing Patient With PCA Pump
CONTENTS: This General Ward policy and procedure serves as a guideline in the
management of patient
on Pain-Controlled Analgesia (PCA) Pump.
1
DEFINITION:
1.1 Pain Controlled Analgesia (PCA) a pain management technique that allows the
client to take
an active role in managing pain.
2
PURPOSES:
2.1 To relieve pain experienced by the patient under his/her
control.
2.2 To provide safe, consistent and effective pain
management.
POLICIES:
3
3.1 Nurse should assess the knowledge and skills of the patient on PCA pump using the
return
demonstration technique.
3.2 Pain assessment should be done every 30 minutes or extended every 2-4 hours
according to the
intensity of pain experienced by the patient.
EQUIPMENT:
4
4.2 IV start kit
4.3 IV catheter
4.4 Primary line IV tubing
4.5 Primary IV fluid (per orders)
4.6 PCA pump and appropriate tubing
4.7 Operational manual for specific pump to be
used
4.8 PCA flow sheet
4.9 Premixed medication in appropriate syringe
5
PREPARATIONS:
5.1 Assess:
5.1.1 Pain (intensity, location, presence of radiation, associated factors, precipitating
factors,
and alleviating factors)
5.1.2 Clients allergies
5.1.3 Baseline vital signs
5.1.4 Clients understanding of the pump
5.1.5 Assemble equipment and supplies
5.2 Determine:
5.2.1 Factors that may contraindicate
5.2.2 The amount of narcotic specified by the order
5.2.3 Bolus and continuous infusion dosage parameters
5.2.4 Type of primary fluid
5.2.5 Compatibility of the primary IV fluid and the PCA medication in the same line
5.3 Calculate:
5.3.1 The initial bolus dose based on the number
of milligrams of drug per milliliter of
261
fluid
Republic of
Yemen 48Modern
Hospital
48
The dose per intermittent bolus delivery

5.3.2
The
4-hour
lockout
drug
limit
5.3.3
PROCEDURES:
Confirm
that
the
drug
is
premixed
with
the
required
amount
5.3.4
ofhow she can
6.1 Explain to the client what you are going to do, why it is necessary, and
diluent.
cooperate.
6
6.4.1 Check the clients identification band.
6.4.2 If not previously assessed, take the baseline vital signs.
6.5 Set up the primary IV line and fluid.
6.5.1 Put on clean gloves.
6.5.2 Start the IV line.
6.6 Set up the PCA infusion line, according to the manufacturers instructions.
6.6.1 Remove the protective caps from the injector (plunger) and premixed drug vial.
6.6.2 Connect (screw or twist) the injector into the drug vial.
6.6.3 Remove excess air from the vial by pushing the injector into the vial.
6.6.4 Connect the PCA tubing to the injector.
6.6.5 Prime the PCA tubing up to the point of the Y-connector.
6.6.6 Clamp the tubing above the Y-connector.
6.6.7 Place the injector with attached vial in the PCA machine, according to the
operational
instructions.
6.7 Connect the PCA infusion line to the primary fluid line.
6.7.1 Connect the PCA tubing to the primary fluid line at the Y-connector site.
6.8 Prime the line below the Y-connector with compatible primary IV fluid.
6.9 Deliver the loading dose.
6.9.1 Set the pump for a lockout time of zero minutes.
6.9.2 Set the volume to be delivered based on calculated dosage volume for the
loading dose.
6.9.3 Inject the loading dose by pressing the loading dose control button.
6.10Set the safety parameters for the infusion on the PCA pump, according to the
manufacturers
instructions. Include:
6.10.1 Dose volume limits
6.10.2 Lockout interval between each dose 4-hour limit. Set the 4-hour dosage limit
as specified
on the orders.
6.11Lock the machine.
6.11.1 Close the door on the pump.
6.11.2 Look for any digital cues or alarms that may indicate the machine is not set,
and make
corrections as needed.
6.11.3 Lock the machine with the key.
6.12Begin the infusion.
6.12.1 Release the clamp on the Y-connector, and press the start button to begin the
infusion.
6.12.2 Place the client control button within reach.
6.13Monitor the client for vital signs, LOC, pain control, and side effects.
6.13.1 Monitor the status of the client every 2 hours during the first 2436 hours of
infusion and
regularly thereafter, depending on the clients health and agency protocol.
6.14Monitor the infusion.
6.14.1 Verify correct PCA parameters.
6.14.2 Observe the IV site for signs of infiltration
262 and phlebitis.
6.14.3 Inspect the tubing for kinks that may occlude the line.
6.14.4 Note the total number of doses and milligrams received.
6.15Document all relevant information.
Republic of
Yemen 48Modern
48
Hospital
6.15.1 Record the initiation of PCA, the dose setting, the doses received, pain
intensity, and all
assessments. See agency protocol.
7
REFERENCE:
7th Edition
263
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Measuring Fluid Intake and Output
measurements of
fluid intake and output.
1 DEFINITION:
1.1 Measuring Fluid Intake and Output - a continuous monitoring and recording of
patients fluid
intake and output to assess fluid and electrolyte balance on a 24 hours period.
1.1.1 Intake includes all fluids taken by oral, enteral and parenteral route.
1.1.1.1 Oral intake includes all liquids taken by mouth such as gelatin, ice cream,
soup,
juice and water.
1.1.1.2 Enteral intake includes all liquids given through nasogastric or
jejunostomy feeding
tube.
1.1.1.3 Parenteral route intake includes all liquids given as IV fluids, IV medicines,
and
blood and its components.
1.1.2 Output includes urine, stool, vomitus, gastric suction and drainage from post
surgical or
other tubes.
2 PURPOSES:
2.1 To maintain an ongoing evaluation of patients hydration status to prevent severe
imbalances.
2.2 To serve as a basis to calculate and measure daily caloric requirements.
2.3 To serve as a guideline for replacement of fluid loss.
3 INDICATIONS:
3.1 After surgery
3.2 Patients with critical and unstable condition
3.3 Patients on fluid restriction
3.4 Patients who are receiving diuretics or intravenous therapy
3.5 Patients with chronic cardiopulmonary and renal illnesses
3.6 Patients whose health status is deteriorating
4 POLICIES:
4.1 Follow
infection control policy.
NURSING
RESPONSIBILITIES:
5
4.2
Measuring
of fluid
intake
and output
is done
with
doctors
order
or asand
necessary.
5.1 Explain the reason
for
measuring
fluid intake
and
output
to the
patient
Record
in
Form
relatives to gain
M1024.
cooperation.
The starting
time and
of measuring
a 24-hour
intake
and urinal
outputorisurine
at 6am
and
5.24.3
Instruct
the patient
the relatives
not to fluid
empty
bedpan,
bag
butends
at
5am ask
of the
should
the
following
day.
nurse
to do so.
The morning
shift
records
the totalto
intake
andinoutput
for 12or
hours
atand
7pm.
Thenot
night
5.34.4
Instruct
a patient
who
is ambulatory
urinate
the bedpan
urinal
must
shift
discard
calculates
his/her
urine.the total 24 hours intake and output
264 at 5am indicating the cumulative
balance.
5.4 Record the output of a patient who has an indwelling foley catheter or drainage
tube frequently or
as necessary.
Republic of
Yemen 48Modern
48
Hospital
5.5 Report immediately any abnormality noted on the color, amount and character of
output to
attending physician or resident on duty.
5.6 Inform immediately any malfunction or accidental removal of catheters, drains or
other tubes to
attending physician or resident on duty.
265
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Medication Preparation and Administration
preparation and
administration of medications.
1 DEFINITION:
1.1 Medication - a substance used to promote health, to prevent, to diagnose, to
alleviate or cure
diseases.
1.2 Medication Preparation - is one of the nursing functions of setting the medicines
ready for
administration. The process involves accurate dosage, calculation, measurement and
proper
handling of medicines.
1.3 Medication Administration - is an act of giving the medicines according to the route,
drug
preparation and safety of the patient.
1.3.1 Routes
1.3.2 Oral
1.3.3 Oral
1.3.4 Sublingual
1.3.5 Buccal
1.3.6 Parenteral
1.3.7 Subcutaneous
1.3.8 Intramuscular
1.3.9 Intravenous
1.3.10 Intradermal
1.3.11 Intrathecal
1.3.12 Intra articular
1.3.13 Topical
1.3.14 Skin
1.3.15 Mucous membranes
1.3.16 Eyes
1.3.17 Ears
1.3.18 Nose
1.3.19 Vaginal
1.3.20 Rectal
1.3.21 Bladder
3
1.3.22 Inhalation
3.1 Prescribed medicine
2 PURPOSE:
3.2 Medication tray
2.1 To ensure patient and staff safety.
3.3 Syringe and needle of different sizes
3.4 Medication cups
3.5 Sterile gauze
3.6 Alcohol swabs, band aids, tongue
depressor
266
3.7 Disposable
gloves, blue pads
Republic of
Yemen 48Modern
Hospital
48
3.8 Scissor
3.9 Saline solution, Sterile water
3.10Sharp disposal container
3.11Razor (if needed)
3.12Water soluble lubricant
3.13Tissues
3.14Oxygen tank
3.15Nebulizer machine
3.16Nebulizer set (cup, tubing,
mask)
3.17Mortar and pestle
3.18Butterfly needle
POLICIES:
4.5 Preparation
4.5.1 Assess:
4.5.1.1 Allergies to medication(s)
4.5.1.2 Clients ability to swallow the medication
4
4.5.1.3 Presence of vomiting or diarrhea that would interfere with the ability to
absorb the
medication
4.5.1.4 Specific drug action, side effects, interactions, and adverse reactions
4.5.1.5 Clients knowledge of and learning needs about the medication
4.5.1.6 Perform appropriate assessments specific to the medication.
4.5.1.7 Know the reason why the client is receiving the medication, the drug
classification,
contraindications, usual dosage range, side effects, and nursing
considerations for
administering and evaluating the intended outcomes for the medication.
4.5.1.8 Aseptic technique and proper procedure in handling and preparation of
medication
must be observed.
4.5.1.9 Special precaution should be taken for the preparation of cytotoxic drugs.
Refer to
chemotherapy policy and procedure. (Refer to GW-061).
4.5.1.10Restricted antibiotic form (see attached form) must be filled up and
presented to the
pharmacy when order is made.
4.5.1.11Follow standard drug calculation and measurement in preparing medications.
4.5.1.12Physician must be informed for the non-availability of the medicines and or if
any
substitute drug is issued.
4.5.1.13Follow hospital standard time in medication administration.
4.5.1.14 OD= 8am
4.5.1.15 BID= 88
4.5.1.16 TID= 818
4.5.1.17 QID= 8 12 4 8
4.5.1.18 q4o= 8 12 4 8 12 4
o4.5.1.19 q6= 6 12 6 12
o4.5.1.20 q8= 6 2 10
o4.5.1.21 q12= 66
4.5.1.22 HS= 10pm
4.6 Each unit should have a drug reference book.
4.7 Never leave prepared medicine unattended.
4.8 Any doubt with the doctors order should be referred to HN/CN and the attending
physician, and to
the CMO, if necessary.
4.9 Verbal or telephone order is not allowed except in emergency cases and unless ordered
by
anesthesiologist.
267 file is obtained within 24 hours.
4.10Signature of ordering physician on the patients
4.11The nurse must be aware of the pharmacological interactions of different drugs during
preparation as
follows:
4.11.1 Drugs that are incompatible should not be given together.

4.11.2 Liquids or syrup should not be poured from one bottle to another.
4.11.3 Drugs that had change in color, odor, consistency. Any expired and unlabelled
bottle should
48Modern
48
never be given.
4.11.4 TheHospital
nurse must have the knowledge of certain medication that is to be delayed
or
omitted.
4.11.5 Medicines should be prepared in the medication preparation area properly lighted.
4.11.6 Each medicine should have a corresponding medication card (Form M1022C)
properly
filled-up as to the following:
4.11.6.1Name and PIN
4.11.6.2Room Number and Bed location
4.11.6.3Route of Administration
4.11.6.4Name of medicine
4.11.6.5Dosage
4.11.6.6Time of Administration
4.11.6.7Date Started
4.11.6.8Date of Discontinue
4.11.7 The one who carried out the doctors order should be the one to prepare the
medication card.
He/She must write his/her complete name at the back of the card.
4.11.8 Once the medicine is discontinued as ordered by the doctor, the card should be
discarded
immediately.
4.11.9 If there is an order to hold the medicine temporarily, the card should be kept in
the kardex
and must be labeled HOLD.
4.11.10 The name of the patient and PIN should be embossed on the medication card.
4.11.11 If the patient is transferred to a different room in the same unit, the room
number in the
medication card should be changed. Crash out the previous and write the present
room
number.
4.11.12 In case a newly admitted patient has his/her own medicine taken at home, the
discretion of
the attending doctor should be solicited whether to continue those medicines or not.
If the
doctor agreed to do so, a written order should be obtained and those medicines
should be
written on the medication sheet and a medication card should be made with a
remark c/o
patient.
4.12Administration
4.12.1 Nurses observe 7 rights in medication administration
4.12.1.1Right patient
4.12.1.2Right medicine
4.12.1.3Right dose
4.12.1.4Right time
4.12.1.5Right route
4.12.1.6Right documentation
4.12.1.7Right frequency
4.12.2 Observe and maintain patients rights in giving medication
4.12.3 Be informed for drug name, purpose, action and potential undesired effects.
4.12.4 Refuse a medication regardless of the consequences.
4.12.5 Have qualified nurse or physician assess a drug history including allergies.
4.12.6 Not to receive unnecessary medications.
4.12.7 Receive appropriate treatment in relation to drug therapy.
4.12.8 Receive labeled medication safely without discomfort in accordance with 7 rights
in drug
administration.
4.12.9 When administering medication, nurses reduce risk of medication errors by:
4.12.9.1use of two (2) identifiers (neither to be patients room number).
4.12.9.2double-checking with each other for any dosage calculations of high-risk
medications;
268as dangerous via policy should not be
both nurses sign. Medications identified
administered by nurses in the ward.
4.12.10 Any medication error incurred, the head nurse, supervisor, director of nursing
and the
Republic of
Yemen
prescribing physician should be informed.

4.12.11 The nurse who prepares the medication should be the one to administer it.
4.12.12 The one giving the medicine must have a sound knowledge about the use, action,
ideal dose,
and side effects of drugs being administered.
4.12.13 Assessment of patients condition and vital signs should be taken before and
48Modern
48
after giving
Hospital
medicine.
4.12.14 Medicines that cannot be administered/given for whatever reason, Head Nurse
and attending
physician should be notified.
4.12.15 Pre aspirated medicine should be used immediately.
4.12.16 Upon administering of medications, the nurse must identify the patient by asking
the full
name and checking the ID band.
4.12.17 Never leave the patient until the medicine is given.
4.12.18 Automatic cancellation of medicines, narcotic, controlled drugs and/or
anticoagulant for
patient who will undergo operation must be followed.
4.13Labeling
4.13.1 Medicine should be labeled as to time and date of opening, name, PIN and expiry
date. Use
Form M0253 to label oral and injectable medications and Form M0252 to label
medicines
for external use.
4.13.2 Must be labeled clearly and legibly.
4.14Storage
4.14.1 Medication storage areas should be kept locked at all times except when nurses
are preparing
medications.
4.14.2 Medication preparation area is well-lit, clean, and located preferably in a closed
area to
avoid distraction.
4.14.3 Excess medicine or medicine refused by the patient should not be returned back
to stock
cabinet or medicine cart.
4.14.4 Any unused and/or left over medicine should be returned back to the pharmacy as
soon as
patient is discharged.
4.14.5 Separate storage for preparations for oral use and those for topical use is a must.
4.14.6 Those medicines that required to be refrigerated must be kept in medicine
refrigerator at
required temperature of 4-8 degree centigrade.
4.14.7 A system of stock rotation must be operated to ensure that there is no
accumulation of old
stocks (e.g. first in, first out)
4.14.8 Regular stock checks should be carried out every shift daily.
4.14.9 Medicines that will be expired within 3 months should be returned back to the
pharmacy and
to be replaced by new one.
4.14.10 Multi-dose vials will be dated with date first used/the seal is broken and will
expire at the
earliest of the following dates:
4.14.10.1Multi-dose Injectables : 30 days
4.14.10.2Allergy Clinic Preparations : 30 days
4.14.10.3Multi-dose Ophthalmic Preparations for clinic use : 14 days
4.14.10.4Nasal Preparations : 30 days
4.14.10.5Optic Drops : 30 days
4.14.10.6Inhalation Solution : 7 days
4.15Documentation
4.15.1 Transcribed the doctors order correctly in the medication sheet (Form M1022),
medication
card and kardex and indicates the following:
4.15.2 Name, PIN and Rm. No.
4.15.3 Name of medicine, dose, route and duration
4.15.4 Starting date of the medicines and discontinuing date, if any
4.15.5 Patients allergies must be highlighted on medication sheet, and to be noted on
top of the
269
file.
4.15.6 Any medication error or adverse drug reaction reported to be written in the
specified form.
4.15.7 Medication error - Incidental report form
Republic of
Yemen
Republic of
Yemen 48Modern
Hospital
48
4.15.8 Adverse drug reaction - Medication deviation report form (M1196)

4.15.9 Never sign/record a medication before it has been administered.
4.15.10 Document the desired or unusual effect of any drug administered.
4.15.11 Any drug administered must be signed/recorded immediately.
4.15.12
Any refused drugs or missed dose due to test or procedures, prescribed
PROCEDURES:
medication
time
5.1 General
Procedure
should
be encircled,
to be indicated and to be signed.
5.1.1 Verify
doctorsreason
order sheet
5.1.3 Gather and arrange all the equipments and supplies needed.
5 or
5.1.4 Observe 7 rights of drug administration and report any discrepancy to HN/CN
Physician.
5.1.5 Obtain appropriate medication.
5.1.6 Read the MAR and take the appropriate medication from the shelf, drawer,
or
the
the
refrigerator.
5.1.7 Compare the label of the medication container or unitdose package against
order on the MAR or computer printout.
5.1.8 Report discrepancies.
5.1.9 Check the expiration date of the medication. Return expired medications to
pharmacy.
5.1.10 Use only medications that have clear, legible labels.
5.1.11 Prepare the medication.
5.1.12 Calculate medication dosage accurately.
5.1.13 Prepare the correct amount of medication for the required dose, without
contaminating the medication.
5.1.14 While preparing the medication, recheck each prepared drug and container
with the
MAR again.
5.1.15 Identify the patient by asking the full name and checking the ID band.
5.2 Medicine by oral route
5.2.1 Types
5.2.1.1 Oral - easiest and commonly used given by mouth and swallowed with
fluid.
5.2.1.2 Sublingual - place under the tongue to dissolve.
5.2.1.3 Buccal - involves placing solid medication in the mouth and against the
mucous
membrane of the cheek until the drug dissolve.
5.2.2 Contraindication
5.2.2.1 Nausea, vomiting and inability to swallow
5.2.2.2 Decrease level of consciousness, comatose
5.2.2.3 Esophageal stricture, lesion of the mouth and oral cancer.
5.2.2.4 Surgery of the mouth/throat.
5.2.2.5 Recent gastrointestinal surgery.
5.2.2.6 Patient with NGT and gastrostomy tube
5.2.3 Preparation
5.2.3.1 Tablet/Capsule
5.2.3.1.1 Refer to general procedure from 5.1.1. - 5.1.5.
5.2.3.1.2 Assess for contraindications to patient receiving oral medication
as
mentioned.
5.2.3.1.3 Locate medicine in the cupboard. Read label of the medicine at
least
270
three times together with the medication sheet and card.
5.2.3.1.4 When removing from medicine cabinet.
5.2.3.1.5 Before pouring medicine.
cup
After pouring medicine and returning to the cabinet.

Calculate correct drug dose and double check calculation.
Pour required number into bottle cap and transfer to medication
Republic
of touching with fingers.
without
5.2.3.1.9
Package tablet/capsule to be placed directly into medicine
Yemen
48Modern
48cup
without
for those
Hospital
removing the wrapper.
5.2.3.1.10 Place all tablets/capsule given at same time in one cup except
requiring pre administration assessment (pulse rate or blood

pressure).
5.2.3.2 Liquid/Syrup
5.2.3.1.6
5.2.3.2.1 Shake bottle well
5.2.3.1.7
5.2.3.2.2 Remove bottle cap from container, place cap upside
down, and
5.2.3.1.8
hold
bottle with label against palm of hand while pouring
5.2.3.2.3 Hold medication cup at eye level pointing thumbnail on the line
indicating the desired dose. Excess liquid or syrup in cup is
discarded
into sink, not to be returned to the bottle.
5.2.3.3 Granules
5.2.3.3.1 Pour the desired quantity in the medicine cup with label toward
the
palm of the hand.
5.2.4 Administration
5.2.4.1 Take the prepared or measured medicine in the medication tray
together with
the medication card to the patient bedside. Keep the medication in sight
at all
times.
5.2.4.2 Identify the patient carefully by:
5.2.4.2.1 Asking his/her full name
5.2.4.2.2 Checking the ID band
5.2.4.3 Explain the purpose and action of each medication and the common
expected
side effects.
5.2.4.4 Place patient in a sitting position if not contraindicated.
5.2.4.5 Place a blue sheet under the chin then administer drug by the use of
spoon or
medication glass. If the patient prefers to handle it be sure his/her hands
are
clean.
5.2.4.6 Offer water with the medicine.
5.2.4.7 Stay with the patient until he/she swallows the medicine.
5.2.4.8 Buccal Administration - instruct the patient to place the medicine in
the mouth
against the cheek until it dissolves completely.
5.2.4.9 Sublingual Medicine - instruct the patient to place medicine under the
tongue.
5.2.4.10NGT/Gastrostomy Administration - crush tablet or open capsule and
dissolve
powder with 20-30ml of water (refer to NGT feeding procedure).
5.2.4.11Dispose used medicine cup in appropriate container.
5.2.4.12Wash hands.
5.2.4.13Document date and time medicine was given and sign.
5.2.4.14Charge supplies used.
5.3 Special Consideration (Oral Medication)
5.3.1 Crush the tablet with mortar and pestle if medicine is to be given in
powdered form.
5.3.2 In administering powdered medicine or effervescent tablets dissolve in the
right
amount of water.
5.3.3 Acids and medicine containing iron should be given thru glass/plastic straw
271
with
water.
5.3.4 Administer medicine to patient with suspected communicable disease as a
last
priority, unless urgently needed.
impossible.
5.3.6 Entire coated pills should not be crushed, since the purpose of coating is to
delay
Republic
absorption,
of thus preventing gastric irritation.
5.3.7 Tablets for buccal or sublingual administration should not be crushed.
Yemen
48Modern
48
5.3.8 Effervescent powder and tablets should be given immediately after
Hospital
dissolving
since
this improves its taste and therapeutic effect.
5.3.9 Cough medicine should be given undiluted and not followed with water.
5.3.10 Protect patient against aspiration by giving a tablet or capsule one at a
time.
5.3.11 Do not administer buccal, sublingual or enteric-coated tablets or
sustained action
medication through an enteral feeding tube.
5.4 Parenteral Route
5.4.1 Types
5.4.1.1 Subcutaneous - injection into tissues just below the dermis of the
skin.
5.4.1.2 Intramuscular - injection into a muscle.
5.4.1.3 Intravenous - injection into a vein
5.4.1.4 Intradermal - injection into the dermis just under the epidermis.
5.4.1.5 Intrathecal - direct administration of medication into sub arachnoids
space.
5.4.1.6 Intra articular - injection to the synovial cavity of a joint.
5.4.2 Contraindication
5.4.2.1 Subcutaneous/Intradermal
5.4.2.1.1 Sites that are inflamed, edematous, scarred or covered with
moles,
birthmarks or other lesions.
5.4.2.1.2 Patients with impaired coagulation mechanisms.
5.4.2.2 Intramuscular
5.4.2.2.1 Same as subcutaneous 5.3.2.1.1. & 5.3.2.1.2.
5.4.2.2.2 Patients with occlusive peripheral vascular disease, edema and
shock.
5.4.2.3 Intravenous
5.4.2.3.1 IV bolus injections are contraindicated when rapid administration
of
drug could cause life threatening complications or when the drug
requires dilution.
5.4.3 Preparation
5.4.3.1 Refer to General Procedure (5.1.1. - 5.1.5.)
5.4.3.2 Prepare the injectable medicine to be given.
5.4.3.2.1 Ampule preparation
5.4.3.2.1.1
5.4.3.2.1.1.1 Tap top of ampule lightly and quickly with finger until
fluid
leaves neck.
5.4.3.2.1.1.2 Place small gauze pad around neck of ampule.
5.4.3.2.1.1.3 Use ampule pile if needed and snap neck fast and firm
away
from hands.
5.4.3.2.1.1.4 Draw-up medication quickly. Hold ampule upside down or
set it on that surface.
5.4.3.2.1.1.5 Insert syringe needle into center of ampule opening
without
touching the rim or shaft of ampule.
5.4.3.2.1.1.6 Aspirate medication into the syringe by gently pulling
back
the plunger.
5.4.3.2.1.1.7 If air bubbles sets in, hold syringe with needle pointing
up.
Tap side of syringe to cause bubble to rise toward needle.
Draw backs slightly on plunger and push plunger upward to
eject air.
272
5.4.3.2.1.1.8 If syringe contains excess fluid, use sink for disposal.
5.4.3.2.1.1.9 Recap needle by scoop method and replace with a new
one.
5.4.3.2.1.1.10 Dispose the use supplies and place broken ampule in

sharp
container.
Republic
5.4.3.2.1.2
of Preparing injections from vials:
5.4.3.2.1.2.1 Remove metal cap/plastic covering top of unused vial.
Yemen
48Modern
48
(wipe
Hospital
off with alcohol swab if vial had been previously opened)

5.4.3.2.1.2.2 Take syringe and remove needle cap. Pull back on
plunger to
draw amount of air into syringe equivalent to volume of
medication to be aspirated from vial.
5.4.3.2.1.2.3 Insert tip of needle with level pointing up through center
of
rubber seal. Inject air into vial holding on into plunger.
5.4.3.2.1.2.4 Invert vial and hold between thumb and middle finger of
non
dominant hand. Grasp end of syringe barrel and plunger with
thumb and forefinger of dominant hand.
5.4.3.2.1.2.5 Keep tip of needle below fluid level
5.4.3.2.1.2.6 Allow air pressure to fill syringe gradually with
medication.
Pull back slightly on plunger if necessary.
5.4.3.2.1.2.7 After correct volume is obtained remove needle from vial
by
pulling back on barrel of syringe.
5.4.3.2.1.2.8 Remove remaining air on syringe by tapping barrel by
holding it upright, tap barrel to dislodge air bubbles. Draw
back slightly on plunger. Push plunger upward to eject air.
Do not eject fluid.
5.4.3.2.1.2.9 Remove needle and change.
5.4.3.2.1.2.10 Clean work area and dispose use supplies.
5.4.3.2.1.3 Mixing medications from 2 vials into one syringe.
5.4.3.2.1.3.1 Check the need for one medication to be drawn before
the
other.
5.4.3.2.1.3.2 Determine the total medication volume you will have in
the
syringe before drawing up both medications.
5.4.3.2.1.3.3 Inject air equal to the amount of medication to be
withdrawn
from each vial, with vial upside down aspirate the contents
from the first and second vial.
5.4.3.2.1.3.4 Remove needle and change.
5.4.3.2.1.3.5 Ensure that vial contents is not contaminated with other
medication.
5.4.3.3 Intradermal
5.4.3.3.1 Disinfect the top of the vial with alcohol swab and let it dry.
5.4.3.3.2 Using a tuberculin syringe withdraw 0.9cc of distilled water and
0.1cc of
the drug to be tested with the use of aspirating needle.
5.4.3.3.3 Remove needle and change.
5.4.3.3.4 Administration
5.4.3.4 Subcutaneous
5.4.3.4.1 Take the medication tray containing the syringe with prepared
medicine,
alcohol swab and medication card to the patient bedside.
5.4.3.4.2 Identify the patient carefully by:
5.4.3.4.3 Asking his/her full name
5.4.3.4.4 Checking the ID band
5.4.3.4.5 Explain the purpose and action of each medication and the
common
expected side effects (if any).
5.4.3.4.6 Select the appropriate injection site. The most common site used
are the
273
outer aspect of abdomen, anterior aspect of the thigh, posterior
aspect of
the upper arm.
Assist patient in a comfortable position.

Clean site with antiseptic swab.
Remove cap from needle by pulling it straight off.
Republic
Hold syringe
of
correctly between thumb and forefinger of dominant
hand as
Yemen in
48Modern
48
dart fashion.
HospitalFor average size patient, spread skin tightly across injections
5.4.3.4.11
site
or pinch
skin with non-dominant hand. For obese patient, pinch skin at site.
5.4.3.4.12 Inject needle firmly and quickly at 45 degrees - 90 degrees,
then
5.4.3.4.7
release
5.4.3.4.8
skin if pinch.
5.4.3.4.9
5.4.3.4.13 Pull back the plunger of the syringe to check if the needle
is not
5.4.3.4.10
in the vein
(optional). If no blood return, inject the medicine slowly.
5.4.3.4.14 If blood appears, remove and prepare a new one.
5.4.3.4.15 Then withdraw the needle while applying alcohol swab gently
above or
over injection site.
5.4.3.4.16 Gently massage the site if not contraindicated.
5.4.3.4.17 Apply band-aid.
5.4.3.4.18 Assist patient to a comfortable position.
5.4.3.4.19 Discard needle and syringe in sharp container.
5.4.3.4.20 Wash hand.
5.4.3.4.21 Document date, time, site and sign.
5.4.3.4.22 Evaluate response to medication.
5.4.3.5 Intramuscular
5.4.3.5.1 Place the prepared injectable medicine in the tray together with
the
medication card, alcohol swab, band-aid, small sharp containers and
disposable gloves.
5.4.3.5.3 By asking his/her name
5.4.3.5.4 Checking the ID band.
5.4.3.5.5 Explain the purpose and action of each medication and the
common
expected side effects.
5.4.3.5.6 Provide privacy and assist patient in a comfortable position.
5.4.3.5.7 Select site for injection using anatomical landmark.
5.4.3.5.8 Vastus Lateralis - located in the anterior aspect of the thigh.
5.4.3.5.9 Ventrogluteal Muscles - located deep and away from major blood
vessels
and nerves.
5.4.3.5.10 Dorsolateral Muscles - muscles in the upper outer quadrant of
the
buttocks.
5.4.3.5.11 Deltoid Muscle - located in the upper arm.
5.4.3.5.12 After selecting appropriate site, wipe the site by using antiseptic
swab.
5.4.3.5.13 Hold syringe between thumb and forefinger in a dart like fashion.
5.4.3.5.14 Pinch skin tightly. If irritating medicine, use Z track method.
5.4.3.5.15 Inject needle quickly and firmly at 90 degrees angle. Then release
skin.
5.4.3.5.16 Grasp the lower end of the syringe with non-dominant hand and
position
dominant hand to the end of the plunger. Do not move the syringe.
5.4.3.5.17 Pull back the plunger to ascertain if needle is in a vein. If no
blood
appears, slowly inject the medication. If blood appears in the
syringe,
discard the medicine and prepare again to start a new procedure.
5.4.3.5.18 Quickly withdraw the needle while applying pressure on the
antiseptic
swab after the medicine is consumed.
274
5.4.3.5.19 Gently massage the site unless contraindicated.
5.4.3.5.20 Assist patient to a comfortable position.
5.4.3.5.21 Discard the uncapped needle and syringe in the sharp container.
Republic of
5.4.3.5.22 Wash hands.

Yemen
48Modern
48
5.4.3.5.23 Document the procedure.
Hospital
5.4.3.5.24
Evaluate response to procedure.
5.4.3.5.25 Charge supplies used and procedure.
5.4.3.6 Intravenous
5.4.3.6.1 Place the prepared injectable medicine in the tray together with
the
medication card, alcohol swab, disposable gloves, labeled syringe
with
saline solution, small sharp container, tourniquet.
5.4.3.6.3 Ask patient his/her name.
5.4.3.6.4 Check ID band.
5.4.3.6.5 Explain the procedure, reason drugs is given and the expected
common side
effect.
5.4.3.6.6 Provide privacy, assist patient in a comfortable position.
5.4.3.6.7 Assess patient intravenous insertion site for signs of infiltration
and
phlebitis. If present, do not give medication; restart IV line in another
site.
5.4.3.6.8 IV push through:
5.4.3.6.8.1 Intravenous lock:
5.4.3.6.8.1.1 Clean off injection port with antiseptic swab.
5.4.3.6.8.1.2 Aspirate for blood return. Clear lock with 1ml saline (a
central venous port may require 5-10ml saline)
5.4.3.6.8.1.3 Administer medication over specified time
recommended.
Use a watch to time administration.
5.4.3.6.8.1.4 After administering medicine clear lock with 1ml saline.
5.4.3.6.8.2 Existing line:
5.4.3.6.8.2.1 Select injection port closest to patient.
5.4.3.6.8.2.2 Clean injection port with antiseptic swab
5.4.3.6.8.2.3 Occlude the intravenous line by pinching tubing just above
injection port.
5.4.3.6.8.2.4 Gently aspirate for blood return, if there is administer
medication over specified time recommended.
5.4.3.6.8.3 Butterfly needle
5.4.3.6.8.3.1 Connect the syringe with medicine to the port of the
butterfly
tubing and push slowly the plunger to fill the tubing with
medicine and to expel the air.
5.4.3.6.8.3.2 Select the site for the IV insertion.
5.4.3.6.8.3.3 Place the tourniquet 4-6 inches above the selected site,
ask the
patient to open and close his/her fist.
5.4.3.6.8.3.4 Clean the site with alcohol swab.
5.4.3.6.8.3.5 Inject the needle at an angle of 25-45 degrees & check for
return flow.
5.4.3.6.8.3.6 Release the tourniquet and stabilize the needle with one
hand.
5.4.3.6.8.3.7 When return flow is present, slowly inject the medicine.
5.4.3.6.8.3.8 Pinch the tubing after medicine is completely injected and
replace the syringe with saline syringe and flush the tubing.
5.4.3.6.8.3.9 Place sterile gauze with alcohol swab over the insertion
site and
remove the needle.
5.4.3.6.8.4 Apply band aid over the site
5.4.3.6.8.5 Inspect the area for redness, pain, swelling, edema.
5.4.3.6.8.6 Observe closely for adverse
275 reaction as the drug is administer
and for
several minutes there after.
5.4.3.6.8.7 Dispose uncap needle and syringe in sharp container.
5.4.3.6.8.8 Wash hands

5.4.3.6.8.9 Document the procedure and note adverse reaction if any.
5.4.3.6.8.10Charge the procedure and supplies.
5.4.3.6.9 Intradermal
Republic
5.4.3.6.9.1of
Place the prepared injectable medicine in the tray together with
theYemen
48Modern
48
medication card, alcohol swab and small sharp container.
Hospital
5.4.3.6.9.2 Identify the patient correctly:
edema,
5.4.3.6.9.3
5.4.3.6.9.4
5.4.3.6.9.5
5.4.3.6.9.6
5.4.3.6.9.7
5.4.3.6.9.8
5.4.3.6.9.9
Ask his/her name

Check ID band
Explain the procedure, reason drug is given.
Provide privacy and assist patient in comfortable position
Select site for injection:
Extend elbow and support it, and forearm in flat surface.
Inspect site for bruises, inflammation, lesion discoloration,
masses and tenderness.

5.4.3.6.9.10Forearm site should be 3-4 finger widths below ante cubital
space and
one hand width above the wrist on inner aspect forearm.
5.4.3.6.9.11Use antiseptic swab in a circular motion to clear skin at site.
5.4.3.6.9.12While holding the swab with non-dominant hand, pull cap from
needle.
5.4.3.6.9.13With non-dominant hand, stretch the skin over site with
forefinger and
thumb.
5.4.3.6.9.14Insert needle slowly at 5-15 degrees angle, level up, until
resistance is
felt; advance to no more than 1/8 inch below the skin. The middle
tip
should be seen through the skin.
5.4.3.6.9.15Do not aspirate, slowly inject the medication until resistance
will be
felt. Note a small bleb, like a mosquito bite forming under the skin
pressure.
5.4.3.6.9.16Withdraw needle while applying antiseptic swab.
5.4.3.6.9.17Do not massage the site.
5.4.3.6.9.18Assist patient in comfortable position.
5.4.3.6.9.19Draw circle around the perimeter of injection site using black
ink.
5.4.3.7 Dispose syringe with needle in the sharp container.
5.4.3.8 Wash hands.
5.4.3.9 Document on the medication card the due time.
5.4.3.10Record the date, time, dose, route and site of injection on medication
record and
nurses notes.
5.4.3.11After 30 minutes return to patient with the physician to evaluate the
result and record
to medication sheet, card and file.
5.4.3.12Charge supplies use.
5.4.4 Special Consideration (Parenteral)
5.4.4.1 For Intramuscular injection, solutions that are oily and viscous or that
contain
suspended particles must be given through needles of larger diameter.
5.4.4.2 Drug that are injected SC should be non-irritating.
5.4.4.3 The volume of injection for SC should be less than 2ml.
5.4.4.4 For drug known to be irritating or staining to the skin, a Z track injection
method is
advised. This method is used for injection of iron salts and for narcotizing or
highly
irritating substances.
5.4.4.5 Providing truthful information when dealing with children is very
important to gain
cooperation.
5.4.4.6 Medium for IV injection must be 276
isotonic solutions (saline of 5%
Dextrose).
5.4.4.7 Rapid delivery of large volume of drug during IV injection can lead to
embolism,
pulmonary edema, elevated BP, or excessive pharmacological responses.
Republic of
Yemen 48Modern
48
Hospital
with
5.4.4.8
If diazepam of chlordiazepoxide HCL is given through IV push, flush
bacteriostatic water instead of saline to prevent drug precipitation due to

incompatibility.
5.4.4.9 After heparin injection by SC route, do not rub or massage the site to
avoid minute
hemorrhage or bruises.
5.4.4.10An intraarticular injection requires sterile technique and usually
performed by a
doctor.Drugs commonly administered intraarticular include corticosteroids,
anesthetics, and lubricants.
5.4.4.11Intrathecal injection is an invasive procedure performed by a doctor under
sterile
conditions with the nurse assisting and requires informed patients consent.
5.4.4.12Streptomycin is not given during the first trimester of pregnancy to avoid
staining of
teeth of the fetus of later life.
5.4.5 Topical Route
5.4.5.1 Site for topical administration
5.4.5.2 Skin
5.4.5.3 Mucous Membrane
5.4.5.4 Eyes
5.4.5.5 Ears
5.4.5.6 Nose
5.4.5.7 Vaginal
5.4.5.8 Rectal
5.4.5.9 Bladder
5.5 Contra-indications
5.5.1 Skin
5.5.1.1 Broken skin (according to type of medicine to be applied) allergies or skin
reactions
to the drug
5.5.1.2 Mucous Membrane
5.5.1.3 Eyes - no specific contra-indication
5.5.1.4 Ears
5.5.1.5 Eardrops containing hydrocortisone is contra-indicated for patient with
herpes, viral
and fungal infection.
5.5.2 Nose
5.5.2.1 Nasal drops that cause vasoconstriction for hypertensive patient.
5.5.3 Vaginal/Rectal
5.5.3.1 Recent MI
5.5.3.2 Recent Rectal/Prostate Surgery
5.5.3.3 Anal, irritation, diarrhea, rectal bleeding and hemorrhoids.
5.6 Administration
5.6.1 Skin
5.6.1.1 Refer to general procedure (5.1.1. - 5.1.5.)
5.6.1.2 Place the prepared medicine in the tray containing disposable gloves,
tongue
depressor, cotton swab, gauze, razor (if needed) together with the
medication card
and bring it to patient bedside.
5.6.1.3 Identify patient correctly by:
5.6.1.4 Asking his/her name
5.6.1.5 Check ID band
5.6.1.6 Explain purpose and action of each medication and the common side
effect.
5.6.1.7 Position patient properly and drape for privacy.
5.6.1.8 Assess patients skin condition.
277
5.6.1.9 Clean the skin prior to application of topical medication:
5.6.1.10If an open wound, clean area with mild soap (no allergies) and water.
5.6.1.11If skin is irritated, use only warm water.
5.6.1.12Keep the area dry.

5.6.1.13Change gloves.
5.6.1.14Apply medication as follows:
5.6.1.15If
Republic
lotionof
or ointment, apply a thin layer smoothly into the skin.
5.6.1.15.1 If aerosol spray is used shake the container and administer
Yemen 48Modern
48
according to
Hospital
direction. Spray evenly over affected area and avoid spraying to
patients
face.
5.6.1.15.2 If gel or paste, apply it evenly using applicator. If applying over an
area with
hair growth, follow direction of hair.
5.6.1.15.3 If powder is used, dust lightly and avoid inhalation by patient.
5.6.1.15.4 If nitroglycerin ointment or paste are used, observe instructions as
follows:
5.6.1.15.5 Remove the old ointment strip and clean the old site thoroughly.
5.6.1.15.6 Squeeze the desired dose out on the medication-measuring strip.
Nitroglycerin paste dosages are measured in inches and applied to the
papermeasuring strip before applying to the patient.
5.6.1.15.7 Apply measuring paper with ointment side down to a non-hairy
portion of
the body.
5.6.1.15.8 Tape the paper in place.
5.6.1.15.9 If transdermal patch is used:
5.6.1.15.9.1Remove the old patch and wash the site of old patch.
5.6.1.15.9.2Wash hand and prepare skin at a new site.
5.6.1.15.9.3Remove the protective covering over the transdermal portion
over the
patch and apply the patch to a smooth clean surface. Write the date
and
time of application on the patch.
5.6.1.16Dispose supplies used.
5.6.1.17Wash hands.
5.6.1.18Document the medication given, the site where it was applied, and the
patients
response to medications.
5.6.1.19Charge all supplies use.
5.6.2 Mucous Membrane:
5.6.2.1 Eyes, ear and nose refer to instillation procedure.
5.6.3 Rectal suppositories/Vaginal pessaries
5.6.3.1 Rectal:
5.6.3.1.1 Check the doctors order.
5.6.3.1.2 Review patient medical record for rectal surgery or any bleeding.
5.6.3.1.4 Prepare all equipments and supplies to be used.
5.6.3.1.5 Identify the patient by asking his/her name or by checking ID band.
5.6.3.1.6 Explain the procedure. Be specific if patient wishes to self-administer
drug.
5.6.3.1.7 Provide privacy.
5.6.3.1.8 Assist patient in Sims position. Drape patient with only anal area
exposed.
5.6.3.1.9 Wear disposable gloves
5.6.3.1.10 Examine anus externally and palpate rectal wall as needed.
5.6.3.1.11 Wear disposable gloves (if previous gloves are soiled).
5.6.3.1.12 Remove suppository from wrapper and lubricate rounded end.
Lubricate
index finger of dominant hand with water-soluble lubricant.
5.6.3.1.13 Ask patient to take slow deep breaths through the mouth and relax
anal
sphincter.
5.6.3.1.14 Retract buttocks with non-dominant hand. Insert suppository gently
through
the anus, passing to internal 278
sphincter and against rectal wall 10cm (4
inch)
in adults, 5cm (2 inch) in children and infants.
5.6.3.1.15 Withdraw finger and wipe anal area with tissue.
5.6.3.1.16 Discard gloves and dispose properly.

5.6.3.1.17 Instruct patient to remain flat or on side for 5 minutes.
5.6.3.1.18 If suppository contains laxative or stool softener place call light
within
Republic
reach.
of
For bedridden patient apply pampers and check thereafter.
Yemen
48Modern
48
5.6.3.1.19 Dispose all supplies properly and wash hand.
Hospital
5.6.3.1.20
Return within 5 minutes to determine whether suppository was
expelled.
5.6.3.1.21 Record drug name, dosage, route of administration, tolerance to
procedure,
date and time.
5.6.3.1.22 Observe for any effects of suppository (e.g. bowel movement,
relief of
nausea) 30 minutes after administration and record.
5.6.3.2 Vaginal Pessaries
5.6.3.2.1 Verify doctors order.
5.6.3.2.3 Prepare all supplies and bring to patients bedside.
5.6.3.2.4 Identify patient properly by asking the full name and checking ID
band.
5.6.3.2.5 Explain the procedure to the patient.
5.6.3.2.6 Provide privacy.
5.6.3.2.7 Assist patient to lie in dorsal recumbent position.
5.6.3.2.8 Keep abdomen and lower extremities draped.
5.6.3.2.9 Wear disposable gloves.
5.6.3.2.10 Inspect condition of external genitalia and vaginal canal.
5.6.3.2.11 Be sure vaginal orifice is well illuminated by room light or
examination
lamp.
5.6.3.2.12 Do perineal care (refer to perineal care procedure)
5.6.3.2.13 Replace new disposable gloves if previous are soiled.
5.6.3.2.14 Remove suppository from foil wrapper and apply lubricant to
rounded end.
Lubricate index finger of dominant hand.
5.6.3.2.15 Gently retract labial fold with non-dominant hand.
5.6.3.2.16 Insert rounded end of suppository along posterior wall of vaginal
canal,
entire length of finger (7.5-10cm or 3-4 inches)
5.6.3.2.17 Withdraw finger and wipe away remaining lubricant from vaginal
orifice of
labia.
5.6.3.2.18 Instruct patient to remain on back at least 10 minutes. (for Prostin
E2 at least
1 hr.)
5.6.3.2.19 Discard all supplies used properly.
5.6.3.2.20 Remove gloves and wash hands.
5.6.3.2.21 Offer perineal pad when patient resumes ambulation.
5.6.3.2.22 Document medication given, date, time, observation made.
5.6.3.2.23 Charge supplies used.
5.6.3.3 Inhalation can be given either by nebulization or aerosolization with
rapid relief for
local respiratory problems, or an easy access for introduction of general
anesthesia
gases.
5.6.3.3.1 Contraindications:
5.6.3.3.1.1 Patients with tachycardia/cardiac arrythmias are
contraindicated to use
of bronchodilators.
5.6.3.3.2 Administration
5.6.3.3.2.1 Follow general procedure (5.1.1. - 5.1.5)
5.6.3.3.2.2 Assess patients ability to use the nebulizer.
5.6.3.3.2.3 Select the proper size of mask appropriate for the patient.
5.6.3.3.2.4 Prepare the medication to be given per doctors order.
5.6.3.3.2.5 Check the nebulizer machine
and O2 tank for proper working
279
condition.
5.6.3.3.2.6 Assist the patient to sit in upright position (if not
contraindicated).
Republic of
Yemen 48Modern
Hospital
48
5.6.3.3.2.7 Administer inhalation by using O2.

5.6.3.3.2.8 Pour the desired amount of drugs into the nebulizer cup.
5.6.3.3.2.9 Connect tubing to nebulizer set, attach to O2 mask.
5.6.3.3.2.10Adjust the humidified oxygen tank valve to 4-6 L or per
doctors order.
5.6.3.3.2.11Attach the O2 mask to the patient properly.
5.6.3.3.3 In using nebulizer machine:
5.6.3.3.3.1 Pour the desired amount of medicine into the nebulizer cup.
5.6.3.3.3.2 Connect tubing to nebulizer machine; attached to oxygen
mask.
5.6.3.3.3.3 Attach the O2 mask to the patient properly.
5.6.3.3.3.4 Turn on the nebulizer machine and set it for 10-15 minutes.
5.6.3.3.3.5 Instruct patient to breath slowly and deeply through the
mask.
5.6.3.3.3.6 Remain with the patient to observe proper inhalation exhalation
technique.
5.6.3.3.4 When nebulizer cup is empty:
5.6.3.3.4.1 Turn off the O2 or nebulizer machine
5.6.3.3.4.2 Detach the tubing from nebulizer cup.
5.6.3.3.4.3 Remove O2 mask from the patient.
5.6.3.3.5 Using metered dose inhalers:
5.6.3.3.5.1 Verify doctors order
5.6.3.3.5.2 Wash hand
5.6.3.3.5.3 Gather all equipment needed
5.6.3.3.5.4 Identify the patient properly
5.6.3.3.5.5 Explain the procedure to the patient
5.6.3.3.5.6 Assess patients ability to use the metered dose inhaler
5.6.3.3.5.7 Place the patient in upright position
5.6.3.3.5.8 Administer inhaled dose of medication
5.6.3.3.5.9 Remove cap and hold inhalers upright, grasping it with
thumbs and
first two fingers.
5.6.3.3.5.10Shake inhaler.
5.6.3.3.5.11Instruct the patient to place the mouthpiece of inhaler in
his/her mouth
(connect aerochamber if ordered).
5.6.3.3.5.12Press down on inhaler to release medication while inhaling
slowly.
5.6.3.3.5.13Hold breath approximately for 10 seconds.
5.6.3.3.5.14Repeat puffs as ordered, waiting 1 minute between puffs.
5.6.3.3.5.15If two inhaled medications are prescribed, wait 5-10 minutes
between
inhalation or as ordered by physician.
5.6.3.3.5.16If there is aerochamber attached to inhaler, instruct the
patient to
inhale deeply and slowly.
5.6.3.3.5.17Explain that patient may feel gagging sensation in throat
caused by
droplets of medication on pharynx or tongue.
5.6.3.3.5.18Aftercare of equipment.
5.6.3.3.5.19Wash hands.
5.6.3.3.5.20Record medication administration, observations, date and
time.
280
5.6.3.3.5.21Charge all the items used.
5.6.3.4 Special consideration
5.6.3.4.1 Nebulizer set should be change everyday.
Republic of
Yemen 48Modern
Hospital
48
Figure : 059-1
* Formulas for Computing Drug Dosages *
Adult:
dose desired
---------------- X quantity on hand = desired quantity to
administer.
dose on hand
dose desired - is the amount of pure drug the physician prescribed.
dose on hand - weight or volume of drug available in units supplied by the
pharmacy.
quantity on hand - is the basic unit or quantity that contains amount on
hand.
amount to administer
of medicine
the nurse
will administer.
Example : Amoxicillin
625mg PO -isactual
ordered.
It is supplied
as liquid
preparation
containing 250mg in 5 ml. How much would the nurse would give?
625mg
---------- X 5ml = 12.5ml
250mg
Pedia
Frieds Rule is usually used to estimate dosages for infants
under age 1.
Childs dose =
childs age in months
--------------------- X average adult dose
150 months
Youngs Rule is usually used to estimate dosage for children ages
2 to 12.
childs age in years
Childs dose =
-------------------------- X average adult dose
childs age in years + 12
Clarks rule - pediatric dosages are calculated by multiplying the weight of the drug
(usually in
milligrams) by weight of the child (in kilograms).
Childs dose = usual adult dose X weight of child in pounds
150
Body Surface Area - Formula used to estimate the pediatric dosages based on the
childs body
surface area.
Surface area in sq. meters X Dose per sq. meter = Approximate child dose
Surface area of child
------------------------- X Dose of Adult = Approximate child dose
Surface area of adult
Surface area of child in sq. meters
----------------------------------- X adult dose = child dose
175
Recommended Dosage (mg or gm/kg/day X body weight/kg = Dose
(mg/day)
---------------------------------------------------------------------------------------------281
Daily Dose
Republic of
Yemen 48Modern
48
Hospital
REFERENCE:
Fundamentals of Nursing concepts, process, and practice 7 th
Edition
282
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Mouth/Oral Care
CONTENTS: This General Ward policy and procedure deals with the procedure in rendering
mouth/oral
hygiene.
1 DEFINITION:
1.1 Mouth/oral hygiene - a hygienic care of the buccal cavity by brushing, flossing,
irrigating,
massaging or use of other devices.
2 PURPOSES:
2.1 To keep the mucosa and lips clean, soft, moist, and intact.
2.2 To prevent infection.
2.3 To remove food debris and dental plaques.
2.4 To alleviate pain, discomfort, and enhance oral intake.
2.5 To prevent halitosis/tooth decay and freshen the mouth.
3 INDICATIONS:
3.1 Dysphagia or difficulty of swallowing
3.2 Febrile condition
3.3 Unconscious patient
3.4 Dehydrated patients
3.5 Artificial feeding
4
4.1 Towel
4.2 Curved basin (emesis basin)
4.3 Disposable clean gloves
4.4 Bite-block to hold the mouth open and teeth apart (optional)
4.5 Toothbrush
4.6 Cup of tepid water
4.7 Dentifrice or denture cleaner
4.8 Tissue or piece of gauze to remove dentures (optional)
4.9 Denture container, as needed
4.10Mouthwash
4.11Rubber-tipped bulb syringe
4.12Suction catheter with suction apparatus (optional)
4.13Foam swabs and cleaning solution for cleaning the mucous
membranes
4.14Petroleum jelly (Vaseline)
4.15Brushing and flossing
4.15.1 Towel
4.15.3 Curved basin (emesis basin)
4.15.4 Toothbrush
4.15.5 Cup of tepid water
4.15.6 Dentifrice (toothpaste)
4.15.7 Mouthwash
4.15.8 Dental floss, at least two pieces 20 cm (8 in) in length
283
4.15.9 Floss holder (optional)
Republic of
Yemen 48Modern
Hospital
48
4.16Cleaning artificial dentures

4.16.2 Tissue or piece of gauze
4.16.3 Denture container
4.16.4 Clean washcloth
4.16.5 Toothbrush or stiff-bristled brush
4.16.6 Dentifrice or denture cleaner
4.16.7 Tepid water
4.16.8 Container of mouthwash
4.16.9 Curved basin (emesis basin)
4.16.10Towel
5
POLICIES:
5.1 Rendered to all partially and totally dependent patients as mentioned above.
5.2 Mouthwash should be given after each meal or four times a day.
5.3 Observe aspiration precaution for unconscious patient.
5.4 Ensure safety to prevent infection.
5.5 Artificial teeth should be removed and cleaned well.
5.6 If patient is able to gargle, he/she is permitted.
6
PREPARATIONS:
6.1 Assess:
6.1.1 Inspect lips, gums, oral mucosa, and tongue for deviations from normal.
6.1.2 Identify presence of oral problems such as tooth caries, halitosis, gingivitis,
loose or
broken teeth.
6.1.3 Assess for gag reflex, when appropriate.
6.1.4 The extent of the clients self-care abilities
6.1.5 The clients usual mouth care practices
6.1.6 Inspect lips, gums, oral mucosa, and tongue for deviations from normal.
6.1.7 For presence of oral problems such as tooth caries, halitosis, gingivitis, or
loose
or
PROCEDURES:
broken
teeth
7.1 Explain
to the
client and the family what you are going to do and why it is
6.1.8
The
client
for bridgework or dentures.
necessary.
7
6.2
Assemble
equipment
andother
supplies:
7.2 Wash hands and observe
appropriate infection control procedures.
7.4.1 Position the unconscious client in a side-lying position, with the head of the
bed lowered.
7.4.2 Place the towel under the clients chin.
7.4.3 Place the curved basin against the clients chin and lower cheek to receive the
fluid from
the mouth.
7.5 Clean the teeth and rinse the mouth.
7.5.1 If the client has natural teeth, brush the teeth. If the client has artificial teeth,
clean them.
7.5.2 Rinse the clients mouth by drawing about 10 mL of water or alcohol-free
mouthwash
into the syringe and injecting it gently into each side of the mouth.
7.5.3 Watch carefully to make sure that all the rinsing solution has run out of the
mouth into
the basin. If not, suction the fluid from the mouth.
7.5.4 Repeat rinsing until the mouth is free of dentifrice, if used.
7.6 Inspect and clean the oral tissues.
284
7.6.1 If the tissues appear dry or unclean, clean them with the foam swabs or gauze
and
cleaning solution, following agency policy.
Republic of
Yemen 48Modern
Hospital
48
7.6.2 Picking up a moistened foam swab, wipe the mucous membrane of one cheek.
If no foam
swabs are available, wrap a small gauze square around a tongue blade and
moisten it.
7.6.3 Discard the swab or tongue blade in a waste container and, with a fresh one,
clean the
next area.
7.6.4 Clean all the mouth tissues in an orderly progression, using separate
applicators: the
cheeks, roof of the mouth, base of the mouth, and tongue.
7.6.5 Observe the tissues closely for inflammation and dryness.
7.6.6 Rinse the clients mouth.
7.97.6.7
Brushing
andand
Flossing
thegloves.
Teeth
Remove
discard
Explain
the client what you are going to do, why it is necessary, and how she
7.7 7.9.1
Ensure
client to
comfort.
can
7.7.1 Remove the basin, and dry around the clients mouth with the towel.
7.7.2 cooperate.
Replace artificial dentures, if indicated.
7.9.2Lubricate
Wash hands
observe
otherpetroleum
appropriate
infection
control
procedures.
7.7.3
theand
clients
lips with
jelly.
If the client
is on
oxygen
7.9.2.1
Assist the client to a sitting position in bed, if health permits. If not, assist
therapy,
do not
the client
use petroleum jelly, because it can cause burns to the skin and mouth. Use
to a side-lying position with the head turned.
another mouth
7.9.3
Prepare
thethat
equipment.
care
product
does not have petroleum in it.
7.9.3.1 Place the towel under the clients chin.
7.8 Document:
7.9.3.2
Put on of
clean
7.8.1
Assessment
the gloves.
teeth, tongue, gums, and oral mucosa
7.9.3.3
Moisten the
of or
the
toothbrush with
tepid water
andgums
apply the
7.8.2
Any problems
suchbristles
as sores
inflammation
and swelling
of the
dentifrice to the
toothbrush.
7.9.3.4 Use a soft toothbrush and the clients choice of dentifrice.
7.9.3.5 For the client who must remain in bed, place or hold the curved basin
under the
clients chin, fitting the small curve around the chin or neck.
7.9.3.6 Inspect the mouth and teeth.
7.9.4 Brush the teeth.
7.9.5 Hand the toothbrush to the client, or brush the clients teeth as follows:
7.9.5.1 Hold the brush against the teeth with the bristles at a 45-degree angle
7.9.5.2 The tips of the outer bristles should rest against and penetrate under the
gingival
7.9.5.3 Move the bristles up and down, using a vibrating or jiggling motion from
the sulcus
to the crowns of the teeth.
7.9.5.4 Repeat until all outer and inner surfaces of the teeth and sulci of the
gums are
cleaned.
7.9.5.5 Clean the biting surfaces by moving the brush back and forth over them in
short
strokes.
7.9.5.6 If the tongue is coated, brush it gently with the toothbrush.
7.9.5.7 Hand the client the water cup or mouthwash to rinse the mouth
vigorously. Then ask
the client to spit the water and excess dentifrice into the basin.
7.9.5.8 Repeat the preceding steps until the mouth is free of dentifrice and food
particles.
7.9.5.9 Remove the curved basin and help the client wipe her mouth.
7.9.6 Floss the teeth. Assist the client to floss independently, or floss the teeth as
follows:
285
7.9.6.1 Wrap one end of the floss around the third finger of each hand.
7.9.6.2 To floss the upper teeth, use your thumb and index finger to stretch the
floss.
Republic of
Yemen 48Modern
Hospital
48
7.9.6.3 Move the floss up and down between the teeth from the tops of the
crowns to the
gum and along the gum lines as far as possible.
7.9.6.4 Make a C with the floss around the tooth edge being flossed.
7.9.6.5 Start at the back on the right side and work around to the back of the left
side, or
work from the center teeth to the back of the jaw on either side.
7.10Variation:
Artificial
Dentures
7.9.6.6 To floss
the lower
teeth, use your index fingers to stretch the floss and
7.10.1 Remove the dentures.
follow
7.10.1.1Put
onas
gloves.
instructions
above.
7.10.1.2If
the client
client tepid
cannot
remove
the dentures,
take the tissue
gauze,
grasp
7.9.6.7
Give the
water
or mouthwash
to rinse
mouth or
and
a
the upper
curved
basin in
plate
the
front
teeth with your thumb and second finger, and move the
which
to at
spit
the
water.
denture
upAssist the client in wiping the mouth.
7.9.6.8
andand
down
slightly.
7.9.7 Remove
dispose
of equipment appropriately.
7.10.1.3Lower
theclean
upper
plate,
move
it out of the mouth, and place it in the
7.9.7.1
Remove and
the
curved
basin.
denture
7.9.7.2 Remove and discard the gloves.
container.
7.9.8 Document
assessment of the teeth, tongue, gums, and oral mucosa.
7.10.1.4 Lift the lower plate, turning it so that the left side, for example, is
slightly lower
than the right, to remove the late from the mouth without stretching the lips.
Place
the lower plate in the denture container.
7.10.1.5Remove a partial denture by exerting equal pressure on the border of
each side of
the denture, not on the clasps, which can bend or break.
7.10.2 Clean the dentures.
7.10.2.1Take the denture container to a sink.
7.10.2.2Using a toothbrush or special stiffbristled brush, scrub the dentures with
the
cleaning agent and tepid water.
7.10.2.3Rinse the dentures with tepid running water.
7.10.2.4If the dentures are stained, soak them in a commercial cleaner.
7.10.3 Inspect the dentures and the mouth.
7.10.3.1Observe the dentures for any rough, sharp, or worn areas that could
irritate the
tongue or mucous membranes of the mouth, lips, and gums.
7.10.3.2Inspect the mouth for any redness, irritated areas, or indications of
infection.
7.10.4 Assess the fit of the dentures.
7.10.5 Return the dentures to the mouth.
7.10.5.1Offer some mouthwash and a curved basin to rinse the mouth. If the client
cannot
insert the dentures independently, insert the plates one at a time.
7.10.5.2Hold each plate at a slight angle while inserting it, to avoid injuring the
lips.
7.10.6 Assist the client as needed.
7.10.6.1Wipe the clients hands and mouth with the towel.
7.10.6.2If the client does not want to or cannot wear the dentures, store them in a
denture
container with water.
286
7.10.7 Label the cup with the clients name and identification number.
7.10.8 Remove and discard gloves.
7.10.9 Document all assessments and include any problems.
Republic of
Yemen 48Modern
48
Hospital
REFERENCE:
8
7th Edition
287
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Nail Care / Foot Care

CONTENTS: This General Ward policy and procedure deals with the procedure in rendering
nail/foot
care.
1 DEFINITION:
1.1 Nail and foot care - a special care and attention given to the feet and nails.
2 PURPOSES:
2.1 To promote cleanliness.
2.2 Controls odor and prevent infection.
2.3 Stimulate good circulation.
2.4 To prevent nails from injuring self or others.
3.2 Basin with warm water
3.3 Soap
3.4 Antiseptic solution, as ordered
3.5 Soft nail brush
3.6 Pumice stone
3.7 Nail scissors and cutter
3.8 Nail pusher and nail pile
3.9 Foot powder
3.10Emollient
3.11Underpad
3.12Towel/wash cloth
4 POLICIES:
4.1 Nail and foot care should be given along with bath or as required.
4.2 Observe infection control measures.
5
PROCEDURES:
5.2 Wash hands before and after the procedure. Wear gloves during procedure.
5.3 Assist patient to be in comfortable position.
5.4 Assess for signs and symptoms of abnormalities.
5.5 Check water temperature as per patients tolerance.
5.6 Soak patients feet/hands in the basin for 2-10 minutes.
5.7 Perform required care as follows:
5.7.1 Foot care:
5.7.1.1 Apply soap, rub gently over feet including interdigitals to ensure thorough
cleaning
and stimulate circulation.
5.7.1.2 Smoothen thick or dry area of tarsus with pumice stone, unless
contraindicated.
5.7.1.3 Rinse feet to remove soap and residues.
5.7.1.4 Dry feet with towel.
5.7.1.5 Apply foot powder between and under toes, unless contraindicated.
5.7.1.6 Check pulse, turgor and capillary 288
refill.
Republic of
Yemen 48Modern
48
Hospital
5.7.2 Nail Care:

5.7.2.1 Dry and place fingers or toes on the blue pad.
5.7.2.2 Trim nails carefully in oval shape or per patients desire.
5.7.2.3 Pile nails to enhance shape and smoothen nail edges.
5.7.2.4 Push cuticles gently with nail pusher, cut cuticles with nail scissors.
5.7.2.5 Remove dirt under nails with nail pusher edge and smoothen nail surface
with nail
brush.
5.7.2.6 Apply emollient around the cuticles to prevent skin chaff.
5.8 Educate patient about self-care, during the procedure.
5.9 Aftercare of equipment and remove gloves.
5.10.1 Procedure done.
5.10.2 Tolerance.
5.10.3 Any abnormality observed.
6
6.1 Commercial polish and cuticle removers should not be used.
6.2 Podiatrist should be consulted when corns and calluses are present.
6.2.1 Non-prescribed preparation should not be used to treat athletes foot and
ingrown
toenails, as it may contain composition that may lead to skin reaction/infection.
6.3 Keep feet clean and dry before wearing socks/stockings and shoes.
6.4 Advice patient to break in new shoes gradually, begin on a half hour of wear on the
first day and
increase time by an hour a day.
6.5 Instruct to report immediately, if any of the following signs are noticed:
6.5.1 Infection or inflammation
6.5.2 Ingrown nails
6.5.3 Breakage of skin in the interdigital areas
6.5.4 Corns or calluses
6.5.5 Burns and pressure
289
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Nasogastric Tube Feeding
nasogastric
tube feeding.
1 DEFINITION:
1.1 Nasogastric Tube (NGT) Feeding - a method of administering a nutritional
supplement or
commercially prepared feeds through a nasogastric tube into the gastro-intestinal
tract.
2 PURPOSES:
2.1 To maintain optimal nutritional status by providing adequate amount of all nutrients.
2.2 To preserve the normal sequence of intestinal and hepatic metabolism.
2.3 To maintain fat metabolism and lipoprotein synthesis.
3 INDICATIONS:
3.1 Patient who has dysphagia.
3.2 Oral or esophageal obstruction.
3.3 Trauma.
3.4 Unconscious or intubated patient.
3.5 Patient who had undergone gastro-intestinal tract surgery.
4.1 Patient with absent bowel sounds
4.2 Suspected intestinal obstruction
4.3 Dysfunctional gag reflex
5.1 Feeding formula/solution
5.2 Calibrated container
5.3 Syringe 60ml. catheter tip
5.4 Sterile water
5.5 Emesis basin
5.6 Stethoscope
5.7 Blue sheet
5.9 Nasogastric tube (NGT) cover
5.10IV pole
5.11Feeding tube
5.12Pump machine
5.13Mepore dressing
5.14Sterile gauze
5.15Adhesive tape
6 POLICIES:
6.1 Administer feeding solution at room temperature.
6.3 Confirm the placement of the tube before administering feeding solution by checking
for gastric
residual or by auscultating the stomach for gurgling sound while injecting 5-10cc of
air.
290
6.4 Only commercially prepared feeding should be used.
6.5 Keep intake and output record.
Republic of
Yemen 48Modern
Hospital
48
PREPARATIONS:
7
7.1 Assess:
7.1.1 For any clinical signs of malnutrition or dehydration.
7.1.2 For allergies to any food in the feeding.
7.1.3 For the presence of bowel sounds.
7.1.4 For any problems that suggest lack of tolerance of previous feedings.
7.2 Determine:
7.2.1 Type, amount, and frequency of feedings
7.2.2 Tolerance of previous feedings
7.3.1 Correct amount of feeding solution
7.3.2 20- to 50-mL syringe with an adapter
7.3.3 Emesis basin
7.3.5 Large syringe with plunger, or calibrated plastic feeding bag with tubing
7.3.6 pH test strip or meter
7.3.7 Measuring container from which to pour the feeding
7.3.8 Water at room temperature
7.3.9 Feeding pump as required
PROCEDURES:
7.4
Assistdoctors
the client
to a for
Fowlers
position
infrequency.
bed, or a sitting position in a chair.
8.1 Verify
order
rate, route,
and
7.4.1
If
a
sitting
position
is
contraindicated,
a slightly
elevated
right
side-lying
8.2 Explain to the client what you are going to do,
why it is
necessary,
and
how he can
position
is
cooperate.
8.3 Washacceptable.
hands and observe other appropriate infection control procedures.
8.5 Assess tube placement.
8
8.5.1 Attach the syringe to the open end of the tube, and aspirate alimentary
secretions. Check
the pH.
8.5.2 Allow 1 hour to elapse before testing the pH, if the client has received a
medication
8.5.3 Use a pH meter rather than pH paper, if the client is receiving a continuous
feeding or if
food coloring has been added to the formula.
8.6 Assess residual feeding contents.
8.6.1 Aspirate all the stomach contents, and measure the amount before
administering the
feeding.
8.6.2 If 100 mL (or more than half the last feeding) is withdrawn, check before
proceeding
with the nurse in charge or refer to agency policy
8.6.3 Reinstill the gastric contents into the stomach, if this is the agency policy or
physicians
order. Remove the syringe bulb or plunger, and pour the gastric contents via the
syringe
into the nasogastric tube.
8.6.4 If the client is on a continuous feeding, check the gastric residual every 46
hours
8.7 Administer the feeding.
8.7.1 Before administering feeding:
8.7.1.1 Check the expiration date of the feeding.
8.7.1.2 Warm the feeding to room temperature.
8.7.1.3 When an open system is used, clean the top of the feeding container with
alcohol
before opening it.
8.7.2 Feeding Bag (Open System)
291
8.7.2.1 Hang the bag from an infusion pole about 30 cm (12 in) above the tubes
point of
insertion into the client.
8.7.2.2 Clamp the tubing, and add the formula to the bag.
8.7.2.3 Open the clamp, run the formula through the tubing, and reclamp the
tube.
8.7.2.4 Attach the bag to the nasogastric/nasoenteric tube, and regulate the drip
Republic of
by adjusting
the clamp
to the drop factor on the bag.
Yemen
48Modern
48
8.7.3 Syringe (Open System)
Hospital
8.7.3.1 Remove the plunger from the syringe, and connect the syringe to a
pinched or
clamped nasogastric tube.
8.7.3.2 Add the feeding to the syringe barrel.
8.7.3.3 Permit the feeding to flow in slowly at the prescribed rate.
8.7.3.4 Raise or lower the syringe to adjust the flow as needed.
8.7.3.5 Pinch or clamp the tubing to stop the flow for a minute, if the client
experiences
discomfort.
8.7.4 Prefilled Bottle with Drip Chamber (Closed System)
8.7.4.1 Remove the screw-on cap from the container, and attach the
administration set with
the drip chamber and tubing.
8.7.4.2 Close the clamp on the tubing.
8.7.4.3 Hang the container on an intravenous pole about 30 cm (12 in) above the
tubes
insertion point into the client.
8.7.4.4 Squeeze the drip chamber to fill it to one-third to one-half of its capacity.
8.7.4.5 Open the tubing clamp, run the formula through the tubing, and reclamp
the tube.
8.7.4.6 Attach the feeding set tubing to the feeding tube, and regulate the drip
rate to
deliver the feeding over the desired length of time.
8.8 Rinse the feeding tube immediately before all of the formula has run through the
tubing.
8.8.1.1 Instill 50100 mL of water through the feeding tube.
8.8.1.2 Be sure to add the water before the feeding solution has drained from the
neck of a
syringe, or from the tubing of an administration set.
8.9 Clamp and cover the feeding tube.
8.9.1.1 Clamp the feeding tube before all of the water is instilled.
8.9.1.2 Cover the end of the feeding tube with gauze held by an elastic band.
8.10Ensure client comfort and safety.
8.10.1.1Pin the tubing to the clients gown.
8.10.1.2Ask the client to remain sitting upright in Fowlers position or in a
slightly elevated
right lateral position for at least 30 minutes.
8.11Dispose of equipment appropriately.
8.11.1.1If the equipment is to be reused, wash it thoroughly with soap and water,
so that it is
ready for reuse.
8.11.1.2Change the equipment every 24 hours or according to agency policy.
8.12Document all relevant information.
8.12.1.1Document the feeding, including amount and kind of solution taken,
duration of the
feeding, and assessments of the client.
8.12.1.2Record the volume of the feeding and water administered on the clients
intake and
output record.
8.13Monitor the client for possible complications.
8.13.1.1Carefully assess clients receiving tube feedings for problems
8.13.1.2To prevent dehydration, give the client supplemental water in addition to
the
prescribed tube feeding, as ordered.
8.13.2 Variation: Continuous-Drip Feeding
8.14If the feeding is a continuous-drip tube feeding, place a label on the container.
8.14.1.1Clamp the tubing at least every 46 hours or as indicated by agency
292
protocol or the
manufacturer, and aspirate and measure the gastric contents. Then flush the
tubing
with 3050 mL of water.
8.14.1.2 Determine agency protocol regarding withholding a feeding.
Republic of
Yemen 48Modern
48
Hospital
8.14.1.3To prevent spoilage or bacterial contamination, do not allow the feeding

solution to
hang longer than 48 hours.
8.14.1.4Follow agency policy regarding how frequently to change the feeding bag
and
tubing.
9
8.15Charge
the supplies used in the Inpatient Charging Form
9.1 Feeding is instilled at an angle of 45o so that air does not enter the stomach.
9.2 Evaluate patients tolerance from tube feeding by checking amount of aspirated
residual every 4
hours, because gastric and intestinal contents can cause injury and necrosis at stoma
site.
10 REFERENCE:
Edition
293
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Nasogastric Tube Insertion
CONTENTS: This General Ward policy and procedure deals with nasogastric tube insertion.
1 DEFINITION:
1.1 Nasogastric tube (NGT) insertion - a procedure wherein a nasogastric tube is inserted
into the
stomach through the nose for diagnostic and therapeutic purposes.
2 PURPOSES:
2.1 To assess and treat upper gastrointestinal bleeding.
2.2 To aspirate gastric secretions to collect gastric contents for analysis.
2.3 To perform gastric lavage.
2.4 To sustain nutritional needs.
2.5 To administer medication.
2.6 To prevent or relieve nausea and vomiting after surgery by decompressing the
stomach.
3.1 NGT # 14 or 16
3.2 Underpad
3.3 Tissues
3.4 Emesis basin
3.5 Penlight
3.6 Non-allergenic tape
3.7 Water-soluble lubricant
3.8 Stethoscope
3.9 Normal saline
3.10Sterile and disposable gloves
3.11Asepto syringe
3.12Thermometer
3.13Sphygmomanometer
3.14Sterile gauze
4 POLICIES:
4.2 Proper information regarding the procedure, outcome, and undesirable effect must be
explained
prior to the procedure.
4.3 NGT should be changed every 2 weeks, as required.
4.4 Ensure safety by observing aspiration precaution.
4.5 Follow standard infection control measures.
4.6 Primary responsibility of PREPARATIONS:
the doctor, assisted by the nurse except in ICU wherein5the
5.1 Assess:
nurses are
5.1.1 Patency of nares and intactness of nasal tissues
allowed.
5.1.2 For history of nasal surgery or deviated septum
5.1.3 Presence of gag reflex
5.1.4 Mental status or ability to cooperate with
procedure
294
Republic of
Yemen 48Modern
Hospital
48
5.2 Determine:
5.2.1 The size of tube to be inserted
5.2.2 Whether the tube is to be attached to suction
5.3.1 Large- or small-bore tube
5.3.2 Guide wire or stylet for smallbore tube
5.3.3 Solution basin filled with warm water (if a plastic tube is being used) or ice (if a
rubber
tube is being used)
5.3.4 Nonallergenic adhesive tape, 2.5 cm (1 in) wide
5.3.7 Facial tissues
5.3.8 Glass of water and drinking straw
5.3.9 20- to 50-mL syringe with an adapter
5.3.10 Basin
5.3.11 pH test strip or meter
5.3.12 Stethoscope
5.3.13 Disposable pad or towel
5.3.14 Clamp or plug (optional)
PROCEDURES:
5.3.15 Suction
apparatus,
if required
6.1 Explain
to the client
what you
are going to do, why it is necessary, and how he can
5.3.16
Gauze
square
or
plastic
specimen bag and elastic band
cooperate.
5.3.17
Safety
pin
and
elastic
band
5.4Provide
Assist the
a high-Fowlers position if his health condition permits, and
6.3
for client
client to
privacy.
support
his
head
6.4 Assess the clients nares.
on a pillow.
6.4.1
Ask the client to hyperextend his head, and, using a flashlight, observe the 6
intactness of
the tissues of the nostrils, including any irritations or abrasions.
6.4.2 Examine the nares for any obstructions or deformities by asking the client to
breathe
through one nostril while occluding the other.
6.4.3 Select the nostril that has the greater airflow.
6.5 Prepare the tube.
6.5.1 If a rubber tube is being used, place it on ice for 5 to 10 minutes. If a plastic
tube is being
used, place it in warm water until the tube is softer and more flexible.
6.5.2 If a small-bore tube is being used, insert stylet or guide wire into the tube,
making sure
that it is secured in position.
6.6 Determine how far to insert the tube.
6.6.1 Use the tube to mark off the distance from the tip of the clients nose to the tip
of the
earlobe and then from the tip of the earlobe to the tip of the xyphoid.
6.6.2 Mark this length with adhesive tape, if the tube does not have markings.
6.7 Insert the tube.
6.7.2 Lubricate the tip of the tube well with water-soluble lubricant or water, to ease
insertion.
6.7.3 Insert the tube, with its natural curve toward the client, into the selected
nostril. Ask the
client to hyperextend the neck, and gently advance the tube toward the
nasopharynx.
6.7.4 Direct the tube along the floor of the nostril
295 and toward the ear on that side.
6.7.5 Slight pressure is sometimes required to pass the tube into the nasopharynx,
and some
clients eyes may water at this point.
Provide the client with tissues, as needed.

If the tube meets resistance, withdraw it, relubricate it, and insert it in the
other nostril.
Once the tube reaches the oropharynx (throat), the client will feel the tube in
Republic of
the throat,
and may48Modern
gag and retch.
Yemen
48
6.7.9 Ask the client to tilt his head forward, and encourage the client to drink and
Hospital
swallow
6.7.10 If the client gags, stop passing the tube momentarily. Have the client rest,
take a few
breaths, and take sips of water to calm the gag reflex.
6.7.11 In cooperation with the client, pass the tube 510 cm (24 in) with each
6.7.6
swallow, until
6.7.7
the indicated length is inserted.
6.7.8
6.7.12 If the client continues to gag, and the tube does not advance with each
swallow, withdraw
it slightly, and inspect the throat by looking through the mouth.
6.8 Ascertain correct placement of the tube.
6.8.1 Aspirate stomach contents, and check the pH.
6.8.2 Auscultate air insufflation by placing a stethoscope over the clients
epigastrium and
injecting 1030 mL of air into the tube while listening for a whooshing sound.
6.8.3 If the signs do not indicate placement in the stomach, advance the tube 5 cm (2
in), and
repeat the tests.
6.8.4 If a small-bore tube is used, leave the stylet or guide wire in place until correct
position is
verified by x-ray.
6.9 Secure the tube by taping it to the bridge of the clients nose.
6.9.1 If the client has oily skin, wipe the nose first with alcohol.
6.9.2 Cut 7.5 cm (3 in) of tape, and split it lengthwise at one end, leaving a 2.5- cm
(1-in) tab
at the end. Place the tape over the bridge of the clients nose, and bring the split
ends
either under and around the tubing, or under the tubing and back up over the
nose.
6.10Attach the tube to a suction source or feeding apparatus, as ordered, or clamp the
end of the
tubing.
6.10.1 The tube, if inserted preoperatively, is usually clamped or plugged, or it may
be covered
with a gauze square or plastic specimen bag and an elastic band.
6.11Secure the tube to the clients gown.
6.11.1 Loop an elastic band around the end of the tubing, and attach the elastic band
to the gown
with a safety pin. Or
6.11.2 Attach a piece of adhesive tape to the tube, and pin the tape to the gown.
6.12Document relevant information.
6.12.1 Document the insertion of the tube, the means by which correct placement
was
determined, and client responses.
6.13Establish a plan for providing daily nasogastric tube care.
6.13.1 Inspect the nostril for discharge and irritation.
6.13.2 Clean the nostril and tube with moistened, cotton-tipped applicators.
6.13.3 Apply water-soluble lubricant to the nostril, if it appears dry or encrusted.
6.13.4 Change the adhesive tape as required.
6.13.5 Give frequent mouth care. The client may breathe through the mouth, and
cannot drink.
6.14If suction is applied, ensure that the patency of both the nasogastric and suction
tubes is
maintained.
6.14.1 Irrigations of the tube with 30 mL of normal saline may be required at regular
intervals.
6.14.2 Keep accurate records of the clients fluid intake and output, and record the
296
amount and
characteristics of the drainage.
6.14.3 Document the type of tube inserted, date and time of tube insertion, type of
suction used,
color and amount of gastric contents, and the clients tolerance of the
Republic of
Yemen 48Modern
48
Hospital
6.15.2 When the tube has advanced to the premarked point, test the pH of the
aspirate to
determine placement in the intestine.
6.15.3 Have proper placement confirmed by x-ray, and tape the tube in place when
confirmation
is received.
7
7.1 Patient with nasogastric tube should have a routine mouth and nares care.
7.2 Maintain and check patency of the tube every 4 hours.
7.3 If nasogastric tube is for drainage, note the color and amount of drainage.
7.4 Maintain an intake and output recording every 12 hours and/or as ordered
8
by the doctor.
REFERENCE:
8.1.Fundamentals of Nursing concepts, process, and practice 7th Edition
297
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Nasogastric Tube Removal
CONTENTS: This General Ward policy and procedure deals with nasogastric tube removal.
1 DEFINITION:
1.1 Nasogastric tube removal - withdrawing/pulling off the NGT in place per medical
advises of
the doctor.
2 PURPOSES:
2.1 To provide comfort.
2.2 To prevent occurrence of complication like gastric ulceration, sinusitis, esophagitis,
pulmonary
and oral infection, skin erosion at the nostril.
2.3 When a maximum therapeutic effect is achieved.
3.1 Stethoscope
3.2 Syringe catheter tip (Asepto syringe)
3.3 Emesis basin
3.5 Penlight, tongue depressor
3.6 Normal saline
3.7 Mouthwash
3.8 Disposable gown (optional)
3.9 Underpads, tissues
4 POLICIES:
4.1 Obtain physicians order for removal of NG tube.
4.3 Primarily the responsibility of the nurse unless difficulties are encountered.
5 PREPARATIONS:
5.1 Assess:
5.1.1 For the presence of bowel sounds
5.1.2 For the absence of nausea or vomiting when tube is clamped
5.2.1 Disposable pad
5.2.2 Tissues
5.2.4 50-mL syringe (optional)
5.2.5 Plastic disposable bag
5.3 Confirm the physicians order to remove the tube.
5.4 Assist the client to a sitting position, if health permits.
5.5 Place the disposable pad across the clients chest to collect any spillage of mucous
and gastric
secretions from the tube.
5.6 Provide tissues to the client to wipe the nose and mouth after tube removal.
PROCEDURES:
6.1 Explain to the client what you are going to do, why it is necessary, and how she can cooperate.
298
Republic of
Yemen 48Modern
6.2 Explain to the client what you are going to do, why it is necessary, and how she can cooperate.
48
Hospital
299
Republic of
Yemen 48Modern
48
Hospital

6.4 Detach the tube.
6.4.1 Disconnect the nasogastric tube from the suction apparatus, if present.
6.4.2 Unpin the tube from the clients gown.
6.4.3 Remove the adhesive tape securing the tube to the nose.
6.5 Remove the nasogastric tube.
6.5.1 Put on disposable gloves.
6.5.2 Optional: Instill 50 mL of air into the tube.
6.5.3 Ask the client to take a deep breath and to hold it.
6.5.4 Pinch the tube with the gloved hand. Quickly and smoothly, withdraw the tube.
6.5.5 Place the tube in the plastic bag.
6.5.6 Observe the intactness of the tube.
6.6 Ensure client comfort.
6.6.1 Provide mouth care, if desired. Assist the client as required to blow her nose.
6.7 Dispose of the equipment appropriately.
6.7.1 Place the pad, bag with tube, and gloves in the receptacle designated by the
agency.
6.8 Assess the nasogastric drainage, if suction was used.
6.8.1 Measure the amount of gastric drainage, and record it on the clients fluid
output record.
6.8.2 Inspect the drainage for appearance and consistency.
6.9 Document all relevant information.
6.9.1 Record the removal of the tube, the amount and appearance of any drainage, if
connected
7
REFERENCE:
to suction, and
any relevant assessments of the client.
7th Edition
300
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

CONTENTS: This General Ward policy and procedure deals with the nursing care of epileptic
Title: Nursing Care of Epileptic Client
client.
1 DEFINITION:
1.1 Epilepsies - are symptom complex of several disorders of brain function characterized
by
recurring seizures. Thus epilepsy is not a disease but a symptom. There may be
associated loss of
consciousness, excess movement or loss of muscle tone or movement, and disturbance
of
behavior, mood, sensation and perception.
1.1.1 Seizures are episodes of abnormal motor, sensory, autonomic, or psychic activity
(or a
combination of these) resulting from sudden excessive discharge from cerebral
neurons.
The seizures usually are sudden and transient.
1.1.2 Classification of Epileptic Seizures
1.1.2.1 Partial Seizures
1.1.2.1.1 Simple partial (consciousness retained)
1.1.2.1.1.1 Motor
1.1.2.1.1.2 Sensory
1.1.2.1.1.3 Autonomic
1.1.2.1.1.4 Psychic
1.1.2.1.2 Complex partial (consciousness impaired)
1.1.2.1.2.1 Simple partial followed by impaired consciousness
1.1.2.1.2.2 Consciousness impaired at onset
1.1.2.2 Partial seizures with secondary generalization
1.1.2.2.1 Generalized Seizures
1.1.2.2.1.1 Absences
1.1.2.2.1.1.1 Typical (absence of involuntary movements or incontinence)
1.1.2.2.1.1.2 Atypical (clinically resembles typical absences seizures and
frequently associated with mental retardation)
1.1.2.2.2 Generalized Tonic-clonic (Grand Mal Seizure) involve bilateral tonic
extension of extremities and followed by synchronous bilateral jerky
movements.
1.1.2.2.3 Tonic - exhibit only one phase of the previously described tonic-clonic
activity.
1.1.2.2.4 Clonic - same as above
1.1.2.2.5 Myoclonic - typified by synchronous, asymmetrical rapid jerking of one
or
more extremity, the trunk or a specific muscle group. No loss of
consciousness.
1.1.2.2.6 Atonic - there is usually loss of consciousness but the episode maybe
so
brief that the patient is unaware of the blackout.
1.1.2.3 Unclassified Seizures - seizures that do not fit any of the aforementioned
classifications, clinically or electrographically they do not meet the criteria of
the
established categories.
301
2 PURPOSES:
2.1 To ensure safety during the seizures attack.
2.2 To prevent complications.
Republic of
Yemen 48Modern
Hospital
48
3
3.1 Padded siderails
3.2 Suction machine
3.3 Suction catheter
3.4 Padded tongue depressor
3.5 Oxygen tank with oxygen devices
3.6 Penlight
3.7 Oral airway
3.8 Sphygmomanometer and
stethoscope
3.9 Blue sheets
3.10Towels
3.11Gauze
3.12Disposable gloves
3.13Mask
3.14Additional pillows
3.15Thermometer
POLICIES:
4
PROCEDURES:
4.1 Ensure patients safety at all time.
5.1 Admission of patient with history of seizure.
4.2 Observe fall and aspiration precautions.
5.1.1 Preparation of the unit.
4.3 Follow hospital infection control
5.1.1.1 Gather all equipments and supplies
needed.
measures.
5.1.2 Orientation of the patient and relatives to the unit.
5.1.3 Admission care. Check vital signs. Establish IV line. Check doctors order for 5
blood
investigation prior to treatment.
5.1.4 Assessment of patients general status:
5.1.4.1 Thorough physical assessment
5.1.4.2 History taking about seizure onset, pattern and precipitating events
5.2 Give the following health instructions:
5.2.1 Encourage patient to study himself and his environment to determine what
specific factors
precipitate his seizures - illness, emotional and physical stress, altered sleep
pattern,
photosensitivity, hyperventilation, menses or other sensory stimulant - and to
avoid them.
5.2.2 Have one member of the family stay with the patient always.
5.2.3 Dentures should be removed if seizure is preceded by aura.
5.3 During seizure attack:
5.3.1 Provide privacy and protect the patient from curious onlookers.
5.3.2 If the patient is in bed, support the head and foot part of the bed with pillow.
5.3.3 If the patient is ambulatory, ease him to the floor if there is enough time. Push
aside any
furniture that may injure the patient during attack.
5.3.4 Loosen constrictive clothing.
5.3.5 If an aura precedes the seizure, insert an oral airway to reduce the possibility
of the
tongue or cheek being bitten.
5.3.6 Do not attempt to open jaws that are clenched in a spasm to insert anything.
Broken teeth
and injury to the lips and tongue may result from such an action.
5.3.7 Try to hold the lower jaw forward if the patient is in flaccid stage. Turn his head
to the
side to facilitate drainage of mucus and saliva to prevent aspiration.
5.3.8 If possible, place the patient on one side with head flexed forward, which allows
the
302
tongue to fall forward and facilitates drainage of saliva and mucus. If suction is
available,
use it if necessary to clear secretions.
Republic of
Yemen 48Modern
Hospital
48
5.3.9 Stay with the patient and observe.

5.3.10 Give anticonvulsant as prescribed.
5.4 After the seizures:
5.4.1 Keep the patient on one side to prevent aspiration. Make sure the airway is
patent.
5.4.2 Reorient him to his environment when he awakens.
5.4.3 Assess for injuries that may have occurred during the attack.
5.4.4 Administer oxygen and do suctioning if necessary.
5.4.5 Check vital signs.
5.4.6 Address hygienic needs. Incontinence or profuse sweating is normal during a
seizure.
Give oral care if needed. Refer to mouth/oral hygiene procedure. (GW-092).
5.5.1 Note date, time of onset and duration of seizure.
5.5.2 Note activity of patient at seizure onset.
5.5.3 Determine if precipitating factors were present.
5.5.4 Note body parts involved and sequence of motor activity.
5.5.5 Note for autonomic signs: pupil size and reactivity, respiratory pattern,
cyanosis,
diaphoresis, vomiting incontinence and salivation.
5.5.6
level of consciousness through arousability, duration of reduced
SPECIAL Assess
CONSIDERATIONS:
consciousness,
6.1 The following are the complications of seizures:
awareness
and memory
6.1.1and
Physical
and Dental
injuriesof the event.
5.5.7
for trauma
in Rhabdomyolysis
the mouth and tongue, and in the body.
6.1.2Check
Myoglobinuria
and
6
5.5.8
CheckMyoglobin
for post-ictal
numbness,
weakness,
sensation
6.1.2.1
- is paralysis,
an iron containing
pigment
foundtingling
in skeletal
muscle& vital
signs. 6.1.2.2 Myoglobinuria - excretion of myoglobulin in the urine.
5.6 Charge
supplies
used.
6.1.2.3
Rhabdomyolysis
- an acute fulminating, potentially, fatal disease of
skeletal muscle
which entails destructions of skeletal muscle as evidence of myoglobinuria
6.1.3 Psychological aberrations
6.2 Monitor urine output to check for myoglobinuria.
6.3 No attempt should be made to restrain the patient during the seizure because
muscular
contractions are strong and restraint can produce injury.
6.4 Health Education:
6.4.1 Patient
6.4.1.1 Emphasize the importance of regularity in taking anti-epileptic drugs.
6.4.1.2 Instruct the patient to watch the toxic effects of anti-epileptic medications
such as
drowsiness, gingival hyperplasia, nervousness, visual difficulties, motor
incoordination, staggering ataxia, bone marrow depression leading to blood
dyscrasias.
6.4.1.3 Instruct patient to avoid taking anti-epileptic medication on an empty
stomach to
prevent gastritis.
6.4.1.4 Instruct patient to brush teeth frequently and massage gums to prevent
infection of
the gingiva.
6.4.1.5 Encourage patient to have periodic blood evaluations when taking antiepileptic
drugs that may depress hemopoiesis.
6.4.1.6 Instruct the patient to keep a record of events surrounding his seizures
(number,
duration, time of occurrence).
303
6.4.1.7 Avoid swimming alone or engaging in sports, occupation or hobbies
involving
serious risk.
Republic of
Yemen 48Modern
48
Hospital
6.4.1.8 Avoid emotional over stimulation.

6.4.1.9 Avoid alcohol when seizures are known to follow alcoholic intake.
6.4.1.10Have regular hours for sleep. Avoid sleep deprivation.
6.4.1.11Seek counseling if necessary during periods of crisis such as death in
family, divorce
and etc.
6.4.1.12Report any changes in health status such as easy bruising, purpura,
jaundice, fever,
recurrent infection or dermatoses.
6.4.1.13Regular follow-up with attending physician is necessary.
6.4.1.14Carry a personal identification card stating that the bearer has epilepsy
and the name
of the drug she/he is taking.
6.4.1.15Anti-epileptic drugs must be regarded as potentially teratogenic.
6.4.2 Family
6.4.2.1 Help the family to perceive and cope in a positive manner as possible.
6.4.2.2 Encourage patient or family to discuss feelings and attitude about
epilepsy.
304
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Obtaining a Wound Drainage Specimen
CONTENTS: This General Ward policy and procedure deals with the guidelines on how to
obtain wound
drainage specimen.
1 DEFINITION:
1.1 Wound Drainage Specimen a sample specimen taken from the wound for laboratory
examination.
2 PURPOSES:
2.1 For determine the type of organism present in the wound.
2.2 To prescribe the specific antibiotic that will enhance rapid wound healing.
3 POLICIES:
4 EQUIPMENTS:
4.1 Clean gloves
4.2 Sterile gloves
4.3 Moisture-proof bag
4.4 Sterile dressing set
4.5 Normal saline and irrigating syringe
4.6 Culture tube with swab and culture medium, and/or sterile syringe with needle for
anaerobic
culture
4.7 Completed labels for each container
4.8 Completed requisition to accompany the specimens to the laboratory
5 PREPARATIONS:
5.1 Assess:
5.1.1 Appearance of wound and surrounding tissue
5.1.2 Character and amount of wound drainage
5.1.3 For signs of infection
5.2 Determine:
5.2.1 Whether the wound should be cleaned before taking the specimen
5.2.2 Whether the site from which specimen will be taken has been specified
6
PROCEDURES:
6.1 Explain to the client what you are going to do, why it is necessary, and how she
can cooperate.
6.4 Remove any moist outer dressings that cover the wound.
6.4.2 Remove the outer dressing, and observe any drainage on the dressing.
6.4.3 Hold the dressing so that the client does not see the drainage.
6.4.4 Determine the amount of the drainage.
305
Discard the dressing in the moisture proof bag. Handle it carefully, so that the
dressing
does not touch the outside of the bag.
6.4.6Republic
Remove yourof
gloves and dispose of them properly.
6.4.7 Open the sterile dressing set using sterile technique.
Yemen 48Modern
48
6.4.8 Assess the wound.
Hospital
6.4.8.1
Put on sterile gloves.
6.4.8.2 Assess the appearance of the tissues in and around the wound and the
drainage.
6.4.9 Clean the wound.
6.4.9.1 Irrigate the wound with normal saline until all visible exudates have been
6.4.5
washed
away.
6.4.9.2 After irrigating, apply a sterile gauze pad to the wound.
6.4.9.3 If a topical antimicrobial ointment or cream is being used to treat the
wound, use a
swab to remove it.
6.4.9.4 Remove and discard sterile gloves.
6.4.10 Obtain the aerobic culture:
6.4.10.1Open a specimen tube, and place the cap upside down on a firm, dry
surface, or, if
the swab is attached to the lid, twist the cap to loosen the swab.
6.4.10.2Hold the tube in one hand and take out the swab in the other.
6.4.10.3Rotate the swab back and forth over clean areas of granulation tissue
from the sides
or base of the wound.
6.4.10.4 Do not use pus or pooled exudates to culture.
6.4.10.5 Avoid touching the swab to intact skin at the wound edges.
6.4.10.6Return the swab to the culture tube, taking care not to touch the top or
the outside of
the tube.
6.4.10.7Crush the inner ampule containing the medium for organism growth at
the bottom
of the tube.
6.4.10.8Twist the cap to secure.
6.4.10.9 If a specimen is required from another site, repeat the steps. Specify the
exact site
on the label of each container. Be sure to put each swab in the appropriately
labeled
tube.
6.4.11 Dress the wound.
6.4.11.1Apply any ordered medication to the wound.
6.4.11.2Cover the wound with a sterile moist transparent wound dressing.
6.4.11.3Arrange for the specimen to be transported to the laboratory
immediately. Be sure
to include the completed requisition.
6.4.12.1Record on the clients chart the taking of the specimen and source.
6.4.12.2Include:
6.4.12.2.1 Date and time
6.4.12.2.2 Appearance of the wound
6.4.12.2.3 Color, consistency, amount, and odor of any drainage
6.4.12.2.4 Type of culture collected
6.4.12.2.5 Any discomfort experienced by the client
6.5 Variation: Obtaining a Specimen for Anaerobic Culture
6.5.1 Insert a sterile 10-mL syringe (without needle) into the wound, and aspirate 1
5 mL of
drainage into the syringe.
6.5.1.1 Attach the needle to the syringe, and expel all air from the syringe and
needle.
6.5.1.2 Immediately inject the drainage into the anaerobic culture tube, and cap
the tube
tightly.
6.5.1.3 Use an anaerobic culture swab system
in which the swab is immediately
306
placed into
a tube filled with an oxygen-free gas or gel environment.
6.5.1.4 Label the tube or syringe appropriately.
Republic of
Yemen 48Modern
48
Hospital
6.5.1.5 Send the tube or syringe of drainage to the laboratory

immediately.
6.5.2 Do not refrigerate the specimen.
7
REFERENCE:
7th Edition
307
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Obtaining Specimens for Culture and
Sensitivity
CONTENTS: This General Ward policy and procedure deals with the procedure of obtaining
specimens
for culture and sensitivity.
1 DEFINITION:
1.1 Obtaining Specimens for Culture and Sensitivity a sterile method or technique used
in
obtaining specimen for specific laboratory cultures and sensitivity.
1.1.1 Sputum Culture
1.1.1.1 Tracheostomy tube
1.1.2 Throat Swab Culture
1.1.3 Wound Culture
1.1.4 Stool Culture - Refer to stool specimen collection.
1.1.5 Urine Culture - Refer to urine specimen collection.
1.1.6 Blood Culture - collected by phlebotomist
2 PURPOSES:
2.1 To diagnose fever of unknown origin.
2.2 To determine the casual organism for an obvious infection and to enable the
physician to identify
the drug of choice.
2.3 To determine the source of an epidemic.
2.4 To test for complete resolution of infection, especially in urinary tract infection.
3.1 Sterile specimen bottle
3.3 Tongue depressor
3.4 Penlight
3.5 Sterile swab stick
3.6 Betadine solution
3.7 Sterile gauze
3.8 Underpad
3.9 Kidney basin
4 POLICIES:
4.2 Instructions are thoroughly explained to the patient if he or she is to obtain the
specimen.
4.3 Specimens are send to the laboratory with proper label as soon as they are
obtained.
PROCEDURES:
5
4.4 Culture should be obtained as much as possible prior to the start of antibiotic. If
5.1 Verify
patient
is on doctors order.
5.2antibiotic
Purpose for
thetime
culture
and was
the procedure
for obtaining
are
at the
culture
obtained, the
laboratorythe
slipspecimen
should indicate
the
explained to the patient.
medication
5.3being
Gather
the equipments/supplies according to the type of culture to be obtained:
taken.
Culture
By Patient
4.55.3.1
DoneSputum
and obtained
under
sterile technique.
308
5.3.1.1 Provide sterile sputum container the night before the sputum is to be
collected.
5.3.1.2 Instruct the patient that early morning specimen can be obtained after
rinsing Republic
the
of
mouth with water.
Yemen 48Modern
48
5.3.1.3 Instruct the patient that only sputum that has come from deep within
the
Hospital
lungs
should be collected.
5.3.1.4 At least (4cc) of sputum must be collected in a sterile sputum container.
5.3.1.5 Provide the patient with an ample supply of tissues to wipe the mouth
after
expectorating the sputum.
5.3.1.6 For hygienic reason, wrap the sputum container with paper towels so the
contents
cannot be seen.
5.3.1.7 As soon as the specimen is obtained, wear gloves and clean the external
surface of
specimen container for any spilled sputum.
5.3.1.8 Label the specimen bottle with patients name, pin no., date and time the
specimen
was obtained.
5.3.1.9 Charge the test and send the specimen to the lab with request.
5.3.2 Sputum Culture through Tracheostomy Tube
5.3.2.1 Check the suction machine if functioning well.
5.3.2.2 Wash hands, wear mask and disposable gloves.
5.3.2.3 Position the patient in high or semi fowlers.
5.3.2.4 Clean the surrounding area of tracheostomy site
5.3.2.5 Connect the sterile suction catheter to the suction tube.
5.3.2.6 Remove disposable gloves and put on sterile one.
5.3.2.7 Remove the sterile suction catheter from the package.
5.3.2.8 Insert the catheter into the trachea without suction.
5.3.2.9 Apply suction while gently rotating the catheter.
5.3.2.10Stop suction and remove catheter immediately once the sputum has
collected inside
the tubing.
5.3.2.11Put the suction catheter inside the sterile specimen container labeled
with patients
name, pin number and room number and close immediately.
5.3.2.12Remove gloves, wash hands.
5.3.2.13Keep patient in comfortable position.
5.3.2.14Note consistency and color of specimen obtained in nursing notes.
5.3.2.15Give the laboratory request to the ward secretary for charging and send
through
computer.
5.3.2.16Keep the specimen in the container box and send to laboratory as soon
as possible.
5.3.2.17Charge the supplies used.
5.3.3 Throat Swab Culture
5.3.3.1 Wash hands and wear disposable gloves.
5.3.3.2 Position the patient in semi-fowler or high fowlers.
5.3.3.3 Depress the patients tongue with spatula using penlight as light source.
5.3.3.4 Quickly but gently, rub the swab over the tonsillar fossa or any area with
lesion or
visible exudate.
5.3.3.5 Avoid touching any other area of the mouth or tongue with the swab.
5.3.3.6 After swabbing the area, return the swab stick to its container and closed
it tightly.
5.3.3.7 Remove gloves, wash hands.
5.3.3.8 Label the container with patients name, PIN, date and time specimen is
collected.
5.3.3.9 Charge the request and send through computer.
5.3.3.10Document the procedure done, date and time the specimen was sent.
5.3.3.11Keep the specimen in the container box and send to laboratory as soon
as possible.
309
5.3.3.12Charge the supplies used.
5.3.4 Wound Swab Culture
5.3.4.1 Wash hands and wear disposable gloves.
Republic of
Yemen 48Modern
48
Hospital
5.3.4.2 Provide privacy, keep the patient in a comfortable position depending on

the site of
wound.
5.3.4.3 Remove dressing and assess wound and drainage.
5.3.4.4 Cleanse the skin around the wound to avoid contamination of the
specimen with skin
flora.
5.3.4.5 Remove gloves, wash hands, then wear new gloves.
5.3.4.6 Twist cap to loosen swab in culturette tube, and remove swab from the
tube.
5.3.4.7 Carefully insert swab into drainage and roll gently. Use another swab if
collecting
specimen from another site.
5.3.4.8 Place swab in tube, being careful not to touch outside of container. Closed
tightly.
5.4 Remove gloves from inside out and discard them in plastic waste bag.
5.5 Wash hands.
5.6 Apply clean dressing to wound.
5.7 Remove all equipment, wash hands and make patient comfortable.
5.8 Label specimen container appropriately and send the specimen to the laboratory
after charging
and sending the request through computer.
5.9 Document collection of specimen, appearance of wound and description of
drainage.
310
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Offering and Removing Bedpan or Urinal
CONTENTS: This General Ward policy and procedure deals with offering and removing
bedpan and
urinal.
1 DEFINITION:
1.1 Offering and Removing Bedpan or Urinal - facilitate proper bowel and bladder
elimination of
bedridden patients and allow accurate observation and measurement of urine and
stool.
2 PURPOSE:
2.1 To help patient evacuate bowel or urine contents normally without discomfort.
3.1 Bedpan/Urinal
3.2 Tissue
3.3 Underpads
PROCEDURES:
3.4
gloves
5.1 Disposable
Wash hands.
4 POLICIES:
5.2 Prepare the supplies needed and bring to patients bedside.
4.1
control policy
must be followed.
5.3 Infection
Wear disposable
gloves.
5
4.2
safety.provide privacy.
5.4 Ensure
Explainpatients
the procedure,
5.5 Raise the bed to highest working level.
5.6 Place the bedpan or urinal on the chair next to the bed or on the foot of the bed. Put
blue sheet
under the buttocks.
5.7 Fold the top linen back just enough to allow for placement of bedpan or urinal.
5.8 If the patient needs assistance to move onto the bedpan, have him/her bend the
knees and rest
his/her weight on the heels.
5.9 Lift the patient by placing one hand under the lower back and slip the bedpan into
place with the
other hand.
5.10For immobile patient, two nurses maybe required to lift him/her on the bedpan.
5.11Placed patient on his/her side, place bedpan against the buttocks and roll patient
on the bedpan.
5.12Ensure the bedpan is in proper place. The buttocks should rest on the rounded shelf
of the
bedpan.
5.13For male patient, place the urinal properly between slightly spread legs with the
penis inside it
and with the urinal resting on the bed.
5.14If indicated, raise the head of the bed as near to sitting position as tolerated.
5.15Place call device and tissue within easy reach. Leave the patient if it is safe to do
so, put side rails
up.
5.16Remove bedpan as the patient lifts the hips
311 up or as patient carefully rolls off to
side. Hold the
pan firmly as patient moves.
5.17Assist patient in wiping soiled anal area. Wipe from pubic area to anus.
Republic of
Yemen 48Modern
48
Hospital
5.18Discard tissue, and use more until the patient is clean. Turn the patient on his/her
side, and spread
the buttocks to clean the anal area. Cover bedpan.
5.19If specimen is required or intake or output is measured, do not place toilet tissue in
the bedpan.
Place tissue in proper receptacle.
5.20Assist the patient to wash and dry his/her hands.
5.21Empty bedpan contents properly.
5.22Dispose gloves and wash hands.
5.23Record intake and output if ordered.
6
5.24Charge
all supplies used
SPECIAL
CONSIDERATIONS:
6.1 A fracture bedpan maybe substituted when it is difficult or uncomfortable to use a
regular bedpan.
6.2 If it is difficult to slide patient onto the bedpan, powder maybe used on the resting
surfaces of the
pan to eliminate friction. Powder should not be used if a specimen is required
because
contamination could result.
6.3 Avoid placing a bedpan or urinal on top of the bedside stand or overbed table to
avoid
contamination of clean equipment and food trays.
6.4 Try to anticipate elimination needs, and offer the bedpan or urinal frequently to help
reduce
embarrassment and minimize the risk of incontinence.
312
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
CONTENTS: This policy and procedure describes the responsibility of nurses with regards to
Title: Oxygen Therapy
the
administration of oxygen therapy.
1 DEFINITION:
1.1 Oxygen a drug and must be initiated by a physicians order.
1.2 Oxygen Therapy the treatment of patients with hypoxemia.
1.3 Hypoxemia- a decreased oxygen tension in the blood.
1.4 Hypoxia decreased oxygen in the tissue.
1.5 Oxygen Therapy Modalities including the following:
1.5.1 Nasal Cannula is used when the patient requires a low-to-medium concentration
of
oxygen for which precise accuracy is not essential. This method is relatively
simple and
allows the patient to move about in bed, talk, cough and eat without interruption
of
oxygen flow.
1.5.2 Nasal Catheter is used less frequently than nasal cannula. This procedure
involves
inserting an oxygen catheter into the nose to the nasopharynx. The catheter
must be
changed at least every 8 hours and inserted into the other nostril. For this
reasons the
nasal catheter is often a less desirable method because insertion may be painful
and
cause trauma to the nasal mucosa.
1.5.3 Oxygen Mask is a device used to administer oxygen, humidity, or heated
humidity. It is
shaped to fit snugly over the mouth and nose and is secured in place with a
strap. The
two primary types of oxygen masks are high and low concentration. A plastic
face mask
with a reservoir bag and a venturi mask can deliver higher concentrations of
oxygen. The
simple face mask delivers oxygen concentrations from 30% to 60%.
2 PURPOSE:
2.1 To prevent or correct hypoxemia.
2.2 To provide guidelines for the use of oxygen therapy equipment.
3 INDICATIONS:
3.1 Hypoxemia documented by clinical laboratory data or suspected by physical
examination.
3.2 Clinical situation where oxygen transport to the tissues may be impaired e.g. shock,
5
acute
5.1
Cannula
coronary insufficiency, acute cerebrovascular accident.
5.1.1 Oxygen supply with a flow meter and adapter
4 COMPLICATIONS:
5.1.2 Humidifier
distilled
or tap
water, according
agencywith
4.1 Hypoventilation
with CO2with
retention
andwater
possible
respiratory
arrest into
patients
protocol
chronic
5.1.3
Nasal cannula
and
tubing
obstructive
pulmonary
disease
(COPD)
who are stimulated to breath by their hypoxic
5.1.4 Tape
drive.
313
4.2 Absorption atelectasis secondary to nitrogen wash out.
4.3 Retrolental fibroplasias primarily in neonates.
4.4 Oxygen toxicity.
Republic of
Yemen 48Modern
Hospital
48
5.1.5 Padding for the elastic band

5.2 Face Mask
5.2.2 Humidifier with distilled water or tap water, according to agency
protocol
5.2.3 Prescribed face mask of the appropriate size
5.2.4 Padding for the elastic band
5.3 Face Tent
5.3.2 Humidifier with distilled water or tap water, according to agency
protocol
POLICIES:
6
5.3.3 Face tent of the appropriate size
6.1 Doctors order should be obtained except in emergency situation.
6.2 Except in emergency, life threatening situations, oxygen therapy shall be started by
respiratory
7
care staff/nursing staff.
PREPARATIONS:
7.1 Assess:
7.1.1 Skin and mucous membrane colornote whether cyanosis is present
7.1.2 Breathing patterns
7.1.3 Chest movements
7.1.4 Chest wall configuration
7.1.5 Lung sounds
7.1.6 Presence of clinical signs of hypoxemia
7.1.7 Presence of clinical signs of hypercarbia
7.1.8 Presence of clinical signs of oxygen toxicity
7.2 Determine:
7.2.1 The order for oxygen, including the administering device and the liter flow rate
(L/min),
or the percentage of oxygen
7.2.2 The levels of oxygen (PO2) and carbon dioxide (PaCO2) in the clients arterial
blood
7.2.3 Whether the client has COPD
7.2.4 Vital signs, especially pulse rate and quality, and respiratory rate, rhythm, and
depth
7.2.5 Results of diagnostic studies
7.2.6 Hemoglobin, hematocrit, complete blood count
7.2.7 Arterial blood gases
7.2.8 Pulmonary function tests
7.2.9 The need for oxygen therapy; verify the order for the therapy
7.2.10 Perform a respiratory assessment to develop baseline data, if not already
available.
8
PROCEDURES:
7.4 Assist the client to a semi-Fowlers position, if possible.
8.17.4.1
Explain
to
the
client
what
you
are
going
to
do,
why
it
is
necessary,
and
how
he
can
Explain that oxygen is not dangerous when safety precautions are observed.
cooperate.
Inform
the
8.2 Wash
hands
and
observe
otherabout
appropriate
infection
controlconnected
procedures.
client
and
support
people
the safety
precautions
with oxygen
use.
8.4 Set up the oxygen equipment and the humidifier.
8.4.1 Attach the flow meter to the wall outlet or tank. The flow meter should be in
the OFF
position.
8.4.2 If needed, fill the humidifier bottle.
8.4.3 Attach the humidifier bottle to the base of the flow meter.
8.4.4 Attach the prescribed oxygen tubing and
314 delivery device to the humidifier.
8.5 Turn on the oxygen at the prescribed rate, and ensure proper functioning.
Republic of
Yemen 48Modern
48
Hospital
8.5.1 Check that the oxygen is flowing freely through the tubing.
8.5.2 There should be no kinks in the tubing, and the connections should be airtight.
8.5.3 There should be bubbles in the humidifier as the oxygen flows through.
8.5.4 You should feel the oxygen at the outlets of the cannula, mask, or tent.
8.5.5 Set the oxygen at the flow rate ordered.
8.6 Apply the appropriate oxygen delivery device.
8.6.1 Cannula
8.6.1.1 Put the cannula over the clients face, with the outlet prongs fitting into
the nares
and the elastic band around the head.
8.6.1.2 If the cannula will not stay in place, tape it at the sides of the face.
8.6.1.3 Pad the tubing and band over the ears and cheekbones as needed.
8.6.2 Face Mask
8.6.2.1 Guide the mask toward the clients face, and apply it from the nose
downward.
8.6.2.2 Fit the mask to the contours of the clients face.
8.6.2.3 Secure the elastic band around the clients head so that the mask is
comfortable but
snug.
8.6.2.4 Pad the band behind the ears and over bony prominences.
8.6.3 Face Tent
8.6.3.1 Place the tent over the clients face, and secure the ties around the head.
8.7 Assess the client regularly.
8.7.1 Assess the clients vital signs, level of anxiety, color, and ease of respirations,
and
provide support while the client adjusts to the device.
8.7.2 Assess the client in 1530 minutes, depending on the clients condition, and
regularly
thereafter.
8.7.3 Assess the client regularly for clinical signs of hypoxia, tachycardia, confusion,
dyspnea,
restlessness, and cyanosis. Review arterial blood gas results if they are
available.
8.7.3.1 Nasal Cannula
8.7.3.1.1 Assess the clients nares for encrustations and irritation. Apply a
watersoluble lubricant as required to soothe the mucous membranes.
8.7.3.2 Face Mask or Tent
8.7.3.2.1 Inspect the facial skin frequently for dampness or chafing, and dry
SPECIAL
9
and treatCONSIDERATIONS:
9.1 Oxygen is delivered
to
a
patient
with
artificial
airway
(tracheostomy,
endotracheal
it as needed.
tube)
with the
8.8 Inspect
the equipment on a regular basis.
use
ofCheck
T-tubethe
adapter
or by
a tracheostomy
maskinorthe
manual
resuscitation
bag. and
8.8.1
liter flow
and
the level of water
humidifier
in 30 minutes
9.2
Use
of
oxygen
facemask
is
contraindicated
to
patient
with
carbon
dioxide
retention.
when
9.3 If the
patients
level
of
consciousness
decreases,
intubation
may
be
necessary.
providing care to the client. Make sure that safety precautions are being
9.4 Diseases that benefit from oxygen therapy includes chronic obstructive pulmonary
followed.
diseases,
8.9 Document findings in the client record.
airway obstruction, pulmonary edema, acute respiratory distress, metabolic
disorders, cardiac 10 REFERENCE:
disorders and shock.
Edition
10.2 SAMSO Operating Manual Oxygen
Therapy
315
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Perineal Care
CONTENTS: This General Ward policy and procedure deals with the procedure of rendering
perineal
care.
1 DEFINITION:
1.1 Perineal Care - a special care or attention given to cleanse the rectal and external
genital area.
2 PURPOSES:
2.1 To promote cleanliness and comfort.
2.3 To remove irritating and odorous secretions.
2.4 Aids in healing.
3.1 Perineal care provided in conjunction with the bed bath
3.1.1 Bath towel
3.1.2 Bath blanket
3.1.3 Clean gloves
3.1.4 Bath basin with water at 4346C (110115F)
3.1.5 Soap
3.1.6 Washcloth
3.2 Special perineal care
3.2.1 Bath towel
3.2.2 Bath blanket
3.2.3 Clean gloves
3.2.4 Cotton balls or swabs
3.2.5 Solution bottle, pitcher, or container filled with warm water or a prescribed
solution
3.2.6 Bedpan to receive rinse water
3.2.7 Moisture-resistant bag or receptacle for used cotton swabs
3.2.8 Perineal pad
4 POLICIES:
4.1 Perineal care should be given at least 2 times (x) a day, and if necessary.
4.2 Infection control policy must be observed.
4.3 Privacy must be observed and verbal consent must be taken prior to procedure.
4.4 Cultural/religious beliefs must be taken into consideration.
5
4.5 Always wash from the cleanest
to dirtiest area.
PREPARATIONS:
5.1 Assess for the presence of:
5.1.1 Irritation, excoriation, inflammation,
swelling
5.1.2 Excessive discharge
5.1.3 Odor, pain, or discomfort
5.1.4 Urinary or fecal incontinence
5.1.5 Recent rectal or perineal surgery
5.1.6 Indwelling catheter
5.2 Determine:
5.2.1 Perinealgenital hygiene practices
316
Republic of
Yemen 48Modern
PREPARATIONS:
48
Hospital
6.1 Explain to
the client what you are going to do, why it is necessary, and how he
or
she can
cooperate.
Self-care
abilities
6.3 Provide 5.2.2
for client
privacy.
5.2.3
Whether
the
client is experiencing any discomfort in the perineal
genital
area
6.4.1 Fold the top bed linen to the foot of the bed and fold the gown up to expose
the genital
area.
6
6.4.2 Place a bath towel under the clients hips.
6.5 Position and drape the client and clean the upper inner thighs.
6.5.1 For Females
6.5.1.1 Position the female in a back-lying position with the knees flexed and
spread well
apart.
6.5.1.2 Cover her body and legs with the bath blanket. Drape the legs by tucking
the
bottom corners of the bath blanket under the inner sides of the legs.
6.5.1.3 Bring the middle portion of the base of the blanket up over the pubic
area.
6.5.1.4 Put on gloves, and wash and dry the upper inner thighs.
6.5.2 For Males
6.5.2.1 Position the male client in a supine position with knees slightly flexed
and hips
slightly externally rotated.
6.5.2.2 Put on gloves, and wash and dry the upper inner thighs.
6.6 Inspect the perineal area.
6.6.1 Note particular areas of inflammation, excoriation, or swelling, especially
between the
labia in females or the scrotal folds in males.
6.6.2 Also note excessive discharge or secretions from the orifices, and the
presence of odors.
6.7 Wash and dry the perinealgenital area.
6.7.1 For Females
6.7.1.1 Clean the labia majora. Then spread the labia to wash the folds between
the labia
majora and the labia minora.
6.7.1.2 Use separate quarters of the washcloth for each stroke, and wipe from
the pubis to
the rectum. For menstruating women and clients with indwelling catheters,
use
clean wipes, cotton balls, or gauze.
6.7.1.3 Take a clean ball for each stroke.
6.7.1.4 Rinse the area well.
6.7.1.5 Dry the perineum thoroughly.
6.7.2 For Males
6.7.2.1 Wash and dry the penis, using firm strokes.
6.7.2.2 If the client is uncircumcised, retract the prepuce to expose the glans
penis for
cleaning. Replace the foreskin after cleaning the glans penis.
6.7.2.3 Wash and dry the scrotum. The posterior folds of the scrotum may need
to be
cleaned.
6.8 Inspect perineal orifices for intactness.
6.8.1 Inspect particularly around the urethra in clients with indwelling catheters.
6.9 Clean between the buttocks.
6.9.1 Assist the client to turn onto the side facing away from you.
6.9.2 Pay particular attention to the anal area
317 and posterior folds of the scrotum in
males.
6.9.3 Clean the anus with toilet tissue before washing it, if necessary.
6.9.4 Dry the area well.
Republic of
Yemen 48Modern
48
Hospital
For post-delivery or menstruating females, apply a perineal pad as needed,

6.9.5from
front to
back.
6.10Document:
6.10.1 Any unusual findings, such as redness, excoriation, skin breakdown,
discharge, or
drainage
6.10.2 Any localized areas of tenderness
318
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Positioning and Mobilizing The Client

CONTENTS: This General Ward policy and procedure deals with the procedure in
positioning and
mobilizing the client on and out of bed.
1 DEFINITION:
1.1 Positioning and Mobilizing the Client - A technique used for mobilizing the patients
from, on
and out of bed following proper body mechanics.
1.1.1 lifting
1.1.2 turning
1.1.3 moving
1.1.4 transferring
2 PURPOSES:
2.1 To provide care for immobilized patients whose position must be changed, who must
be moved
up in bed, or who must be transferred from a bed to chair/stretcher.
2.2 For early ambulation.
2.3 To prevent discomfort and deformities.
2.4 To prevent post-op complications and bedsore.
2.5 To serve as an exercise.
3.1 Lifting/moving/transferring device with safety gadgets
4 POLICIES:
4.1 Ensure safety of both patient and nurse.
4.2 Proper working condition of the device to be used.
4.3 Proper techniques regarding mobilization should be followed.
PROCEDURES:
5
4.5 Cultural and religious beliefs must be taken into consideration.
5.1 Moving the Client Up on Bed
5.1.1 Assess:
5.1.1.1 The clients physical abilities
5.1.1.2 Ability to understand instructions
5.1.1.3 Degree of comfort or discomfort when moving. If needed, administer
analgesics or
perform other pain-relief measures.
5.1.1.4 Clients weight
5.1.1.5 Your own strength and ability to move the client
5.1.2 Determine:
5.1.2.1 Assistive devices that will be required
5.1.2.2 Encumbrances to movement, such as an IV or a heavy cast on one leg
5.1.2.3 Medications the client is receiving, as certain medications may hamper
movement
or alertness of the client
5.1.2.4 Assistance required from other health care personnel
319
Republic of
Yemen 48Modern
Hospital
48
Assistive devices such as overhead trapeze, pull and/or turn sheet, and
5.1.4
transfer or sliding
bar
5.2 Logrolling a Client
5.2.1 Assess:
5.2.1.1 The clients physical abilities
5.2.1.2 Ability to understand instructions
5.2.1.3 Degree of comfort or discomfort when moving. If needed, administer
analgesics or
perform other pain-relief measures.
5.2.1.4 Clients weight
5.2.1.5 Your own strength and ability to move the client
5.2.2 Determine:
5.2.2.2 Encumbrances to movement, such as an IV or a heavy cast on one leg
5.2.2.3 Medications the client is receiving, as certain medications may hamper
movement
or alertness of the client
5.2.3.1 Assistive devices such as overhead trapeze, pull and/or turn sheet, and
transfer or
sliding bar
5.3 Turning the Client to Lateral or Prone Position
5.3.1 Determine:
5.3.1.2 Encumbrances to movement
5.3.1.3 Medications the client is receiving
5.4 Assisting the Client to Sit on the Side of the Bed
5.4.1 Determine:
5.4.1.2 Encumbrances to movement
5.4.1.3 Medications the client is receiving
5.5 Transferring Client Between Bed and Chair
5.5.1 Before transferring a client, assess the following:
5.5.1.1 The clients body size
5.5.1.2 Ability to follow instructions
5.5.1.3 Activity tolerance
5.5.1.4 Muscle strength
5.5.1.5 Joint mobility
5.5.1.6 Presence of paralysis
5.5.1.7 Level of comfort
5.5.1.8 Presence of orthostatic hypotension
5.5.1.9 The technique with which the client is familiar
5.5.1.10The space in which the transfer is maneuvered
5.5.1.11The number of assistants needed to accomplish the transfer safely
5.5.1.12The skill and strength of the nurse(s)
5.5.2 Implement pain relief measures so that they are effective when the transfer
begins.
5.5.3.1 Robe or appropriate clothing
5.5.3.2 Slippers or shoes with nonskid soles
320
5.5.3.3 Transfer (walking) belt
5.5.3.4 Chair, commode, wheelchair, or stretcher, as appropriate to client need
5.5.3.5 Sliding board
5.5.4 Remove obstacles from the area used for the transfer.
5.6 Transferring Client Between Bed and Stretcher
5.6.1 Before transferring a client, assess the following:
5.6.1.1 The clients body size
Republic
offollow instructions
5.6.1.2
Ability to
5.6.1.3 Activity
tolerance
Yemen
48Modern
48
Hospital
5.6.1.5 The space in which the transfer is to be maneuvered

5.6.1.6 The number of staff needed to accomplish the transfer safely
5.6.1.7 The skill and strength of the nurses
5.6.2 If indicated, implement pain relief measures so that they are effective when
the transfer
begins.
5.6.3.1 Stretcher
5.6.3.2 Optional: sliding board
5.6.4 Obtain the necessary equipment and nursing personnel to assist in the
transfer.
5.7 Assisting Client to Ambulate
5.7.1 Assess:
5.7.1.1 Length of time in bed and time up previously
5.7.1.2 Baseline vital signs
5.7.1.3 Range of motion of joints needed for ambulating
5.7.1.4 Muscle strength of lower extremities
5.7.1.5 Need for ambulation aids
5.7.1.6 Clients intake of medications that may cause drowsiness, dizziness,
weakness, and
orthostatic hypotension, and seriously hinder the clients ability to walk
safely
5.7.1.7 Presence of joint inflammation, factures, muscle weakness, or other
conditions that
impair physical mobility
5.7.1.8 Ability to understand directions
5.7.2 Implement pain relief measures so that they are effective when the transfer
begins.
5.7.3 Plan the length of the walk with the client, considering nursing or physician
orders.
5.7.4.1 Transfer belt, if the client is known to be unsteady
5.7.4.2 Wheelchair for following client, or chairs along the route, if the client
needs to rest
5.7.5 Assure availability of other personnel to assist you, if needed.
5.7.5.1 Roll up the sheet as close as possible to the clients body, and pull the
client to the
side of the bed.
5.7.5.2 Adjust the clients head, and reposition the legs appropriately.
5.7.5.3 While standing on the side of the bed nearest the client, place the
clients near arm
across his chest.
5.7.5.4 Abduct the clients far shoulder slightly from the side of the body, and
externally
rotate the shoulder.
5.7.5.5 Place the clients near ankle and foot across the far ankle and fo
ot.
5.7.5.6 Raise the side rail next to the client before going to the other side of the
bed.
5.7.5.7 Position yourself on the side of the bed toward which the client will turn,
directly in
line with the clients waistline and as close to the bed as possible.
5.7.5.8 Lean your trunk forward from the hips. Flex your hips, knees, and ankles.
Assume
a broad stance with one foot forward and the weight placed on this forward
foot.
321 lateral position.
5.7.6 Pull or roll the client toward you to the
5.7.6.1 Place one hand on the clients far hip and the other hand on the clients
far
shoulder.
Republic of
Yemen 48Modern
Hospital
48
5.7.6.2 Tighten your gluteal, abdominal, leg, and arm muscles; rock backward,
shifting
your weight from the forward to the backward foot; and roll the client
onto the side
of the body to face you.
5.7.6.3 Position the client on his side with arms and legs positioned and
supported
properly.
5.7.6.4 To turn a client to the prone position, follow the preceding steps, with
two
exceptions:
5.7.6.4.1 Instead of abducting the far arm, keep the clients arm alongside
the body
for the client to roll over.
5.7.6.4.2 Roll the client completely onto the abdomen. Never pull a client
across the
bed while he is in the prone position.
5.7.6.5
Document
all relevant
information.
Variation: Turning
the Client
to Prone Record:
5.7.6.6.1.1.1
5.7.6.5.1
Time
and
change
of
position moved from and position moved to
Position
5.7.6.5.2 Any signs of pressure areas
5.8 Assisting
Client
on the
Side of the Bed
5.7.6.5.3
Use to
of Sit
support
devices
5.8.1
Explain
to
the
client
what
are going
do, why it is necessary, and how he
5.7.6.6 Ability of client to assistyou
in moving
andto
turning
can
5.7.6.6.1 Response of client to moving and turning
cooperate.
5.8.4 Position yourself and the client appropriately before performing the move.
5.8.4.1 Assist the client to a lateral position facing you.
5.8.4.2 Raise the head of the bed slowly to its highest position.
5.8.4.3 Position the clients feet and lower legs at the edge of the bed.
5.8.4.4 Stand beside the clients hips, and face the far corner of the bottom of
the bed.
Assume a broad stance, placing the foot nearest the client forward. Lean
your trunk
forward from the hips. Flex your hips, knees, and ankles.
5.8.5 Move the client to a sitting position.
5.8.5.1 Place one arm around the clients shoulders and the other arm beneath
both of the
clients thighs near the knees. Tighten your gluteal, abdominal, leg, and
arm
muscles.
5.8.5.2 Lift the clients thighs slightly.
Variation: Teaching the Client How To Sit on the
5.8.5.4.1.1.1
5.8.5.3 Pivot on the balls of your feet in the desired direction facing the foot of
Side of the Bed Independently
the bed
while pulling the clients feet and legs off the bed.
5.8.1
Instruct
thesupporting
client to: the client until he is well balanced and comfortable.
5.8.5.4
Keep
5.8.1.1
Assess
vital Roll to the side and lift the far leg over the near leg. Grasp the
mattresssigns
edgeas
with
indicated by the clients health status.
the lower arm and push the fist of the upper arm into the mattress.
5.8.1.2 Push up with the arms as the heels and legs slide over the mattress
edge.
5.8.1.3 Maintain the sitting position by pushing both fists into the mattress
behind and to
322
the sides of the buttocks.
5.8.2 Document all relevant information. Record:
Republic of
Yemen 48Modern
Hospital
48
5.9 Transferring Client Between Bed and Chair

5.9.1 Explain to the client what you are going to do, why it is necessary, and how
she can
cooperate
5.8.2.1 Time and change of position moved from and position
moved to
5.8.2.2 Any signs of pressure areas
5.9.4 Position the equipment appropriately.
5.8.2.3 Use of support devices
5.9.4.1 Lower the bed to its lowest position, so that the clients feet will rest flat
5.8.2.4 Ability of client to assist in moving and turning
on the
5.8.2.5 Response of client to moving and turning
floor.
5.9.4.2 Lock the wheels of the bed.
5.9.4.3 Place the wheelchair parallel to the bed, as close to the bed as possible.
5.9.4.4 Put the wheelchair on the side of the bed that allows the client to move
toward her
stronger side.
5.9.4.5 Lock the wheels of the wheelchair and raise the footplate.
5.9.5 Prepare and assess the client.
5.9.5.1 Assist the client to a sitting position on the side of the bed. Assess the
client for
orthostatic hypotension before moving the client from the bed.
5.9.5.2 Assist the client in putting on a bathrobe and nonskid slippers or shoes.
5.9.5.3 Place a transfer belt snugly around the clients waist. Check to be
certain that the
belt is securely fastened.
5.9.6 Give explicit instructions to the client. Ask the client to: Move forward and sit
on the
edge of the bed.
5.9.6.1 Lean forward slightly from the hips.
5.9.6.2 Place the foot of the stronger leg beneath the edge of the bed and put
the other foot
forward. The client should not grasp your neck for support.
5.9.6.3 Place the clients hands on the bed surface or on your shoulders, so that
the client
can push while standing. The client should not grasp your neck for support
5.9.7 Position yourself correctly. Stand directly in front of the client.
5.9.7.1 Lean the trunk forward from the hips. Flex the hips, knees, and ankles.
Assume a
broad stance, placing one foot forward and one back.
5.9.7.2 Mirror the placement of the clients feet, if possible.
5.9.7.3 Encircle the clients waist with your arms, and grasp the transfer belt at
the clients
back with thumbs pointing downward. Tighten your gluteal, abdominal, leg,
and
arm muscles.
5.9.8 Assist the client to stand, and then move together toward the wheelchair.
5.9.8.1 On the count of three, ask the client to push with the back foot, rock to
the forward
foot, and extend (straighten) the joints of her lower extremities.
5.9.8.2 Push or pull up with the hands, while pushing with the forward foot, rock
to the
back foot, extend the joints of the lower extremities, and pull the client
(directly
toward your center of gravity) into a standing position.
5.9.8.3 Support the client in an upright standing position for a few moments.
5.9.8.4 Together, pivot or take a few steps toward the wheelchair.
5.9.9 Assist the client to sit. Ask the client
to:
323
5.9.9.1 Back up to the wheelchair and place the legs against the seat
5.9.9.2 Place the foot of the stronger leg slightly behind the other
5.9.9.3 Keep the other foot forward
Republic of
Yemen 48Modern
48
Hospital
5.9.9.4 Place both hands on the wheelchair arms or on your shoulders.

5.9.9.5 Stand directly in front of the client. Place one foot forward and one
back.
5.9.9.6 Tighten your grasp on the transfer belt, and tighten your gluteal,
abdominal, leg,
and arm muscles.
5.9.9.7 On the count of three, have the client shift the body weight by rocking
to the back
foot, and lower the body onto the edge of the wheelchair seat by flexing
the joints
of the legs and arms.
5.9.9.8 Place some body weight on the arms, while shifting your body weight
by stepping
back with the forward foot and pivoting toward the chair while lowering
the client
onto the wheelchair seat.
5.9.10 Ensure client safety. Ask the client to push back into the wheelchair seat.
5.9.10.1Lower the footplates, and place the clients feet on them. Apply a seat
belt as 5.9.11.3.1.1.1.1Variation: Angling the
required.
Wheelchair
5.9.11 For
Document
Record:
5.9.12
clients relevant
who haveinformation.
difficulty walking,
place the wheelchair at a 455.9.11.1Number
of staff needed for transfer
degree
angle to
5.9.11.2Length
of time up in chair
the bed.
5.9.11.3Client
response to
transfer Transferring
and being upWithout
in chair aorBelt
wheelchair
5.9.12.1.1.1.1
Variation:
5.9.13 For clients who need minimal assistance, place the hands against the sides
of the clients
chest (not at the axillae) during the transfer.
5.9.14 For clients who require more assistance, reach through the clients axillae
and place the
hands on the clients scapulae during the transfer.
5.9.15 AvoidVariation:
placing hands
or pressure
the axillae,
Transferring
withon
a Belt
and Twoespecially
Nurses for clients who
have
upper5.9.1 When the client is able to stand, position yourselves on both sides of the
extremity
client,
facing paralysis or paresis.
the same direction as the client.

5.9.1.1 Flex your hips, knees, and ankle.
5.9.1.2 Grasp the clients transfer belt with the hand closest to the client, and
with the other
hand, support the clients elbows.
5.9.2 Coordinating your efforts, all three nurses should stand simultaneously,
pivot, and move
Variation:
to the Transferring
wheelchair. a Client with an Injured Lower Extremity
5.9.1
When
the
client has
an injured
lower
extremity,
movement
should always
5.9.3
Reverse
the
process
to lower
the client
onto
the wheelchair
seat.
occur toward
the clients unaffected (strong) side.
Variation: Using a Sliding Board
5.9.1 For a client who cannot stand, use a sliding board to move without nursing
assistance.
5.10Transferring Client Between Bed and Stretcher
5.10.1 Explain to the client what you are going to do, why it is necessary, and
how he can
cooperate.
324
Republic of
Yemen 48Modern
Hospital
48

5.10.4 Adjust the clients bed in preparation for the transfer.
5.10.4.1Lower the head of the bed until it is flat, or as low as the client can
tolerate.
5.10.4.2Raise the bed so that it is slightly higher than the surface of the
stretcher.
5.10.4.3Ensure that the wheels on the bed are locked. Pull the drawsheet out
from both
sides of the bed.
5.10.5 Move the client to the edge of the bed, and position the stretcher.
5.10.5.1Roll the drawsheet as close to the clients side as possible.
5.10.5.2 Pull the client to the edge of the bed, and cover the client with a
sheet or bath
blanket to maintain comfort.
5.10.5.3Place the stretcher parallel to the bed, next to the client, and lock the
stretcher
wheels.
5.10.5.4Fill the gap that exists between the bed and the stretcher loosely with
the bath
blankets (optional).
5.10.6 Transfer the client securely to the stretcher.
5.10.6.1In unison with the other staff members, press your body tightly
against the
stretcher.
5.10.6.2Roll the pull sheet tightly against the client.
5.10.6.3Flex your hips and pull the client on the pull sheet in unison directly
toward you
and onto the stretcher
5.10.6.4Ask the client to flex his neck during the move, if possible, and place
his arms
across the chest.
5.10.7 Ensure client comfort and safety.
5.10.7.1Make
the client
comfortable, unlock the stretcher wheels, and move
Variation:
Using a Transfer
Board
the
stretcher
5.10.1 Turn the client to a lateral position away from you, position the board close
away from the bed.
to the
5.10.7.2Immediately
raise
the
stretcher
side
rails and/or fasten the safety
clients back, and roll
the
client
onto the
board.
straps
the
5.10.2across
Pull the
client and board across the bed to the stretcher. Safety belts may be
client.
placed
over
Variation:
Using a Three-Person Carry (Use Caution)
5.10.8
Document
relevant
information.
Record:
the
chest, people
abdomen,
and
legs
5.10.1
Three
of about
equal height
stand side-by-side, facing the client.
5.10.8.1Equipment
used or bed to which the client will be moved is placed at a
5.10.1.1The stretcher
5.10.8.2Number
of people needed for transfer
right
angle at
5.10.8.3Destination,
reason for transfer is transport from one location to
the foot of theifbed.
another
5.10.1.2The wheels of the bed and stretcher are locked.
5.10.1.3Each person flexes the knees and places the foot nearest to the
stretcher slightly
forward. The arms of the lifters are put under the client at the head and
shoulders,
hips and thighs, and upper and lower legs.
5.10.1.4On the count of 3, the lifters roll the client onto their chests and step
back in
unison.
5.10.1.5They then pivot around to the stretcher and lower the client by flexing
their knees
and hips until their elbows are on the
325 surface of the stretcher.
5.10.1.6The client is then released on the stretcher surface and is aligned and
covered, and
the stretcher side rails are raised.
Republic of
5.11Assisting Client to Ambulate

Yemen 48Modern
48 hw
5.11.1 Explain to the client what you are going to do, why it is necessary, and
Hospital
she can
cooperate.
5.11.4 Prepare the client for ambulation. Apply elastic (antiemboli) stockings, as
required.
5.11.5 Assist the client to sit on the edge of the bed. Assess the client carefully for
signs and
symptoms of orthostatic hypotension. Assist the client to stand by the side of
the bed
until she feels secure.
5.11.6 Ensure client safety while assisting the client to ambulate.
5.11.6.1Encourage the client to ambulate independently if she is able, but walk
beside the
client.
5.11.6.2Remain physically close to the client, in case assistance is needed at any
point.
5.11.6.3Use a transfer or walking belt if the client is slightly weak and unstable.
5.11.6.4Make sure the belt is pulled snugly around the clients waist and
fastened securely.
5.11.6.5Grasp the belt at the clients back, and walk behind and slightly to one
side of the
client
5.11.6.6If it is the clients first time out of bed following surgery, injury, or an
extended
period of immobility, or if the client is quite weak or unstable, have an
assistant
follow you and the client with a wheelchair, in the event that it is needed
quickly.
5.11.6.7If the client is moderately weak and unstable, walk on the clients
weaker side and
interlock your forearm with the clients closest forearm.
5.11.6.8Encourage the client to press her forearm against your hip or waist for
stability, if
desired.
5.11.6.9In addition, have the client wear a transfer or walking belt.
5.11.6.10If the client is very weak and unstable, place your near arm around the
clients
waist, and, with your other arm, support the clients near arm at the elbow.
5.11.6.11Walk on the clients stronger side.
5.11.6.12Again, have the client wear a transfer or walking belt, incase of an
emergency.
5.11.6.13Encourage the client to assume a normal walking stance and gait, as
much as
possible.
5.11.7 Protect the client who begins to fall while ambulating.
5.11.7.1If a client begins to experience the signs and symptoms of orthostatic
hypotension
5.11.7.7Variation: Two Nurses
or extreme weakness, quickly assist the client into a nearby wheelchair or
5.11.8 After the client stands, assume a position with one nurse at either side.
other
5.11.8.1Grasp the inferior aspect of the clients upper arm with your nearest
chair, and help the client to lower her head between her knees.
hand and the
5.11.7.2Stay with the client. When the weakness subsides, assist the client back
clients lower arm or hand with your other hand.
to bed.
5.11.8.2Optional: Place a walking belt around the clients waist.
5.11.7.3 If a chair is not close by, assist the client to a horizontal position on the
5.11.8.3Each nurse grasps the side handle with the near hand and the lower
floor
aspect of the
before fainting occurs.
clients upper arm with the other hand.
5.11.7.4Assume a broad stance with one foot in front of the other.
5.11.8.4Walk in unison with the client, using a smooth, even gait, at the same
5.11.7.5Bring the client backward so that
your body supports the person.
326
speed and
5.11.7.6Allow the client to slide down your leg, and lower her gently to the floor,
with steps the same size as the clients.
making
sure the clients head does not hit any objects.
Republic of
Yemen 48Modern
48
Hospital
5.11.8.5If the client starts to fall and cannot regain strength or balance, slip
your arms
under the clients axillae, grasp the clients hands, and lower the person
gently to
the floor or to a nearby chair.
5.11.9 Document distance and duration of ambulation in the client record.
REFERENCE:
6
7th Edition
327
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Post Mortem Care

CONTENTS: This General Ward policy and procedure deals with the guidelines in rendering
post
mortem care.
1 DEFINITION:
1.1 Post mortem care is the immediate physical care rendered for the dead body.
2 PURPOSES:
2.1 To clean and prepare the deceased body.
2.2 To comfort and support the bereaved family.
3.1 Shroud kit (Plastic shroud sheet, chin strap, underpad, 3 ID tags, 36 & 60 ties)
3.2 Basin of water
3.3 Wash cloth
3.4 Towel
3.5 Adhesive tape
3.6 Eye goggles (for infected cases)
3.7 Disposable items:
3.7.1 Gloves
3.7.2 Apron
3.7.3 Mask
4 POLICIES:
4.1 Attending/witnessing physician pronounces the death and notifies patients
relatives.
4.2 Death Report should be filled up immediately by the Treating Doctor. It is readily
available in
Admission/Discharge Office.
4.3 Dead body should be for kept maximum of 2 hours in the area then to be sent to
mortuary.
4.4 Social and cultural values should be respected. Only Muslim staff of the same gender
is allowed
to render post-mortem care to Muslims dead body.
4.6 Dead body should pass only through the Morgue Exit.
4.7 Nurses should remind Admission/Discharge Office regarding amputated body parts or
aborted
fetus prior to discharge of the concerned patient.
4.8 Admission and Discharge Office is responsible to follow up with relatives the release
of the
deceased or amputated body part upon payment of the bills.
5 for
4.8.1PROCEDURES:
For foreigners, government formalities should be finalized and presented
the release5.1 Post-Mortem Care:
5.1.1
After the doctor pronounced the death of a patient, note the time
of the
body.
of
death.
4.9 It is a must for amputated body part or aborted fetus to be taken by the patient with
5.1.2 Inform the Nursing Supervisor.
him/her
5.1.3
Assemble
the equipment and supplies to be used.
immediately
upon
discharge.
4.10All deceased patients should be logged328
in and out in the mortuary logbook which is
available in
ER.
If the deceased is a Muslim, a Muslim nurse of the same gender shall render the
post-
Republic of
mortem care.
Yemen
48Modern
48
5.1.5 Wash hands, wear gloves, apron and mask and follow infection control
measures. Hospital
5.1.6 Disconnect IV tubing, suction, and oxygen. Remove cannula, catheters, drains
and tubes
if present.
5.1.7 Position the deceased in proper body alignment.
5.1.8 Close eyelids.
5.1.4
5.1.9 Put back dentures, if any.
5.1.10 Wash and clean the body with wash cloth removing all dirt, blood stains, and
secretions.
5.1.11 Dry with towel.
5.1.12 Apply proper dressing to open wounds.
5.1.13 Fill up 3 identification tags. Data include the following:
5.1.13.1Patients name and PIN
5.1.13.2Room and bed number
5.1.13.3Treating doctors name
5.1.13.4Name of hospital and city location
5.1.13.5Date and time expired
5.1.13.6Whether patient has a communicable disease
5.1.14 Wrap with plastic shroud following procedures below:
5.1.14.1Place deceased on the shroud sheet with underpad underneath the buttocks
and cover the
genitals with another blue pad.
5.1.14.2Fasten chin strap to keep mouth closed.
5.1.14.3Place hands over abdomen. Secure wrist and ankles with ties.
5.1.14.3.1 Tie together the big toes and ankles to maintain alignment of
extremities.
5.1.14.3.2 Attach ID tag to the big toe.
5.1.14.4Wrap sheet around the body.
5.1.14.5Tie above elbows, at the waist, and below the knees.
5.1.14.6Attach ID tag at head part outside.
5.1.15 Attach ID tag to personal effects.
5.1.16 Document and complete the records.
5.1.17 Notify the Ward Secretary to update charges and discharge from the Computer;
inform
Admission/Discharge Officer and ER Staff for the mortuary key.
5.1.18 Follow up with Treating doctor to fill up the Death Report) for the relatives to
process
government formalities.
5.1.19 Bring the corpse accompanied by relatives to the mortuary.
5.1.20 Record in ER Logbook and ask key from the ER Nurse.
5.1.21 With the help of ER porter, keep the corpse in freezer receptacle and lock. Label
the outside
of Mortuary Freezer.
5.1.22 Advise relatives to settle the bills in Admission/Discharge Office.
5.1.23 Let relatives sign (Form M1056) acknowledging receipt and endorse personal
belongings to
them.
5.1.24 Submit the Death Report to Admission/Discharge Office and surrender Mortuarys
key to
Emergency Room Station.
5.1.25 To collect the body from the morgue, the relatives should sign the consent of
Release of
Dead Body (Form M1050) from Admission/Discharge Office.
5.1.26 ER staff releases the body to the relatives after Admission/Discharge Officer
signs the release
in the mortuary logbook, which indicates that bills are paid.
5.1.27 For foreigners, government formalities are complied before the body is released.
5.1.28 Upon exit, the corpse should pass only
329through the morgue exit.
5.1.29 Aftercare of equipment.
5.2 Care of Amputated Body Parts and Fetus:
5.2.1 Obtain Death Report from Admission/Discharge Office prior to theprocedure.
Republic of
Yemen 48Modern
48
Hospital
5.2.1.1 In case of emergency still birth or abortion (it can be done after.)
5.2.2 Let the Treating Doctor fill the Death Report (Form M5007).
5.2.3 Clean, pack, and label:
5.2.3.1 For Fetus:
5.2.3.1.1 Intra Uterine Fetal Death (IUFD) - keep in the specimen container
with
Formaline. Close tightly and label: fetus identity following mothers
name; treating doctor; date and time of delivery; gender (if identified);
and
weight (if can be weighed).
5.2.3.1.2 Full Term Fetus - wrap first with blue sheet then double wrap with
still
birth shroud. Follow procedures of Post Mortem Care from 5.1.15.1 to
5.1.15.6.
5.2.3.2 For amputated body part:
5.2.3.2.1 Wrap in the shroud pack and apply tag on the outside and in
mortuary
freezer
5.2.3.2.2 For small body parts like finger, place in a specimen container and
label it.
5.2.3.3 Follow procedures on Post Mortem Care from steps 5.1.21. to 5.1.29.
5.3 Care of Infected Dead Body:
5.3.1 Health personnel should follow standard precautions during the care of
infected dead
body. Wash hands before and after dead body contact.
5.3.2 If there is possibility of splash of body fluids, wear eye goggles in addition to
apron,
gloves, and mask.
5.3.2.1 Wear filter mask for TB patient.
5.3.3 Cover all cuts and open lesion on the hand with waterproof dressing.
5.3.4 Double wrap body of patient with shroud pack who had varicella, pnuemonia
plaque,
herpes zoster, hemorrhagic fever, hepatitis, tuberculosis, etc. so that the
outside of
shroud is uncontaminated.
5.3.5 Use red tag and label stating the type of infection patient suffered.
5.3.6 Inform ER staff about the deceased who died or suffered from communicable
disease.
5.3.7 Wrap linen in an orange bag, seal and label Isolation to be treated by
Laundry Staff as
infected and take the necessary precautions.
5.3.8 The room should be fumigated and other equipment be thoroughly cleaned
with phenolic
disinfectant.
5.3.9 Send all use instruments to CSSD for sterilization.
5.3.10 Mortuary room should be well ventilated and provided with facilities for
handwashing
such as skin disinfectants.
330
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Post-Operative Care

CONTENTS: This General Ward policy and procedure deals with the guidelines in rendering
postoperative care.
1 DEFINITION:
1.1 Post-Operative Care - is the nursing care provided from completion of surgical
procedure
through the time the patients condition stabilizes following surgery.
2 PURPOSES:
2.1 Early detection and prevention of potentially life-threatening complications.
2.2 Close monitoring during recuperation from the effect of anesthesia and surgical
procedure.
2.3 To evaluate the patients needs and response to surgery.
3.1 Thermometer
3.2 Stethoscope and Sphygmomanometer
3.3 Warm blanket
3.4 Disposable gloves (optional)
3.5 O2 tank with O2 devices
3.6 Kidney basin
3.7 Blue sheet
3.8 Suction apparatus
3.9 IV Stand
3.10Other devices, as needed:
3.10.1 Pulse Oximeter
3.10.2 Perfusor Pump
3.10.3 Diatek Machine
3.10.4 Wire cutter, if indicated.
3.11Medications as ordered
3.12Anti-embolism stockings (optional)
4
POLICIES:
4.1 Post op care varies according to:
4.1.1 type of surgery
4.1.2 type of anesthesia
4.1.3 condition of patient
4.1.4 surgeon
4.2 Ensure safety.
4.2.1 Observe fall precaution. (Raise the side rails of the bed).
4.2.2 Frequent monitoring of vital signs every 30 minutes for 2 hours then hourly
until stable.
4.2.3 Assessment of: post-op site; drains for any bleeding or oozing; connecting
tubes in safe
position.
4.2.4 Patency of intravenous fluids during transfer from Recovery Room to the
Ward.
4.3 Observe aspiration precaution.
4.4 No patient leaves Recovery Room until Anesthesiologist gives transfer order.
331
4.5 Prevention of potential complication.
Republic of
Yemen 48Modern
Hospital
48
4.7 Post-operative anesthesia order should be started in Recovery Room and is

endorsed to ward
nurse on transfer. Ward nurse should inform Resident on duty to transcribe postoperative orders
in the Doctors Order Sheet (Form M1043).
5
PROCEDURES:
5.1 Unit preparation.
5.1.1 Ensure that the patient bedside is clean.
5.1.2 Postoperative bed should be ready.
5.1.3 Provide on bedside:
5.1.3.1 Tissues
5.1.3.2 mouth gag (optional)
5.1.3.3 stethoscope and sphygmomanometer
5.1.3.4 suction apparatus
5.1.3.5 IV stand
5.1.3.6 O2 tank with O2 devices
5.1.3.7 kidney basin, blue sheet
5.1.4 Regulate room temperature to meet patients needs. Avoid draft.
5.1.5 Have clean unit gown available at bedside.
5.1.6 Call bell to be within patients reach.
5.2 Inform patient that he is back in the room from Recovery Room. Place the patient in
comfortable and safe position.
5.3 Assess patients post-operative condition.
5.3.1 Check level of consciousness and vital signs.
5.3.2 Check dressing for discharges and take note of color, presence of odor and
amount of
drainage.
5.3.3 Ensure that all tubes are patent and equipments are functioning.
5.3.4 Maintain IV infusion at correct rate and assess the site.
5.4 Instruct the patient and relatives to maintain NPO till further order.
5.5 Administer analgesics as ordered.
5.5.1 Double check medication given while in Recovery Room.
5.6 Provide safe environment:
5.6.1 Keep bed in low position and side rails up.
5.6.2 Put No Smoking sign if receiving O2.
5.7 Provide oral hygiene.
5.8 Promote and maintain good circulation.
5.8.1 Encourage early ambulation.
5.8.2 Assist patient to turn from side to side every 2 hours, if not contraindicated.
5.8.3 Application of anti-embolism stockings, if prescribed.
5.9 Monitor Input and Output, and record.
5.10Assess for bowel and bladder movement.
5.10.1 Bowel - peristaltic movement is expected within 4 hours after surgery.
5.10.2 Bladder - voiding is expected within 8 hours after surgery at least 30ml.
5.11Encourage cough and deep breathing exercises.
5.12Maintain personal hygiene.
5.12.1 Evening care including oral hygiene.
5.13Document:
5.13.1 level of consciousness
5.13.2 vital signs
5.13.3 dressing and drains. Note for the following:
5.13.3.1bleeding
5.13.3.2color, odor, and amount of drainage (Label drainage bag, if more than
332
one.)
5.13.4 post operative orders carried out and observations made.
Republic of
Yemen 48Modern
48
Hospital
5.13.5 IV infusion and Input & Output Chart as

to:
5.13.5.1flow rate
5.13.5.2site
5.13.5.3additives, if any
5.13.6 Psychological support given
333
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Post-Operative Teaching: Moving, Leg Exercises, Deep
Breathing and Coughing
CONTENTS: This General Ward policy and procedure deals with the guidelines in providing
teaching to
postoperative clients.
1 DEFINITION:
1.1 Post-Operative Teaching - instructions given to the clients that have undergone
surgery to
prevent occurrence of postoperative complications.
2 PURPOSES:
2.1 For prevention of any postoperative complications.
2.2 For early return of clients to his activities of daily living.
3.1 Pillow
3.2 Teaching materials, if appropriate
4 POLICIES:
4.1 Nurses should provide health teachings to all clients undergoing surgery.
4.2 All teachings provided to the client should be documented accordingly.
5 PREPARATION:
5.1 Assess:
5.1.1 Vital signs
5.1.2 Discomfort
5.1.3 Temperature and color of feet and legs
5.1.4 Breath sounds
5.1.5 Presence of dyspnea or cough
5.1.6 Learning needs of the client
5.1.7 Anxiety level of the client
5.1.8 Client experience with previous surgeries and anesthesia
5.2 Determine:
5.2.1 The type of surgery
5.2.2 The time of the surgery
5.2.3 The name of the surgeon
5.2.4 The preoperative orders the agency practices for preoperative care
5.4 Check that potential distracters to teaching are not present. Include the family in
the
teaching, if
6
PROCEDURES:
appropriate.
cooperate.
6.4 Show the client ways to turn in bed and to get out of bed.
6.4.1 Instruct a client who will have a right abdominal incision or a right-sided chest
incision
to turn to the left side of the bed and sit up as follows:
6.4.2 Flex the knees.
334
6.4.3 Splint the wound by holding the left arm and hand or a small pillow against
the incision.
Republic of
Yemen 48Modern
Hospital
48
6.4.4 Turn to the left while pushing with the right foot and grasping a partial side
rail on the
left side of the bed with the right hand.
6.4.5 Come to a sitting position on the side of the bed by using the right arm and
hand to push
down against the mattress and swinging the feet over the edge of the bed.
6.4.6 Teach a client with left abdominal or left-sided chest incision to perform the
same
procedure but splint with the right arm and turn to the right.
6.4.7 For clients with orthopedic surgery, use special aids, such as a trapeze, to
assist with
movement.
6.5 Teach the client the following three leg exercises:
6.5.1 Alternate dorsiflexion and plantar flexion of the feet.
6.5.2 Flex and extend the knees, and press the backs of the knees into the bed
while
dorsiflexing the feet. Instruct clients who cannot raise their legs to do
isometric exercises
that contract and relax the muscles.
6.5.3 Raise and lower the legs alternately from the surface of the bed.
6.5.4 Flex the knee of the stable leg, and extend the knee of the moving leg.
6.6 Demonstrate deep-breathing (diaphragmatic) exercises as follows:
6.6.1 Place your hands palms down on the border of your rib cage, and inhale slowly
and
evenly through the nose until the greatest chest expansion is achieved
6.6.2 Hold your breath for 2 to 3 seconds.
6.6.3 Then exhale slowly through the mouth.
6.6.4 Continue exhalation until maximum chest contraction has been achieved.
6.7 Help the client perform deep-breathing exercises.
6.7.1 Ask the client to assume a sitting position.
6.7.2 Place the palms of your hands on the border of the clients rib cage to assess
respiratory
depth.
6.7.3 Ask the client to perform deep breathing.
6.8 Instruct the client to cough voluntarily after a few deep inhalations.
6.8.1 Ask the client to inhale deeply, hold the breath for a few seconds, and then
cough once
or twice.
6.8.2 Ensure that the client coughs deeply and does not just clear the throat.
6.9 If the incision will be painful when the client coughs, demonstrate techniques to
splint the
abdomen.
6.9.1 Show the client how to support the incision by placing the palms of the hands
on either
side of the incision site or directly over the incision site, holding the palm of
one hand
over the other.
6.9.2 Show the client how to splint the abdomen with clasped hands and a firmly
rolled pillow
7
held against
the clients abdomen.
REFERENCE:
6.10Inform the client
about
the
expected
frequency
of
these
exercises.
6.10.1 Instruct the
client to start the exercises as soon after surgery as possible.
7th Edition
6.10.2 Encourage clients
with
abdominal
orErb,
chest
surgery
to carry
out deep
Barbara
Kozier,
Glenora
Audrey
Berman,
Shirlee
Snyder
breathing and
335
coughing at least every 2 hours, taking a minimum of five breaths at each
session.
6.11Document the teaching and all assessments.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Post Thyroidectomy Care

post
thyroidectomy care.
1 DEFINITION:
1.1 Post thyroidectomy care - a post-operative nursing care rendered to a patient who
has
undergone thyroidectomy.
2 PURPOSES:
2.1 Early detection and prevention of potentially life threatening complication.
2.2 To evaluate the patients needs and response to surgery.
3.1 Tracheostomy set
3.2 Suction machine and accessories
3.3 Pillows and sandbags
3.4 Oxygen tank and oxygen devices
3.5 Kidney basin
3.6 Suture removal set
3.7 Thermometer
3.8 Sphygmomanometer and stethoscope
3.9 Medications as ordered
3.11Pulse oximeter
4 POLICIES:
4.1 Ensure safety:
4.1.1 Fall precaution
4.1.2 Aspiration precaution
4.1.3 Assessment and proper intervention if any complication occurs.
4.1.4 Strict compliance to doctors orders.
4.2 Follow standard infection control policy.
4.3 Maintain a non-stressful and quiet environment.
4.4 All necessary and emergency equipment should be available at bedside prior to
5
PROCEDURES:
receiving
the
5.1patient.
Assess for level of consciousness.
5.2 Vital signs every 15 minutes for 1 hour, then every 30 minutes for 2 hours or
according to
doctors order.
5.3 Keep on semi-fowlers position when conscious unless contraindicated, support head
and neck
with pillows and sandbags.
5.4 Instruct the patient and relatives the importance of avoiding stress on suture line
by:
5.4.1 Prevent flexion and hyperextension of neck.
5.4.2 Support the head with both hands behind back when turning or getting up
from the bed.
336 drugs per doctors order.
5.4.3 Prevent vomiting by giving anti-emetic
5.5 Observe for complications as follows:
5.5.1 Damage of laryngeal nerve.
Republic of
GENERAL NURSING DEPARTMENTAL MANUAL (2007 EDITION)

Yemen 48Modern
356
Hospital
48
5.5.1.1 Hoarseness or whispering voice suggesting possible nerve damage.

5.5.2 Hemorrhage:
5.5.2.1 Note hypotension, tachycardia, and other signs of hypovolemia and
shock.
5.5.2.2 Watch for signs of irregular breathing, swelling, and choking.
5.5.2.3 Watch for repeated clearing of the throat or complain of smothering or
difficulty of
swallowing.
5.5.3 Tetany:
5.5.3.1 First - tingling of toes and fingers, around the mouth; apprehension.
5.5.3.2 Second - positive Chvosteks sign (tapping the cheek over the facial nerve
causes a
twitch of the lip or facial muscles).
5.5.3.3 Third - Trousseaus sign (carpopedal spasm induced by occluding
circulation in the
arm with blood pressure cuff).
5.6 Observe for signs of thyroid storm like elevated temperature, tachycardia, marked
agitation,
restlessness, tremor progressing to delirium, nausea, vomiting, and diarrhea.
5.7 Continuously assess for signs of airway obstruction like tachycardia, restlessness,
apprehension,
stridor, cyanosis, and provide proper intervention.
5.8 Administer narcotic as needed.
5.8.1 If respiration is below 12 breaths/minutes and respiratory congestion is
present, consult
physician for further order.
5.9 Encourage deep breathing and coughing exercises. Suction mouth and trachea, if
necessary.
5.10Encourage the patient to take cold fluids.
5.11Maintain fluid chart for 2-3 days or as ordered.
5.12Tracheostomy set, endotracheal tube, laryngoscope and oxygen must be available
for immediate
use.
5.14Proper and accurate documentation regarding patients condition, observation,
and reaction.
337
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL

Title: Postural Drainage
postural
drainage.
1 DEFINITION:
1.1 Postural drainage - the use of specific positions so that the force of gravity can
assist in the
removal of bronchial secretions from the affected bronchioles into the bronchi and
trachea by
means of coughing or suctioning.
1.2 Techniques:
1.2.1 Percussion - the movement done by striking the chest wall in a rhythmic
fashion with
cupped hands over the chest segment to be drained.
1.2.2 Vibration - a technique of applying manual compression and tremor to the
chest wall
during the exhalation phase of respiration.
2 PURPOSES:
2.1 To use gravity as a means of aiding the clearance of secretion from the lung
periphery to the
larger bronchi, thereby facilitating expectoration or suctioning of secretion.
2.2 To expand the lung tissue.
2.3 To promote efficient use of respiratory muscles.
2.4 To prevent or treat atelectasis and pneumonia for bedridden patient.
3 INDICATIONS:
3.1 For presence of secretions in bronchitis, cystic fibrosis, pneumonia, asthma,
emphysema, and
bronchiectasis.
3.2 Restrictive pulmonary disease (neuromuscular).
3.3 Diseases associated with aspiration (cerebral palsy, muscular dystrophy).
3.4 Post operative pain with impaired breathing (thoracic or abdominal incision).
3.5 Prolonged immobility.
3.6 Chronic obstructive pulmonary disease (emphysema).
4.1 Acute pulmonary bleeding with hemoptysis and immediate post hemorrhage stage.
4.2 Fractured ribs or unstable chest wall.
4.3 Lung contusion, pulmonary tuberculosis, untreated pneumothorax, acute asthma or
bronchospasm, lung abscess or tumor, head injury and recent myocardial infarction.
5.1 Emesis basin
5.2 Extra pillow
5.3 Tissue
5.4 Stethoscope
5.5 Suction machine and accessories
5.6 Equipment for oral care
5.7 Analgesics
338
5.8 Thermometer
Republic of
POLICIES:
Yemen
6.1 Doctors
order 48Modern
of treatment should be documented.
Hospital
339
48
Republic of
Yemen 48Modern
PROCEDURES:
48
Hospital
7.1 Check doctors

order for the location of affected lung area, prescribed type, and
sequence of
procedure.
7.2 Identify correct patient to prevent errors.
6.2 Should be done for 20-30 minutes before meals or 2 hours after meals and at bed
7.3 Wash hands before and after procedure and wear gloves to prevent crosstime (2-4 x a
contamination.
day).
7.4 Explain the procedure and any adverse effects patient might experience in order to
6.3 Discontinue procedure if tachycardia, palpitation, dyspnea, chest pain or other
allay anxiety
symptoms which
and gain better cooperation.
may indicate hypoxemia.
7.5 Assemble equipment/supplies.
6.4 Keep patient in bed for 1 hour after the procedure.
6.5 Procedure is done under close supervision.
7.7 Assess the condition by auscultating the lungs. Check vital signs as baseline
7
information.
7.8 Determine the time patient had taken last diet/tube feeding.
7.9 Let the patient wear loose fitting gown.
7.10Administer medication that may decrease pain perception as needed/ordered.
7.11Provide tissue and emesis basin to the patient.
7.12Position the patient.
7.12.1 Maintain each position for at least 5-10 minutes and a maximum of 20-30
minutes for
the entire procedure.
7.12.2 Make the patient at ease before the procedure and as comfortable as possible
while he
assumes each position. Patient is positioned so that affected area is near
vertical position
and gravity is used to assist drainage of the specific segment.
7.12.3 Encourage patient to breath slowly through the nose and blow through the
mouth while
assuming position.
7.12.4 Use chest percussion and vibration to loosen bronchial secretion and propel
sputum in
the direction of gravity drainage, if ordered.
7.12.4.1Percussion:
7.12.4.1.1 Instruct the patient to breath slowly and deeply using the
diaphragm to
promote relaxation.
7.12.4.1.2 Keep hands in a cupped shape with fingers flexed and thumb
pressed
tightly against the index finger.
7.12.4.1.3 Percuss each segment for 1-2 minutes by alternating the hands in a
rhythmic manner.
7.12.4.1.4 Listen for a hollow sound on percussion to verify correct
performance of
the technique.
7.12.4.2Vibration:
7.12.4.2.1 Ask the patient to inhale deeply and then exhale through pursed
lips.
7.12.4.2.2 During exhalation firmly press the hand flat against the chest wall.
7.12.4.2.3 Vibrate during 5 exhalation over each chest segment.
7.12.4.2.4 After 3 or 4 vibrations, encourage patient to cough using
diaphragmatic
breathing throughout postural drainage exercise, to be done in
accordance
to patients tolerance.
7.12.5 Observe clinical response of patient and listen to changes in breathing sound.
7.13Suction as required or as ordered.
7.14Assist the patient in a comfortable position and reassess the condition after the
procedure.
340
7.14.1 Advice patient to brush teeth and use mouthwash after the procedure.
7.15Encourage fluid intake to maintain fluid-electrolyte balance and prevent
dehydration.
Republic of
Yemen 48Modern
48
Hospital
7.17Document in the Nursing Notes:
7.17.1 Time and date.
7.17.2 Positions maintained and duration of the procedure.
7.17.3 Amount, character, color, and odor of secretion
expectorated.
7.17.4 Patients tolerance to procedure.
7.17.5 Untoward reaction noted during the procedure.
7.18Charge the procedure and supplies used in the Inpatient
Charging Form
341
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL
Title: Pre-Operative Care
preoperative care.
1 DEFINITION:
1.1 Preoperative care is the preparation and assessment of physical, physiological, and
psychological condition of the patient prior to surgery.
2 PURPOSES:
2.1 Physical:
2.1.1 To minimize post-op complications e.g. by teaching deep-breathing exercises,
early
ambulation, following infection control measures.
2.1.2 To assess the physical condition of the patient so that potential problems can be
anticipated and prevented.
2.1.3 To ensure that the patient is on optimum physical condition prior to surgery.
2.1.4 To minimize the risk of surgical wound infection.
2.2 Psychological:
2.2.1 To ensure that patient understands the nature of the surgery to be done.
2.2.2 To teach the patient what to expect post-operatively e.g. about any drain,
catheters, and
so on that may be necessary afterwards.
2.2.3 To assess the area of anxiety that patient may have and discuss them using
nursing
intervention, if appropriate.
2.3 Physiological:
2.3.1 To ensure all necessary investigations (lab, ECG, x-ray) have been done.
2.3.2 To assist in bowel and bladder preparation by the means of
enema/catherization, if
indicated.
2.4 Legal:
2.4.1 To obtain an informed consent from the patient to protect the health team
members, and
the institution against any claim by the patient. Refer to Informed Consent
Policy GW019).
3.1 Razor (disposable, if possible)
3.3 Blue sheet
3.4 Supplies for bathing (Refer to Bathing Procedures)
3.5 Specimen bottles, if needed
3.6 Kidney basin
3.7 Enema kit (Refer to Enema Procedures)
3.8 Clean gown, bedsheet, drawsheet, blanket
3.9 Documentation: Consent form, OR Checklist,
Consent for Valuables
342
Republic of
POLICIES:
Yemen
48Modern
4.1 Ensure
safety by:
4.1.1 Identifying
correct patient.
Hospital
48
343
Republic of
Yemen 48Modern
Hospital
48
4.1.2 Checking type of operation.

4.1.3 Checking and shaving site of operation.
4.1.4 Observing aspiration and fall precautions.
4.2 Ensure that patient is physically, psychologically, physiologically, and legally
prepared.
4.3 Observe for infection control measures as per hospital policy.
4.4 Belongings and valuables should be safeguarded and room should be locked while
patient is in
OR. Valuables should be kept in the safety vault of Admission/Discharge Office.
4.5 Follow proper documentation according to hospital policy:
4.5.1 Consent for operation must be signed by the patient and witnessed by the
Treating
Doctor.
4.5.2 Valuables should be fully accounted and documented:
4.5.2.1 Itemized valuables should be counted and documented before taking
PROCEDURES:
from the
5.1 Night Prior to Surgery:
patient. Ensure that patients signature is obtained.
5.1.1 Upon patients admission, check for doctors orders, signed consent, and
4.6 In shaving.
medical
4.6.1 Cultural consideration must be observed.
investigations (whether done or not).
5
4.6.2 Shave only the site of operation. Refer to Shaving.
5.1.2 Take vital signs.
4.7 Pre-op medications should not be injected on the operation site.
5.1.3 Inform the Anesthetist on duty, if patient is not yet seen from OPD or ER.
5.1.4 Inform the Specialist on duty of the concerned department to further assess
the patient
and for some orders, if necessary.
5.1.5 Explain the procedures to be done to lessen anxiety and gain cooperation of
the patient.
5.1.6 Assemble all supplies and equipment needed.
5.1.7 Wash hands before and after the procedures.
5.1.8 Start preparation after being seen by the Anesthetist:
5.1.8.1 Keep patient Nothing Per Orem (NPO) starting from 12:00 midnight unless
the
time is specified by the Attending Doctor.
5.1.8.2 For malnourished patients, or those with metabolic deficiencies, Total
Parenteral
Nutrition (TPN) may be started, as prescribed.
5.1.8.3 Smoking patients should be advised not to smoke for at least 8-12 hours
prior to
surgery.
5.1.8.4 Administer enema, unless contraindicated.
5.1.8.5 Supervise and assist the patient to take a bath with antiseptic soap.
5.1.8.5.1 Special attention to be given to areas known to harbor many
pathogens like:
5.1.8.5.1.1 hands and feet including nails
5.1.8.5.1.2 groin
5.1.8.5.1.3 perineum and buttocks
5.1.8.5.1.4 axillae
5.1.8.5.2 For immobilized/bedridden patient, assist in giving bath using antimicrobial soap solution.
5.2 Morning of Surgery:
5.2.1 Supervise and assist patient in taking shower with antimicrobial soap solution,
if
possible.
5.2.2 If patient is unable to move, wash the site of operation and its surrounding
area with soap
344
and water and dry.
5.2.3 Shave the patient according to site of operation.
5.2.3.1 Shaving should be done 1-2 hours before going to Operation Room.
Republic of
Yemen 48Modern
GENERAL NURSING DEPARTMENTAL MANUAL (2007 EDITION)
Hospital
48
5.2.3.2 Get verbal consent from the patient. If patient is unconscious inform the
relatives.
5.2.3.3 Assess skin site for rash, abrasion.
5.2.3.4 Take extra caution to avoid cuts and epidermal damage.
5.2.4 Use sterile gauze to swab the operation site with skin disinfectant for 2
minutes.
5.2.5 Let the patient to void immediately before going to Operation Room.
5.2.5.1 Use indwelling catheter, if required as per doctors order. Observe
aseptic
technique.
5.2.6 Take vital signs and give pre-medications as ordered.
5.2.7 Complete the pre-operative checklist. (Form M1003)
5.2.8 Allergies and any positive result for HIV and Hepatitis test should be noted
outside the
patients file and should be verbally endorsed to OR Nurse.
5.2.9 Keep patient covered. Do not expose female patients hair and face.
5.2.10 Raise bedside rails and keep the bed locked to ensure safety during transfer.
5.2.11 The assigned nurse will accompany the patient to Operating Room upon
receiving a call
from OR staff.
5.2.11.1Endorse patient to OR staff along with complete file, X-Ray films,
medication (if
any) and PIN card.
5.2.11.1.1 Prepare post op bed and leave in the corridor outside the Recovery
Room
Area.
5.2.11.1.2
Keep bedside
rails up to prevent
relatives
sitting
or lying
on
6.1 In high
risk operation,
use antimicrobial
soap as
bathing from
agent,
otherwise,
follow
the
bed.
the
procedure
5.2.12
Aftercare of equipment.
above.
5.2.13
Charge
the procedure
and supplies
used in
thehas
Inpatient
Charging
Form. or is
6.2 Special
precautions
are necessary
for patient
who
diabetic
foot, gangrene
a victim of
RTA (Road Traffic Accident) because the skin may become heavily contaminated.
6.2.1 On the day of operation, bath should be given to the patient before sending to
OR. Wash
operation site with anti-microbial soap in 3 separate occasions. If there is no
time, cover
the area with povidine-iodine and leave it for at least 30 minutes.
6.2.2 Subsequent cleaning can be done in the Operation Theatre.
363
345
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Pressure Ulcer Assessment
Applies to: General Ward and Specialty UnitsS

CONTENTS: This General Ward policy and procedure deals with the guidelines in pressure
ulcer
management.
1 DEFINITION:
1.1 Pressure Ulcer any lesion or wound in the skin caused by a damaged underlying
tissue.
1.2 Assessment is a scientific way of appraising the patients risk or extends of
pressure ulcer.
2 PURPOSES:
2.1 Identify those patients who are at risk for pressure ulcer.
2.2 Know the extent of pressure ulcer.
2.3 Develop an individualized nursing care plan for patient with impaired skin integrity.
2.4 Promote evaluation program for pressure ulcers by establishing timetable
assessment.
3 POLICIES:
3.1 All patients are assessed for pressure ulcer.
3.2 Braden Scale is completed within 8 hours to identify patient at risk for pressure ulcer.
3.3 Patient with pressure ulcer on admission or acquired, initial/weekly ulcer assessment
form must
be completed (Section III).
3.4 Each pressure ulcer is documented on a separate pressure ulcer assessment form.
3.5 Pressure ulcer should be monitored and documented weekly or PRN in the pressure
ulcer
assessment form.
3.6 Document the time of completion of the initial assessment form. This must be
checked and
counter-checked by HN or CN to ensure that it is done within the time frame.
3.7 Notify the Physician, Dietitian, Head Nurse, Infection Control Nurse, Nursing
Supervisor and QI
4
PROCEDURES:
Nurse, if patient has a pressure ulcer. Obtain physician order and carry out necessary
4.1 The
nurse
admits
the
patient
and
take
vital
signs
including
height
and
weight,
intervention.
where
it is Critical Care Sheet (Form M1195) is used to document patient repositioning as
3.8 The
documented
on the Nursing Admission Assessment (Form M5252).
required
4.2 When
a
patient
is having a pressure ulcer or at a risk of having it, pressure ulcer
accordingly.
assessment
3.9 QI Nurse organizes the multidisciplinary meeting for those identified case.
form is thenpressure
filled up.ulcer report is reviewed and completed by QI Nurse.
3.10Monthly
4.2.1
Hospital
PIN card
is embossed
on the
form for
correct an
patient
identity.
3.11Acquired pressure
ulcer
after hospital
admission
requires
incident
report.
4.2.2 On the right upper corner of form the following is filled in:
4.2.2.1 Date/Time of admission
4.2.2.2 Age
4.2.2.3 Sex
4.2.2.4 Room number
4.2.3 Section 1 Braden scale is accomplished by scoring system (1-4) based on
346
the risk
assessment tool for predicting pressure ulcer.
Republic of
Yemen 48Modern
48
Hospital
4.2.4 Total score is then computed. If Braden Scale is less than 16 (<16), nurse
initiates
appropriate intervention according to pressure ulcer intervention
guidelines.
4.2.5 Section II This specify the exact site and location of the pressure ulcer.
Encircle
the number according to the area affected.
4.2.6 Section III Initial/Weekly Pressure Ulcer Assessment (back of the form)
pressure ulcer
assessment is documented by checking the corresponding item according to the
descriptions weekly.
4.3 Nurses signature is affixed completely.
347
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Rectal Tube Insertion
rectal
tube insertion.
1 DEFINITION:
1.1 Rectal tube insertion - a dependent nursing action conducted by gently inserting a
rectal catheter
approximately 10-15 cm into anal canal.
2 PURPOSES:
2.1 To relieve flatulence.
2.2 To alleviate dyspnea due to abdominal distention.
2.3 Used to control diarrhea that cannot be controlled with medical management and/or
use of rectal
pouches, pads or diapers due to extensive breakdown.
3.1 After recent rectal or prostatic surgery.
3.2 Recent myocardial infarction.
3.3 Patient with disease of the rectal mucosa.
3.4 Those receiving anti-coagulation therapy.
4.1 Rectal tube or catheter, 22 to 30 French
4.2 Water-soluble lubricant.
4.3 Ostomy odor eliminator or similar product (optional)
4.5 Disposable pads
4.6 Stethoscope
4.7 Kidney basin
4.8 Orange bag
4.9 Adhesive tape
4.10Tap water
5 POLICIES:
5.2 Proper identification of the patient.
5.3 Observed for hospital infection control policy.
6 the
5.4 Never leave the rectal tube inserted for more than 20 minutes unless ordered by
PROCEDURES:
Treating
6.1 Check doctors order and identify the patient.
Doctor. privacy and explain the procedure.
6.2 Provide
6.3 Assess the condition by auscultating the bowel sound to determine if the patient is
experiencing
reduced or increased peristalsis and establish a baseline for comparisons after the
procedure.
6.4 Gather all equipment, wash hands and wear gloves.
6.5 Assist the patient to a Sims position and348
place blue pads under buttocks.
6.6 Apply lubricant to a gloved finger.
Republic of
Yemen 48Modern
48
Hospital
6.7 Insert lubricated gloved finger into rectum to check for possible obstructions prior
to insertion of
rectal tube.
6.8 Change gloves if soiled from rectal examination.
6.9 Lubricate end of catheter.
6.10Gently insert catheter into anal canal approximately 10-15 cm. (4-6) while
instructing patient to
breath deeply and slowly to relax anal sphincter.
6.11Immerse other end of the rectal tube into the disposable kidney basin filled with
tap water.
6.12Observe for return flow.
6.13Tape rectal tube into the buttocks and the other end of tube to kidney basin or
attach drainage
bag to end of catheter if rectal tube is not to be removed within 30 minutes.
6.14If desired outcome is obtained, remove the catheter gently. If time limit exceeds
without positive
result, inform the physician.
6.15Aftercare of equipment. Remove gloves and wash hands.
6.16Assist the patient in comfortable position.
6.17.1 Date and time of insertion.
6.17.2 Amount, color, and consistency of any expelled contents.
6.17.3 Assessment of patients abdomen hard, distended, soft, drum-like on
percussion.
6.17.4 Presence of bowel sounds before and after insertion.
349
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Removing, Cleaning, and Inserting a Hearing
Aid
CONTENTS: This General Ward policy and procedure deals with the procedure on removing,
cleaning,
and inserting a hearing aid.
1 DEFINITION:
1.1 Hearing Aid an appliance placed in the external ear/s that aids in hearing.
2 PURPOSES:
2.1 To enhance hearing capabilities of a client having impaired hearing.
3.1 Clients hearing aid
3.2 Soap, water, and towels, or a damp cloth
3.3 Pipe cleaner or toothpick (optional)
3.4 New battery (if needed)
4 POLICIES:
4.1 Infection control policy must be observed.
4.2 Privacy must be observed.
5 PREPARATIONS:
5.1 Assess:
5.1.1 For the presence of inflammation, excessive wax, drainage, or discomfort in the
external
ear
5.2 Determine:
5.2.1 If the client has experienced any problems with the hearing aid and hearing aid
PROCEDURES:
6
practices
5.3
Assemble
equipment
and
supplies:
cooperate.
6.4 Remove the hearing aid.
6.4.1 Turn the hearing aid off and lower the volume.
6.4.2 Remove the earmold by rotating it slightly forward and pulling it outward.
6.4.3 If the hearing aid is not to be used for several days, remove the battery.
6.4.4 Store the hearing aid in a safe place, and label with clients name.
6.4.5 Avoid exposure to heat and moisture.
6.5 Clean the earmold.
6.5.1 Detach the earmold if possible.
6.5.2 Disconnect the earmold from the receiver of a body hearing aid, or from the
hearing aid
case of behind the- ear and eyeglasses hearing aids where the tubing meets the
hook of
the case.
6.5.3 Do not remove the earmold if it is glued or secured by a small metal ring.
6.5.4 If the earmold is detachable, soak it in a mild soapy solution. Rinse and dry it
well.
6.5.5 Do not use isopropyl alcohol.
350
6.5.6 If the earmold is not detachable, or is for an in-the-ear aid, wipe the earmold
with a damp
cloth.
Republic of
Yemen 48Modern
48
Hospital
Check that the earmold opening is patent. Blow any excess moisture6.5.7
through
the
opening, or remove debris using a pipe cleaner or toothpick.

6.5.8 Reattach the earmold if it was detached from the rest of the hearing aid.
6.6 Insert the hearing aid.
6.6.1 Determine from the client if the earmold is for the left or the right ear.
6.6.2 Check that the battery is inserted in the hearing aid. Turn off the hearing aid,
and make
sure the volume is turned all the way down.
6.6.3 Inspect the earmold to identify the ear canal portion.
6.6.4 Line up the parts of the earmold withthe corresponding parts of the clients
ear.
6.6.5 Rotate the earmold slightly forward, and insert the ear canal portion.
6.6.6 Gently press the earmold into the ear while rotating it backward.
6.6.7 Check that the earmold fits snugly by asking the client if it feels secure and
comfortable.
6.6.8 Adjust the other components of a behind-the-ear or body hearing aid.
6.6.9 Turn the hearing aid on, and adjust the volume according to the clients needs.
6.7 Correct problems associated with improper functioning.
6.7.1 If the sound is weak or there is no sound.
6.7.2 Ensure that the volume is turned high enough.
6.7.3 Ensure that the earmold opening is not clogged.
6.7.4 Check the battery.
6.7.5 Ensure that the ear canal is not blocked with wax.
6.7.6 If the client reports a whistling sound or squeal after insertion:
6.7.7 Turn the volume down.
6.7.8 Ensure that the earmold is properly attached to the receiver.
6.7.9 Reinsert the earmold.
6.8 Document pertinent data.
351
Republic of
Yemen 48Modern
Hospital
48

CONTENTS: This General Ward policy and procedure deals with the guidelines in the
application of
restraints.
1 DEFINITION: Are physical or chemical devices used to limit patients movement.
48 MODERN HOSPITAL
1.1 Classification of Restraints
1.1.1 Physical Restraint - is any manual method, or physical or mechanical device,
material or
equipment involuntarily attached or positioned adjacent to the patients body that
he or she
Title: Restraints
cannot easily remove, that restricts freedom of movement or normal access to ones
body. The
following are types of physical restraints:
1.1.1.1 Vest and Belt Restraints - applied to prevent falls from a bed or chair,
permit full
movement of arms and legs.
1.1.1.2 Limb Restraints - used to prevent removal of supportive equipment such as
IV lines,
indwelling catheters and nasogastric tubes, allow only slights limb motion.
1.1.1.3 Mitt Restraints - used to prevent removal of supportive equipment,
discourage the
scratching of skin rashes or sores and prevent the combative patient from
injuring self or
nursing staff.
1.1.1.4 Body Restraints - used to control the combative or hysterical patient,
immobilize all
or most of the body.
1.1.2 Chemical Restraint - is achieved by the use of chemical or pharmacologic agents,
such as
sleeping pills, sedatives and tranquilizers.
1.1.3 herapeutic Devices - used to reduce the risk of injury but which are not
considered
restraints and do not require orders for implementation.
1.1.4 Procedure - Related Protective Immobilization
1.1.4.1 example temporary use of an armboard during IV administration, body
restraint during
surgery and soft wrist ties for intubated patients.
1.1.5 Protective Devices
1.1.5.1 example temporary use of bed rails, table top, chair or lap belts for patients
in chairs or
for those who are confused or at risk for falls.
1.1.6 Underlying Principles for Applying Physical Restraint
1.1.6.1 Restraints should be used only when necessary.
1.1.6.2 The reason for using restraints should be explained to the patient and
family to prevent
misinterpretation and to ensure cooperation.
1.1.6.3 Any restraint should be checked frequently to make sure that it is effective.
It should
be removed periodically to prevent skin irritation or impairment or circulation.
1.1.6.4 Restraints should always be applied in a manner that maintains proper body
alignment
and ensures comfort.
1.1.6.5 Any restraint that requires attachment to the bed should be secured to the
bedsprings or
frame, never the mattress or side rails. This allows the side rails to be adjusted
without
removing the restraint or injuring the
352patients extremity.
1.1.6.6 Any knots that are required should be tied in a manner that permits their
quick release.
This is a safety precaution.
Republic of
Yemen 48Modern
Hospital
48
3 INDICATIONS:
2
PURPOSES:
3.1
For psychiatric patients who are highly combative, agitated and restless.
2.1
To elderly
ensure patients
patientswho
safety
security
respecting his/her rights and dignity and
3.2 For
areand
restless
andwhile
uncooperative.
ensuring
3.3 For confused or disoriented patients.
relation
use of during
restraint.
3.4well-being
For infantsinand
small to
children
treatments and examinations.
2.2
To
limit
movement
of
confused,
disoriented or combative patients from injuring self or
others.
4.1 For seizure-prone patients because they exaggerate the risk of fracture and trauma.
2.3Presence
To facilitate
examination
and to aidas
initdiagnostic
treatment.
4.2
of wounds
or IV catheters
may causetests
skinand
irritation
and restrict blood
2.4
To
establish
a
patient-focused
process
for
implementation,
application and
flow.
documentation of the
5 POLICIES:
of restraints.
5.2use
Restraints
can only be implemented through a written order from an appropriate
medical
official.
5.2.1 A documented nursing assessment is available prior to notifying the physician
and
recommending restraints.
5.2.2 Orders are to be confined to the type of restraint and the length of time the
restraint will
be used.
5.2.3 Physicians must assess and reassess patients as appropriate and documented
in the
patients file.
5.2.4 Nurses must assess the restrained limb every 30 minutes to check for the
status of the
circulation and the patients responses. It should be documented in the medical
record.
5.3 A patients condition should be monitored, regularly reviewed, and documented
during the
period he is restrained.
5.4 Patients dignity and rights are protected.
5.4.1 Patient should be kept covered when attending to his/her physical needs.
5.5 Underlying principles for applying physical restraints should be observed at all
times.
5.5.1 Restraints should be used only when necessary.
5.5.2 The least restrictive and most effective means of restraint is used.
5.5.3 Restraints should be applied correctly and appropriately.
5.5.4 Restraints should be applied in such a way as to allow immediate release in
cases of
emergency situations.
5.5.5 Restraints should always be applied in a manner that maintains proper body
alignment
and ensures comfort.
5.6 A person who should apply restraint should be competent enough.
5.7 The reason for using restraints should be explained to the patient and family to
prevent
misinterpretation and to ensure cooperation.
5.8 Restraints should be checked frequently to make sure that it is effective. It should
be removed
periodically to prevent skin irritation or impairment or circulation.
5.9 Any restraint that requires attachment to the bed should be secured to the bedsprings
6 PREPARATIONS:
or frame,
Assess:
never the mattress or side6.1
rails.
This allows the side rails to be adjusted without
6.1.1
The behavior indicating the possible need for a
removing the
restraint
restraint or injuring the patients extremity.353
5.10 Any knots that are required should be tied in a manner that permits their quick
release. This is a
safety precaution.
Republic of
Yemen 48Modern
Hospital
48
7 PROCEDURES:
7.1 Determine the need for restraint. If indicated, obtain doctors order which includes
the type of
restraints
to Underlying
be used and
the length
of timebehavior
the restraints will be used.
6.1.2
cause
for assessed
7.2 Explain
reason
for
use
of
restraint
to
the
patient
and
family. And obtain
6.1.3 What other protective measures may be
implemented
before informed
applying
consentafrom
restraint
the patient
familyofbefore
applying
the restraint.
6.1.4or
Status
skin to
which restraint
is to be applied
7.3 Wash6.1.5
hands.
Circulatory status distal to restraints and of extremities
7.4 Provide
forEffectiveness
client privacy,ofifother
indicated.
6.1.6
available safety precautions
7.5 To apply
restraint,
consider
the
6.2 Assemble equipment and following:
supplies:
7.5.1 Belt
Restraint
(Safety
Belt)
6.2.1
Appropriate
type
and size of restraint
7.5.1.1 Determine that the safety belt is in good order. If a Velcro safety belt is to be
used,
make sure that both pieces of Velcro are intact.
7.5.1.2 If the belt has a long portion and a shorter portion, place the long portion of
the belt
behind (under) the bedridden client and secure it to the movable part of the bed
frame.
7.5.1.3 Place the shorter portion of the belt around the clients waist, over the gown.
7.5.1.4 There should be a fingers width between the belt and the client; or
7.5.1.5 Attach the belt around the clients waist, and fasten it at the back of the
chair; or
7.5.1.6 If the belt is attached to a stretcher, secure the belt firmly over the clients
hips or
abdomen.
7.5.2 Jacket Restraint
7.5.2.1 Place vest on client, with opening at the front or the back, depending on the
type.
7.5.2.2 Pull the tie on the end of the vest flap across the chest, and place it through
the slit in
the opposite side of the chest.
7.5.2.3 Repeat for the other tie.
7.5.2.4 Use a half-bow knot to secure each tie around the movable bed frame, or
behind the
chair to a chair leg.
7.5.2.5 Fasten the ties together behind the chair using a square (reef) knot.
7.5.2.6 Ensure that the client is positioned appropriately to enable maximum chest
expansion
for breathing.
7.5.3 Mitt Restraint
7.5.3.1 Apply the commercial thumbless mitt to the hand to be restrained.
7.5.3.2 Make sure the fingers can be slightly flexed and are not caught under the
hand.
7.5.3.3 Follow the manufacturers directions or securing the mitt.
7.5.3.4 If a mitt is to be worn for several days, remove it at least every 24 hours.
7.5.3.5 Wash and exercise the clients hand, then reapply the mitt.
7.5.3.6 Check agency practices about recommended intervals for removal.
7.5.3.7 Assess the clients circulation to the hands shortly after the mitt is applied
and at
regular intervals.
7.5.4 Wrist or Ankle Restraint
7.5.4.1 Pad bony prominences on the wrist or ankle, if needed to prevent skin
breakdown.
7.5.4.2 Apply the padded portion of the restraint around the ankle or wrist.
7.5.4.3 Pull the tie of the restraint through the slit in the wrist portion or through
the buckle.
7.5.4.4 Using a half-bow or a square knot,
354 as appropriate, attach the other end of the
restraint
to the movable portion of the bed frame.
7.5.4.5 Remove restraint for at least 15 minutes every 2 hours.
Republic of
Yemen 48Modern
48
Hospital
7.5.4.6 Check restrained extremity for:

7.5.4.6.1 Skin integrity
7.5.4.6.2 Color
7.5.4.6.3 Pulses
7.5.4.6.4 Temperature
7.5.4.7 Sensation
7.5.4.8 When applying restraint consider the client privacy all the time by:
7.5.4.8.1 Keep the client covered.
7.5.4.8.2 Address the client in calm manner.
7.5.4.8.3 Attend to all of the clients physical needs as feeding, hygiene, etc.
7.5.4.9 Asses for signs of sensory deprivation such as increased sleeping, anxiety,
panic and
hallucinations.
7.5.4.10 Wash hands.
7.5.4.11 Document:
7.5.4.11.1 Behavior(s) indicating the need for the restraint
7.5.4.11.2 All other interventions implemented in attempt to avoid the use of
restraints and
their outcomes
7.5.4.11.3 The time the physician was notified of the need for restraint
7.5.4.12 Also record:
7.5.4.12.1 The type of restraint applied, the time it was applied, and the goal
for its
application
7.5.4.12.2 The clients response to the restraint
7.5.4.12.3 The times that the restraints were removed and skin care given
7.5.4.12.4 Any other assessments and interventions
7.5.4.12.5 Explanations given to the client and significant others
8 SPECIAL
CONSIDERATIONS:
7.5.4.12.6
Adjust the plan of care as required.
8.1 The following are physiologic hazards associated with the use of restraints:
8.1.1 Danger of suffocation from improperly applies vests
8.1.2 Impaired circulation
8.1.3 Altered skin integrity such as abrasions, skin tears and bruises
8.1.4 Pressure ulcers and contractures
8.1.5 Diminished muscle tone and bone mass
8.1.6 Fractures
8.1.7 Altered nutrition and hydration
8.1.8 Aspiration and breathing difficulties
8.1.9 Incontinence
8.2 It is very important that the appropriate size of restraint is selected. A restraint that
is too small
will be uncomfortable for the patient and may cause agitation or constriction of body
parts. A
restraint that is too large or loose, where the patient can slide down or forward may
result in
asphyxiation.
8.3 The distinction between restraints and therapeutic devices stems from the intent
rather than the
type of device used. For example a bed rails can be considered either a restraint or a
therapeutic
device depending upon the reason for its use.
9 REFERENCE:
355
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: SGH Cocktail
CONTENTS: This General Ward policy and procedure discusses about the components and
indications of
SGH cocktail.
1 DEFINITION:
1.1 SGH Cocktail - an in-house preparation of mixture using more than 2 drugs
incorporated to IV
fluids mainly NSS, given via infusion for orthopedic cases.
2 PURPOSE:
2.1 To relieve pain and inflammation.
3 CONTRAINDICATION:
3.1 Depending on the disease condition and doctors order (e.g. diabetic, hypertension).
4.1 NSS and other medications
4.2 IV cannula (different sizes)
4.3 IV tubing
4.4 Tourniquet
4.5 Transparent dressing - IV 3000
4.6 Blue pad
4.8 Razor
4.9 Syringes and needles
4.10IV Pole
4.11Adhesive tape
4.12Small sharp container
4.13Sterile gauze
4.14Band aid
4.15Alcohol pad
4.16Sterile H2O
5
TYPES AND COMPONENTS:
5.1 SGH Cocktail 1
5.1.1 NSS 500ml.
5.1.2 Tilcotil 20mg
5.1.3 Lasix 10mg
5.1.4 Solu Cortef 100mg
5.1.5 Becozyme 2ml
5.2 SGH Cocktail 2
5.2.1 NSS 500ml.
5.2.2 Lasix 10mg
5.2.4 Becozyme 2ml
5.2.5 Tilcotil 20mg.
5.3 SGH Cocktail 3
5.3.1 NSS 500ml
5.3.2 Tilcotil 20mg
356
Republic of
Yemen 48Modern
48
Hospital

5.3.4 Becozyme 2ml
5.4 SGH Cocktail 4
5.4.1 NSS 500ml
5.4.2 Tilcotil 20mg
5.4.3 Lasix 10mg
5.4.4 Becozyme 2ml
5.5 SGH Cocktail 5 (Pedia)
5.5.1 NSS 250ml
5.5.2 Tilcotil 10mg
5.5.3 Lasix 5mg
5.5.5 Becozyme 1ml
POLICIES:
6
6.1 Should be given only upon written doctors order.
6.2 Follow infection control measures during preparation and administration.
6.3 Proper labeling of the IV fluid as to:
6.3.1 additives
6.3.2 date and time started
6.3.3 date and time due
6.3.4 flow rate
6.4 Follow five rights in medication administration.
6.5 Proof of payment must be presented prior to procedure for OPD/ER Patient.
7 PROCEDURES:
7.1 Check doctors order.
7.2 Wash hands.
7.3 Prepare SGH Cocktail as ordered. Hook IV set and prime tubing. Keep set sterile.
7.5 Provide privacy. Explain the purpose of SGH Cocktail.
7.6 Check for existing line. If present, flush cannula with sterile water and connect to IV
tubing.
Regulate to a desired rate as ordered. If there is no cannula, follow procedure for IV
cannula
insertion GW-084.
7.7 Check infusion frequently to ensure that it will be consumed on time. Monitor IV set
regularly for
presence of pain, redness, or swelling. If noted, remove cannula and insert again.
7.8 Wash hands.
7.9 Sign the medication sheet.
7.10.1 Time infusion started and time consumed.
7.10.2 Condition of the IV site.
7.10.3 Site of IV insertion (if done).
357
Republic of
Yemen 48Modern
Hospital
48
48 MODERN HOSPITAL
Title: Cleaning Mercury Spills
CONTENTS: This General Ward policy and procedure deals with the guidelines on how safely
clean
mercury spills
1 DEFINITION:
1.1 Liquid Mercury Spills also known as elemental or metallic mercury, forms a droplet
that can
accumulate in the tiniest of spaces and then emit vapors into the air.
1.1.1 Mercury vapor in the air is odorless, colorless, and very toxic.
1.1.2 Most mercury exposures occur by breathing vapors, by direct skin contact or by
eating food
or drinking water contaminated with mercury.
1.1.3 Health problems caused by mercury depend on how much has entered your body,
how it
entered your body, how long you have been exposed to it, and how your body
responds to
the mercury.
2 PURPOSES:
2.1 To prevent occurrence of serious health complications brought about by exposure to
mercury.
3 POLICIES:
3.1 All mercury spills, regardless of quantity, should be treated seriously.
3.2 Observe strictly the precautions in cleaning mercury spills:
3.2.1 Never use a vacuum cleaner to clean up mercury. The vacuum will put mercury
into the air
and increase exposure. The vacuum appliance will be contaminated and have to be
thrown
away.
3.2.2 Never use a broom to clean up mercury. It will break the mercury into smaller
droplets and
spread them.
3.2.3 Never pour mercury down a drain. It may lodge in the plumbing and cause future
problems
during plumbing repairs. If discharged, it can cause pollution of the septic tank or
sewage
treatment plant.
3.2.4 Never wash mercury-contaminated items in a washing machine. Mercury may
contaminate
the machine and/or pollute sewage.
3.2.5 Never walk around if your shoes might be contaminated with mercury.
Contaminated
clothing can also spread mercury around.
3.3 Mercury spills should be reported to the local authority for proper disposal.
4 EQUIPMENTS:
4.1 4 to 5 ziplock-type bags
4.2 trash bags (2 to 6 mm thick)
4.3 rubber or latex gloves
4.4 paper towels
4.5 cardboard or squeegee
4.6 eyedropper
358
4.7 duct tape, or shaving cream & small paint brush
4.8 flashlight
4.9 powdered sulfur (optional)
Republic of
PREPARATIONS:
Yemen
48Modern
5.1 Remove
everyone
from the area where cleanup will take place.
5.2 Shut door of
impacted area.
Hospital
359
48
PROCEDURES:
Republic of
6.1 Spills: Less than or equal to the amount in a thermometer
Yemen 48Modern
48
6.1.1 Put on rubber or latex gloves.
Hospital
6.1.2 If there
are any broken pieces of glass or sharp objects, pick them up with
care.
Place all
broken objects on a paper towel. Fold the paper towel and place in a zip lock bag.
Secure
the bag and label it.
5.3 Turn off ventilation system.
6.1.3 Locate visible mercury beads. Use a squeegee or cardboard to gather mercury
5.4 Mercury can be cleaned up easily from the following surfaces: wood, linoleum, tile
beads. Use
and any other
slow sweeping motions to keep mercury from becoming uncontrollable. Take a
like surfaces.
flashlight,
5.5 If a spill occurs on carpet, curtains, upholstery or other like surfaces, these
hold it at a low angle close to the floor in a darkened room and look for additional
contaminated items
glistening beads of mercury that may be sticking to the surface or in small
should be thrown away.
cracked areas of
5.6 Only cut and remove the affected portion of the contaminated carpet for disposal.
the surface. Note: Mercury can move surprising distances on hard-flat surfaces,
6
so be sure
to inspect the entire room when "searching."
6.1.4 Use the eyedropper to collect or draw up the mercury beads. Slowly and
carefully squeeze
mercury onto a damp paper towel. Place the paper towel in a zip lock bag and
secure. Make
sure to label the bag.
6.1.5 After you remove larger beads, put shaving cream on top of small paint brush
and gently
"dot" the affected area to pick up smaller hard-to-see beads. Alternatively, use
duct tape to
collect smaller hard-to-see beads. Place the paint brush or duct tape in a zip lock
bag and
secure. Make sure to label the bag.
6.1.6 OPTIONAL STEP: It is OPTIONAL to use commercially available powdered sulfur to
absorb the beads that are too small to see. The sulfur does two things: (1) it
makes the
mercury easier to see since there may be a color change from yellow to brown
and (2) it
binds the mercury so that it can be easily removed and suppresses the vapor of
any missing
mercury.
6.1.6.1 Note: Powdered sulfur may stain fabrics a dark color. When using powdered
sulfur, do
not breathe in the powder as it can be moderately toxic. Additionally, users
should
read and understand product information before use.
6.1.7 Place all materials used with the cleanup, including gloves, in a trash bag. Place
all
mercury beads and objects into the trash bag. Secure trash bag and label.
6.1.8 Contact the local Ministry of Health Department, municipal waste authority or
the local fire
department for proper disposal in accordance with the laws.
6.1.9 Remember to keep the area well-ventilated to the outside (i.e., windows open
and fans
running) for at least 24 hours after your successful cleanup.
6.2 Spills: More than the amount in a thermometer
6.2.1Isolate the area.
6.2.2 Turn down temperature.
6.2.3 Open windows.
6.2.4 Don't let anyone walk through the mercury.
6.2.5 Don't vacuum.
6.2.6 Contact the local Ministry of Health.
6.2.7
6.3 Spills: Greater than One Pound (Two Tablespoons)
360
6.3.1 Any time one pound or more of mercury is released to the environment, it is
mandatory to
call the authority at once Ministry of Health or the Fire Department.
Republic of
Yemen 48Modern
48
Hospital
7 REFERENCE:
7.1 Environmental Protection Agency homepage; //
www.EPA.com
361
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Shaving
CONTENTS: This General Ward policy and procedure deals with the guidelines procedures in
shaving.
1 DEFINITION:
1.1 Shaving is done to remove unwanted hair, usually after bath or shower and as often as
required.
2 PURPOSES:
2.1 To promote comfort and grooming.
2.2 To minimize skin contamination and decrease the risk of postoperative wound infection.
3 CONTRAINDICATION:
3.1 For patients with facial skin disorder/wound.
4.1 Electric or disposable razor with blade
4.2 Shaving cream/soap
4.3 Wash basin with warm water
4.4 Wash cloth or bath towel
4.5 After-shave lotion (per patients preference)
4.6 Mirror
4.7 Sharp scissors and comb (for mustache)
4.9 Blue pad
4.10Small sharp disposal container
5 POLICIES:
5.1 Cultural beliefs and practices should be considered.
5.2 Should be done regularly i.e. once daily as part of hygiene care.
5.3 Shave patients going for operation according to site of operation.
6 PROCEDURES:
6.1 Assemble equipment.
6.3 Place patient to a comfortable position and assist, if needed.
6.5 Place towel/blue pad under the area to be shaved.
6.6 Apply shaving cream (as patient preferred).
6.6.1 Electric shaver is preferred for patients on anticoagulant therapy or has a
bleeding
disorder.
6.7 Shave the area, holding the razor at 45o angle to the skin. For skin preparation of
patient going to
OR
6.8 Gently pull the skin taut, use short firm strokes in the direction of hair growth.
6.9 After shaving, wash the area and dry with towel.
6.10Apply after-shave lotion on the face, if desired.
362
6.12Dispose used blade and gloves in appropriate container.
6.13Wash hands.
6.14Document the procedure and charge the supplies used
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Sitz Bath
sitz bath
administration.
1 DEFINITION:
1.1 Sitz Bath - a method of immersing the perineal area in warm water with or without
medicated
solution, as indicated.
2 PURPOSES:
2.1 To relieve discomfort.
2.2 To promote wound healing.
2.3 To increase circulation and reduce inflammation.
2.4 To relax local muscles.
2.5 To facilitate easy removal of anal pack.
3 INDICATIONS:
3.1 Rectal surgery/episiotomy during childbirth.
3.2 Painful hemorrhoids/vaginal inflammation.
4 CONTRAINDICATION:
4.1 Non-ambulatory, debilitated patients.
5.1 Sitz basin
5.2 Solution or medication
5.3 Mat bath
5.4 Towels
5.5 Patients gown
5.6 Dressing and ointment as ordered.
5.8 Thermometer
6 POLICIES:
6.1 Obtain Obtain physicians order. Identify correct client.
6.2 Follow standard precautions.
6.3 Sitz bath should not be more than 15-20 minutes, as indicated.
7
PROCEDURES:
6.4 Check water temperature according to patients tolerance.
7.1 Check doctors order and assess patients condition.
7.2 Explain the procedure and wash hands.
7.3 Prepare all necessary items needed.
7.4 Check vital signs, instructs the patient to void.
7.5 Provide privacy. Collect water in the sitz bath basin. Check the temperature. It should
not be too hot
or too cold.
7.6 Wear gloves. Instruct and assist patient to sit on the basin slowly to immerse the
perineal area and to
hold on for 10-20 minutes.
7.7 Provide safety measures.
363
7.8 Drape to avoid chills that may cause vasoconstriction.
Republic of
Yemen 48Modern
48
Hospital
7.9 Stay with patient for a while to assess general condition or reaction.
7.10When the prescribed time is finished, ask the patient to use the safety rail for
standing.
7.11Assist back to the bed, redress the wound, if needed.
7.12Reassess patients general condition.
7.14Remove gloves and wash hands.
7.15Document: time, duration, wound condition before and after, vital signs, tolerance
and any
complications.
364
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Skin Test
CONTENTS: This General Ward policy and procedure deals with the procedures in performing
skin test.
1 DEFINITION:
1.1 Medication a substance used to promote health, to prevent, to diagnose, to alleviate
or cure
diseases.
1.2 Medication Preparation one of the nursing functions of setting the medicines ready for
administration. The process involves accurate dosage, calculation, measurement and
proper handling
of medicines. Medication preparation includes skin testing to certain drugs.
1.3 Skin Test a method for determining induced sensitivity by applying an antigen
(allergen) or
inoculating it into the skin, induced sensitivity (allergy) to the specific antigen is
indicated by an
inflammatory reaction of one of two general kinds.
1.4 Results of Skin Test result of hypersensitivity reaction either :
1.4.1 Positive Result/Response itching and marked increase in the size of the original
bleb. A
wheal greater than 5mm or more with significant flair 10mm or more or with
pseudopodia.
1.4.2 Negative Result/Response no increase in the size of the original bleb or no
greater than
the control site.
1.5 Ambiguous Result/Response a wheal reaction slightly larger than the original bleb with
or
without accompanying erythematous flare and larger than the control site.
2 PURPOSE:
2.1 To ensure client safety in the administration of medication.
2.2 To determine the sensitivity for certain medication.
2.3 To reduce the incidence and severity of hypersensitive reaction.
3.1 Prescribed medicine
3.2 Medication tray
3.3 Tuberculine syringe
3.4 Sterile gauze
3.5 Alcohol swabs
3.6 Underpads
3.7 Saline solution or sterile water
3.8 Sharp disposal container
3.9 Stethoscope
3.11Thermometer
POLICIES:
4.1 Preparation
365
Republic of
4.1.1 Aseptic technique and proper procedure in handling and preparation of medication.
48
4.1.2Yemen
Medicines 48Modern
should be prepared in the medication preparation area properly
lighted.
4.2 Anaphylactic
tray should be available at bedside.
Hospital
4.2.1 Anaphylactic tray shall consist of :

4.2.1.1 Epinephrine(pre-loaded) 1mg (1:1000 for subcutaneous use)
4.2.1.2 Epinephrine 1:10,000 for intravenous use
4.2.1.3 Diphenhydramine 50mg/ml
366
Republic of
Yemen 48Modern
Hospital
48
4.2.1.4 Hydrocortisone 100mg/2ml

4.2.1.5 Ventolin inhaler
4.2.1.6 Tourniquet
4.2.1.7 Alcohol swabs
4.2.1.8 Sterile gauze (2X2)
4.2.1.9 Lancets
4.2.1.10Tape measure
4.2.1.11Syringes (1ml / 3ml)
4.2.1.12Tongue depressor
4.2.1.13Airway (adult / pedia)
4.3 Administration
4.3.1 Obtain physicians order.
4.3.2 Observe 7 rights in giving medication.
4.3.3 Right client
4.3.4 Right medicine
4.3.5 Right dose
4.3.6 Right time
4.3.7 Right route
4.3.8 Right frequency
4.3.9 Right documentation
4.3.10 Observe and maintain clients rights in giving medication.
4.3.10.1Be informed for drug name, purpose and action.
4.3.10.2Received labeled medication safely without discomfort in accordance with 7
rights in
drug administration.
4.3.11 Skin test should be administered by a qualified nurse who prepares it.
4.3.12 The one giving skin test must have a sound knowledge about the use and
action.
4.3.13 Prepare 0.1ml of solution + 0.9ml distilled water or isotonic saline. Introduce
0.1ml of the
diluted medicine or just enough to form a bleb.
4.3.14 Assessment of clients condition and vital signs should be taken before and
after giving skin
test.
4.3.15 Skin test that cannot be administered for whatever reason or any error incurred
during
administration, head nurse and attending physician should be informed.
4.4 Labeling
4.4.1 Medicine should be labeled as to time and date of opening, name, PIN and expiry
date.
PROCEDURES:
5
Must be labeled clearly and legibly.
4.5 Document the administration of the skin test, the result and if appropriate physician
5.2 Wash hands before the procedure and wear gloves if necessary.
notification in
5.3 Prepare needed equipments and supplies.
the clients medical records.
5.4 Preparation :
4.6 Notify the attending physician if there is any sensitivity reaction.
5.4.1 Put the injectable medicine in the tray together with the medication card,
alcohol swab and
small sharp container.
5.4.2 Identify the client correctly by asking clients name and check ID band.
5.4.3 Explain the procedure. Provide privacy and assist client in comfortable position
5.4.4 Select site for injection :
5.4.4.1 Extend elbow and support it, forearm in flat surface.
5.4.4.2 Inspect site for bruises, inflammation, lesion, discoloration, edema, masses
and
tenderness.
367
Republic of
Yemen 48Modern
48
Hospital
5.4.4.3 Forearm site should be 3-4 finger width below ante cubital fossa and one
hand width
above the wrist on inner aspect of forearm.
5.4.4.4 Locate an area of skin on the inner volar surface of the forearm.
5.4.5 Use antiseptic swab in a circular motion to clean the site.
5.4.6 While holding the swab with non dominant hand, pull cap from needle.
5.4.7 With non dominant hand, stretch the skin over the site with forefinger and
thumb.
5.4.8 Insert needle slowly at 5-15 degrees angle, bevel up, until resistance is
felt.Advance to no
more than 1/8 inch below the skin. The middle tip should be seen through the
skin.
5.4.9 Do not aspirate, slowly inject the medication until resistance will be felt. Note a
small bleb,
like a mosquito bite forming under the skin pressure.
5.4.10 Withdraw needle while applying antiseptic swab.
5.4.11 Do not massage the site.
5.4.12 Draw a circle around the parameter of injection site using black ink.
5.4.13 Dispose syringe with needle in the sharp container.
5.4.14 After 30 minutes, inform the physician to evaluate the result.
5.5 Assist client to a comfortable position.
5.6 Observe closely for adverse reaction as skin test is administered and for several
times there after.
5.7 Wash hands.
5.8 Charge and dispose the supplies used.
5.9 If client is for admission, document the skin test in the nurses notes.
368
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Stool Specimen Collection
collecting
stool specimen.
1 DEFINITION:
1.1 Stool Specimen Collection is the collection of fecal matter eliminated in a single bowel
movement
required for the complete evaluation of patient with gastro-intestinal disturbances.
2 PURPOSES:
2.1 To determine the presence of parasites.
2.2 To determine the progress of therapy.
2.3 To aid in establishing diagnosis.
2.4 To evaluate presence of GI bleeding.
3 INDICATIONS:
3.1 Gastro-intestinal benign or malignant tumors
3.2 Ulceration
3.3 Inflammation of the upper or lower gastro-intestinal system
3.4 Hematophilia
3.5 Swallowing of naso-pharyngeal blood
4.1 Bed pan
4.2 Stool specimen container properly labeled with patients name, pin number, room
number, date &
time
4.4 Kleenex or tissue paper
4.5 Mask (optional)
4.6 Tongue depressor or spatula
4.7 Lubricant
4.8 NSS or tap water
4.9 Enema set
5 POLICIES:
5.1 Strict infection control measure should be followed for specimen collection.
5.2 The collected specimen should be properly labeled and immediately sent to Laboratory
Department.
5.3 The importance of proper specimen collection should be explained to the patient.
PROCEDURES:
6.1 Check for doctors order as to the stool examination method required.
6.2 Assemble all supplies needed.
6.3 Identify the correct patient and explain the procedure to get patients cooperation throughout
the
procedure.
369
Republic of
6.4 Provide adequate privacy.

Yemen
48Modern
6.5 Wash
hands, wear
gloves and mask.
6.6 Perform stool
collection procedure:
Hospital
6.6.1 For Bacteria/Parasite Examination:
48
370
Republic of
Yemen 48Modern
48
Hospital
6.6.1.1 Let the patient pass stool in bedpan. Request patient to avoid voiding so as
not to
small
it.
contaminate stool, and not to put tissue paper on it.

6.6.1.2 Give tongue depressor, gloves and specimen container for patient to collect
amount of stool. Otherwise, if patient is unable to move, the nurse should do
6.6.2 For Occult Blood Stool Examination - to retrieve specimen digitally:

6.6.2.1 Follow special diet as prescribed by the Treating Doctor i.e. to have high
fiber with no
red meat for 48-72 hours prior to the test.
6.6.2.2 Hold medications as ordered by the Treating Doctor i.e. iron preparations,
iodine,
colchicines, salicylates, steroids, and ascorbic acid.
6.6.2.3 Lubricate gloved index finger, insert into the rectum and collect a small
piece of stool.
6.6.3 By Enema Administration:
6.6.3.1 Follow Enema Procedure.
6.6.3.2 Only NSS or tap water should be used.
6.7 Keep the stool in a clear wide-mouthed plastic specimen container with a tight fitting
lid.
6.8 Let patient to wash and dry anus to be free from infection and foul odor.
6.9 Dispose tongue depressor properly wrapped in tissue paper.
6.12Fill up the Laboratory List Request (Form M2034), indicating whether patient is
taking any
medication (antibiotic) that can alter the flora of intestines.
6.13Request Ward Secretary to charge in the computer and send the request to
Laboratory Department
through computer online.
6.14Follow up the results and inform the Attending Physician in order to plan out the
management.
6.15Record in the Nurses Notes the procedure done and observations made.
371
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
CONTENTS: This General Ward policy and procedure deals with the procedures in performing
Title: Suctioning
suction.
1 DEFINITION:
1.1 Suctioning - the aspiration of secretions by a catheter connected to suction machine
with an
application of a negative pressure to create vacuum to enable secretions to move from
an area of
higher pressure (airway) to an area of lower pressure (suction bottle).
1.1.1 Oropharyngeal and Nasopharyngeal
Is used when the patient is able to cough effectively but is unable to clear secretions by
expectorating or swallowing.
1.1.1 Orotracheal and Nasotracheal
Is necessary when the client with pulmonary secretions is unable to cough and does not
have an
artificial airway. This technique is similar as above, but the catheter tip is moved
further in to
suction the trachea.
1.1.1 Suctioning through an Artificial Airway
An artificial airway is an oral airway or an endotracheal, nasotracheal or tracheostomy
tube.
Indications for an artificial airway include decreased level of consciousness, airway
obstruction,
mechanical ventilation and removal of tracheal secretions.
2 PURPOSES:
2.1 To provide a patent airway by keeping it clear of excessive secretions
2.2 To obtain sputum specimen for diagnostic purposes.
2.3 To prevent infection that may result from the accumulation of secretions in the
respiratory tract.
2.4 To provide rest and comfort.
3 INDICATIONS:
3.1 Inability to cough and expectorate effectively (infants and comatose patients).
3.2 Inability to swallow.
3.3 Light bubbling or rattling breath sounds that indicates the accumulation of secretions.
3.4 When patient shows any signs and symptoms of hypoxia.
3.5 Labored respirations.
3.6 Increased peak inspiratory pressure in patient on mechanical ventilation.
4.1 Sterile gloves
4.2 NSS
4.3 Sterile suction catheter
4.4 Suction machine
4.5 Kidney basin
4.6 Mask
4.7 Kleenex/Tissue paper
4.8 Materials needed for oral care and tracheostomy care
4.9 Stethoscope
372
4.10 Oxygen if necessary
4.11Underpad
4.12Pulse Oximeter
Republic of
Yemen 48Modern
Hospital
48
5
POLICIES:
5.2 Proper assessment of patients condition should be done before and after suctioning.
Monitor the
following:
5.2.1 Rate depth and rhythm of respiration to evaluate airway.
5.2.2 Oxygen saturation to determine oxygen level and adequate air exchange.
5.3 Encourage coughing and deep breathing to decrease need for suctioning.
5.4 Everytime suctioning is done, a sterile suction catheter should be used.
5.5 Suctioning should be done 10-15 seconds only.
6
PREPARATIONS:
6.1 Assess:
6.1.1 Client for the presence of congestion on auscultation of the thorax
PROCEDURES:
6.1.2 Note
the clients
ability orindicating
inability to
remove the
secretions
coughing
7.1 Assess
for signs
and symptoms
presence
of upper
airwaythrough
secretions;
6.2 Determine:
gurgling
6.2.1 If the client
has been
suctioninpreviously;
if so, review
the documentation
respirations,
restlessness,
vomitus
mouth, drooling.
Auscultate
breath sounds.of the
procedure
7.2
Wash hands.
6.2.2 Assemble
equipment
supplies.
7.3 Assemble
all equipments
toand
be used.
7
7.4 Explain the procedure to the patient, (if patient is conscious).
7.6 Place patient in a comfortable working position. Lower siderails closer to you. Place
the patient in
semi-fowlers position if conscious, and unconscious patient should be placed in lateral
position
facing you.
7.7 Place blue sheet across patients chest.
7.8 Turn suction to appropriate pressure:
7.8.1 Wall unit
Adult : 100 - 120 mmHg
Child : 95 - 110 mmHg
Infant : 50 - 95 mmHg
7.8.1 Portable unit
Adult : 10 - 15 mmHg
Child : 5 - 10 mmHg
Infant : 2 - 5 mmHg
7.9 Administer oxygen as ordered (Refer to oxygen inhalation therapy procedure)
7.10Open sterile suction package. Set-up sterile container touching only the outside
surface and pour
sterile saline solution.
7.11Wear sterile gloves and mask.
7.12The dominant hand will handle the catheter and must remain sterile, while the nondominant hand
is considered clean rather than sterile.
7.13Using dominant hand, pick-up the sterile catheter and connect to suction tubing that
is held with
non-dominant hand or unsterile hand.
7.14Moisten the catheter by dipping into the container of sterile saline. Occlude Y-tube to
check
suction.
7.15Suctioning technique:
7.15.1 Nasopharyngeal or Oropharyngeal Cavities:
7.15.1.1Prepare the client.
7.15.1.1.1 Position a conscious person
373who has a functional gag reflex in the
semiFowlers position, with the head turned to one side for oral suctioning or
with
the neck hyperextended for nasal suctioning.

7.15.1.1.2 Position an unconscious client in the lateral position, facing you.
7.15.1.1.3 Place the towel or moisture-resistant pad over the pillow or under
the chin.
Republic
7.15.1.2Prepare
theof
equipment.
7.15.1.2.1
Set
the
pressure on the suction gauge, and turn on the suction.
Yemen 48Modern
48
Open the
Hospital
lubricant (if performing nasopharyngeal suctioning).

7.15.1.2.2 Open the sterile suction package.
7.15.1.2.3 Set up the cup or container, touching only the outside.
7.15.1.3Pour sterile water or saline into the container.
7.15.1.3.1 Put on the sterile gloves, or put on a non-sterile glove on the
nondominant
hand and then a sterile glove on the dominant hand.
7.15.1.3.2 With your sterile gloved hand, pick up the catheter, and attach it to
the suction
unit.
7.15.1.4Make an approximate measure of the depth for the insertion of the
catheter, and test
the equipment.
7.15.1.4.1 Measure the distance between the tip of the clients nose and the
earlobe.
7.15.1.4.2 Mark the position on the tube with the fingers of the sterile gloved
hand.
7.15.1.4.3 Test the pressure of the suction and the patency of the catheter by
applying
your sterile gloved finger or thumb to the port or open branch of the Yconnector (the suction control) to create suction.
7.15.1.5Lubricate and introduce the catheter.
7.15.1.5.1 For nasopharyngeal suction, lubricate the catheter tip with sterile
water,
saline, or water-soluble lubricant;
7.15.1.5.2 For oropharyngeal suction, moisten the tip with sterile water or
saline.
7.15.1.5.3 For Oropharyngeal suction, pull the tongue forward, if necessary,
using
gauze.
7.15.1.5.4 Do not apply suction during insertion. Advance the catheter about
1015 cm
(46 in) along one side of the mouth into the oropharynx.
7.15.1.5.5 For Nasopharyngeal Suction, without applying suction, insert the
catheter
the premeasured or recommended distance into either naris and
advance it
along the floor of the nasal cavity. Never force the catheter against an
obstruction. If one nostril is obstructed, try the other.
7.15.1.6Perform suctioning.
7.15.1.6.1 Apply your finger to the suction control port to start suction, and
gently rotate
the catheter.
7.15.1.6.2 Apply suction for 510 seconds while slowly withdrawing the
catheter, then
remove your finger from the control and remove the catheter.
7.15.1.6.3 A suction attempt should last only 1015 seconds. During this time,
the
catheter is inserted, the suction applied and discontinued, and the
catheter
removed.
7.15.1.6.4 It may be necessary during oropharyngeal suctioning to apply
suction to
secretions that collect in the vestibule of the mouth and beneath the
tongue.
7.15.1.7Clean the catheter, and repeat suctioning as above.
7.15.1.7.1 Wipe off the catheter with sterile gauze if it is thickly coated with
374
secretions.
7.15.1.7.2 Dispose of the used gauze in a moisture-resistant bag. Flush the
catheter with
sterile water or saline.
7.15.1.7.3 Relubricate the catheter, and repeat suctioning until the air passage
Republic of
Yemen 48Modern
Hospital
48
7.15.1.8.2 Attach the suction tubing to the sputum trap air vent.
7.15.1.8.3 Suction the clients nasopharynx or oropharynx. The sputum trap
will collect
the mucus during suctioning.
7.15.1.8.4 Remove the catheter from the client.
7.15.1.8.5 Disconnect the sputum trap tubing from the suction catheter.
7.15.1.8.6 Remove the suction tubing from the trap air vent.
7.15.1.8.7 Connect the tubing of the sputum trap to the air vent. Connect the
suction
catheter to the tubing.
7.15.1.8.8 Flush the catheter to remove secretions from the tubing.
7.15.1.9Promote client comfort.
7.15.1.9.1 Offer to assist the client with oral or nasal hygiene Assist the client
to a
position that facilitates breathing.
7.15.1.10Dispose of equipment and ensure availability for the next suction.
7.15.1.10.1Dispose of the catheter, gloves, water, and waste container.
7.15.1.10.2 Wrap the catheter around your sterile gloved hand and hold the
catheter as the
glove is removed over it for disposal.
7.15.1.10.3 Rinse the suction tubing as needed by inserting the end of the
tubing
into the or Nasotracheal
7.15.1
Orotracheal
used
water container.
Empty and
theorsuction
collection
container
7.15.1.1The
catheter
is passed through
therinse
mouth
nose and
move further
in to
as
suction
the
needed or indicated by protocol.
trachea.
7.15.1.10.4 procedure
Change theas
suction
tubing and and
container
daily.
7.15.1.2Same
in oropharyngeal
nasopharyngeal
suctioning.
Ensure that supplies are available for the next suctioning.
7.15.27.15.1.10.5
Artificial Airway
7.15.1.11Assess
theaeffectiveness
ofor
suctioning.
7.15.2.1Suctioning
Tracheostomy
Endotracheal Tube
7.15.1.11.1Auscultate
the
clients
breath
o ensure they
are clear
7.15.2.1.1 Prepare the equipment. Attachsounds
the resuscitation
apparatus
toof
the
secretions.
oxygen
7.15.1.11.2Observe
skin color, dyspnea, and level of anxiety.
source.
7.15.1.12Document
relevant
Record
the100
procedure:
7.15.2.1.1.1Adjust
thedata.
oxygen
flow to
percent flush. Open the sterile
7.15.1.12.1The
amount, consistency, color, and odor of sputum
supplies
in
7.15.1.12.2The
clientsfor
breathing
status before and after the procedure
readiness
use.
7.15.2.1.1.2Place the sterile towel, if used, across the clients chest below
the
tracheostomy.
7.15.2.1.1.3Turn on the suction, and set the pressure in accordance with
agency
policy.
7.15.2.1.1.4Put on goggles, mask, and gown, if necessary.
7.15.2.1.1.5Put on sterile gloves.
7.15.2.1.1.6Holding the catheter in the dominant hand and the connector in
the
nondominant hand, attach the suction catheter to the suction tubing.
7.15.2.1.2 Flush and lubricate the catheter. Using the dominant hand, place the
catheter
tip in the sterile saline solution.
7.15.2.1.2.1Using the thumb of the nondominant hand, occlude the thumb
control,
and suction a small amount of the sterile solution through the
catheter.
7.15.2.1.3 If the client does not have copious
375 secretions, hyperventilate the
lungs with a
resuscitation bag before suctioning. Summon an assistant, if one is
available,
Republic of
Yemen 48Modern
Hospital
48
for this step.

7.15.2.1.3.1Using your nondominant hand, turn on the oxygen to 1215 L/min.
If the
the
client is receiving oxygen, disconnect the oxygen source from the

tracheostomy tube using your nondominant hand.
7.15.2.1.3.2Attach the resuscitator to the tracheostomy or endotracheal tube.
7.15.2.1.3.3 Compress the Ambu bag 35 times, as the client inhales. Observe
rise and fall of the clients chest to assess the adequacy of each
ventilation. Remove the resuscitation device and place it on the bed or
the
clients chest, with the connector facing up.

7.15.2.2Closed Airway/Tracheal Suction System (In-Line Catheter)
7.15.2.2.1 If a catheter is not attached, put on clean gloves, aseptically open a
new closed
catheter set, and attach the ventilator connection on the T piece to the
ventilator tubing.
7.15.2.2.2 Attach the client connection to the endotracheal tube or tracheostomy.
7.15.2.2.3 Attach one end of the suction connecting tubing to the suction
connection port
of the closed system, and the other end of the connecting tubing to the
suction
device.
7.15.2.2.4 Turn suction on, occlude or kink tubing, and depress suction control
valve (on
closed catheter system) to set suction to the appropriate level.
7.15.2.2.5 Release the suction control valve. Use the ventilator to
hyperoxygenate and
hyperinflate the clients lungs.
7.15.2.2.6 Advance the suction catheter enclosed in plastic sheath with dominant
hand.
Steady the T piece with the nondominant hand.
7.15.2.2.7 Depress the suction control valve and apply suction for no more than
10
seconds, and gently withdraw the catheter.
7.15.2.2.8 Repeat as needed, remembering to provide hyperoxygenation and
hyperinflation as needed.
7.15.2.2.9 When done suctioning, withdraw the catheter into its sleeve and close
the
access valve, if appropriate.
7.15.2.2.10Flush the catheter by instilling normal saline into the irrigation port
and
applying suction. Repeat until the catheter is clear.
7.15.2.2.11Close the irrigation port and close the suction valve.
7.16Wash hands. Remove gloves.
7.17Auscultate the patient and listen to chest for breathing sound to assess effectiveness
of suctioning.
7.18Render oral hygiene.
7.19After care of the suction machine.
7.19.1 Always disconnect the suction machine from the mains prior to cleaning.
7.19.2 Everyday wipe the machine housing with a surface disinfectant. Allow to dry.
7.19.3 Send suction bottle and tubing to CSSD for cleaning and sterilization.
REFERENCE:
7.19.4 Put on new suction
tubing and bottle.
8
7th suctioning.
Edition
7.20.1 Date and time of
Barbara
Kozier, Glenora Erb, Audrey Berman, Shirlee Snyder
7.20.2 Patients tolerance
to procedure.
7.20.3 Character and amount of secretions. 376
7.20.4 Character of patients respiration before and after suctioning.
7.20.5 Oxygen saturation level by pulse oximetry.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Total Parenteral Nutrition
CONTENTS: This General Ward policy and procedure deals with the guidelines in
administering total
parenteral nutrition.
1 DEFINITION:
1.1 Total Parenteral Nutrition - the parenteral administration of hypertonic solutions
thereby
achieving anabolism, through central vein.
1.1.1 Composition of total parenteral solutions:
1.1.1.1 Energy:
1.1.1.1.1 Various combinations of dextrose, fat emulsion or both provide calories.
1.1.1.1.2 Most adults require approximately 1500 calories per day post
operatively to
prevent catabolism of body proteins but persons with hypermetabolic
condition require more than 2000 calories.
1.1.1.2 Dextrose:
1.1.1.2.1 Dextrose solutions range from 10 to 70 percent.
1.1.1.2.2 Hypertonic dextrose solutions used in TPN may necessitate the use of
insulin
to prevent hyperglycemia.
1.1.1.3 Lipid emulsions:
1.1.1.3.1 Lipid emulsions are isotonic and contain 10 or 20 percent of safflower or
soybean oil, egg yolk phospholipids (as emulsifier) and glycerin.
1.1.1.3.2 It can be given via Piggyback with amino acid and dextrose solutions
or all 3
can be mixed in the same bag (Total Nutrient Admixture).
1.1.1.3.3 When TPN continues for more than 2 to 3 weeks, lipid emulsions are
necessary to prevent essential fatty acid deficiency.
1.1.1.3.4 Using both dextrose and lipids improved glucose tolerance and less
fluid
retention.
1.1.1.3.5 It should be refrigerated to prevent aggregation of fat particles.
1.1.1.4 Protein:
1.1.1.4.1 Contain both essential and non-essential amino acids.
1.1.1.4.2 Used principally for protein repletion and are not relied on for calories.
1.1.1.5 Vitamins and minerals.
2 PURPOSES:
2.1 To meet patients high energy requirement.
2.2 To promote cell growth and repletion.
3 INDICATIONS:
3.1 Severe burns
3.2 Acute pancreatitis
3.3 Inflammatory bowel disease
3.4 Ulcerative colitis
3.5 Acute renal failure
3.6 Mild to moderate hepatic failure
3.7 Cardiac disease or surgery
377
Republic of
CONTRAINDICATIONS:
48Modern
48
4.1 The Yemen
following are
contraindicated when using central venous line for hyperalimentation.
Hospital
378
Republic of
Yemen 48Modern
Hospital
48
4.1.1
Infusion of blood or blood products.
4.1.2
Bolus infusion of drugs.
4.1.3
Simultaneous administration of IV solutions.
4.1.4
Measurement of central venous pressure.
4.1.5
Aspiration of blood for routine laboratory tests.
4.1.6
Addition of medication to an intravenous hyperalimentation solution
container.
5
5.1 Infusion pump
5.2 Infusion tubing
5.3 Sterile gloves
5.4 Alcohol spray 70%
5.5 Sterile gloves 10 x 10
5.6 Transparent dressing
5.7 Dressing set
5.8 Face masks
5.9 Scissors
6 POLICIES:
6.2 7 Rights in giving medication should be followed.
PROCEDURES:
6.3 It should
done under aseptic technique.
7.1 Preparation
ofbe
equipment:
6.4 Nurses
must
aware of the solution
complication
and s
provide
7.1.1
Compare
the be
contents
with of
theTPN
doctor
order. proper intervention,
if
any Check
of the the solution for cloudiness, turbidity, particles, and container for cracks. If
7.1.2
complication occurs.
any,
6.5return
TPN solution
should
in Pharmacy.
the solution
to be
theprepared
Pharmacy.
7.1.3 Using aseptic technique, insert the pump tubing into the post of the solution. 7
7.1.4 Prime the tubing and remove air.
7.2 Essential steps:
7.2.1 If patient has no central line, arrange for Central Line Insertion to be done in ICU.
If patient
has central line, take vital signs as baseline.
7.2.2 Explain the procedure to the patient.
7.2.3 Wash hands, wear disposable gloves and mask.
7.2.4 Place the patient in supine position with the head turned away from the catheter
insertion
site.
7.2.5 Remove the dressing carefully, pulling the tape gently from the skin to minimize
trauma.
Inspect the site for signs of infection and the catheter for leakage or other
mechanical
problems.
7.2.6 Remove gloves and put on sterile gloves. Cleanse the insertion site with alcohol
70%.
Work in a circular motion, moving from the insertion site outward to the edge of
the
adhesive border to avoid introducing contaminants from the uncleaned area.
7.2.7 Working in a circular motion as before, cleanse the insertion site and the
catheter for 2
minutes with the povidone-iodine solution.
7.2.8 Instruct the patient to perform Valsava maneuver or to hold his breath on deep
inspiration as
the IV tubing is changed.
7.2.9 Ensure that the junction of the catheter tubing is secured, remove the
contaminated gloves
and put on a sterile pan.
379
7.2.10 Continue to cleanse the skin with povidone-iodine solution for 3 minutes.
7.2.11 Using a sterile swab or sponge, apply anti-microbial ointment to the stem of the
insertion
Republic of
Yemen 48Modern
Hospital
48
site and to the hub of the catheter at the catheter tubing junction, being careful
not to loosen
the connection.
7.2.12 Apply sterile dressing, tape securely, and occlusively to the skin.
7.2.13 Write on the tape the date and time dressing was changed.
7.2.14 Remove gloves, wash hands.
7.2.15 Begin infusion at a slow rate (usually 10ml/hour). Then, as ordered, increase
the adults
infusion rate.
7.2.16 Check the infusion pumps volume meter and the time tape every 30 minutes
or more
frequently, if necessary.
7.2.17 Record vital signs every 4 hours.
7.2.18 Assist the patient in a comfortable position.
7.2.19 Aftercare of the equipment.
7.2.20 Documentation:
SPECIAL
CONSIDERATIONS:
7.2.20.1Record
the time and date of dressing and solution changes.
8.1
If
the
patient
develops
fever,
discontinue
the site.
TPN solution and replace it with dextrose
7.2.20.2The
condition
of the
catheter
insertion
10%
in
water
7.2.20.3Type of solution infused.
after informing the
doctor. Change
the IV tubing and dressing and notify the doctor who
7.2.20.4Patients
tolerance,
vital signs.
might
7.2.20.5Note for patients progress and response.
8
order for fungal
and abnormal,
bacterial cultures
solution,
tubing, and blood.
7.2.20.6Note
for any
adversefor
or altered
responses.
8.2
Observe
the
patient
for
signs
of
thrombosis
or
thrombophlebitis
such
as
erythema
and
7.2.21 Charge for the supplies and equipment used.
edema at the
catheter insertion site, ipsilateral swelling of the arm, neck or face, pain along the
course of the vein
and other systemic manifestation.
8.3 Be alert for swelling at the catheter insertion site, indicating extravasation of the TPN
solution,
which can cause necrosis.
8.4 Observe for signs of air embolism such as:
8.4.1 dyspnea
8.4.2 apprehension
8.4.3 chest pain
8.4.4 tachycardia
8.4.5 hypotension
8.4.6 cyanosis
8.4.7 seizures and loss of consciousness
8.4.8 cardiopulmonary arrest
8.5 TPN can cause many complications, nursing intervention for more prevalent
complications are
presented.
8.5.1 Sepsis:
8.5.1.1 Monitor for sudden elevation of fever and glucose.
8.5.1.2 Use aseptic technique when hanging solution and preparing tubing to
prevent bacterial
contamination.
8.5.2 Hyperglycemia and hypoglycemia:
8.5.2.1 Monitor flow rate hourly.
8.5.2.2 Monitor closely blood glucose levels of person at risk of developing blood
glucose
problems (early phase injury; diabetes mellitus, pancreatic disease, sepsis,
surgery, use
380
of B-blockers, phenytoin, steroids, epinephrine, thiazide diuretics.
8.5.3 Lipid overload
1.1.1.1 Give initial fat solution slowly.
Republic of
Yemen 48Modern
48
Hospital
8.5.3.1 Notify the physician, if an acute reaction or fat overload occurs

(hyperlipedemia, fever
focal seizures, pruritic urticuria, leukocytosis hepatosplenomegaly).
8.5.4 Nutritional deficiencies:
8.5.4.1 Monitor physical status for possible nutrient excesses or deficiencies.
8.6 When discontinuing TPN, decrease the infusion rate slowly to minimize the risk of
hyperinsulinimia
and resulting hypoglycemia. Weaning usually takes place over 24 to 48 hours but can
be completed
in 4 to 6 hours if the patient receives sufficient oral or IV carbohydrates.
381
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Tracheostomy Care
CONTENTS: This General Ward policy and procedure deals with the guidelines in doing
tracheostomy
care.
1 DEFINITION:
1.1 Tracheostomy Care - is the method of cleaning the tracheostomy tube and keeping the
site clean
and dry, thus preventing skin irritation and infection.
2 PURPOSES:
2.1 To ensure airway patency.
2.2 To maintain mucus membrane and skin integrity.
3.1 Sterile gloves
3.2 Antiseptic solution
3.3 NSS 1000cc
3.4 Cotton tip applicators
3.5 Gauze 10 x 10
3.6 Tracheostomy ties
3.7 Underpad
3.8 Kidney basin (2) sterile
3.9 Zinc oxide cream
3.10Mask and goggles
3.11Hydrogen peroxide
3.12Adhesive tape
3.13Scissors
3.14Sterile Forceps
4 POLICIES:
4.1 Policy on infection control must be observed.
4.2 Cleaning of the Fresh Stoma should be performed every 8 hours or more frequently as
necessary.
4.3 Tracheostomy ties should be changed every 24 hours or as necessary.
5 PREPARATIONS:
5.1 Assess:
5.1.1 Respiratory status, including ease of breathing, rate, rhythm, depth, and lung
sounds
5.1.2 Pulse rate
5.1.3 Character and amount of secretions from tracheostomy site
5.1.4 Presence of drainage on tracheostomy dressing or ties
PROCEDURES:
6
5.1.5 Appearance
incision
6.1 Explain
to the clientof
what
you are going to do, why it is necessary, and how he can
cooperate.
6.1.1 Provide for a means of communication, such as eye blinking or raising a finger, to
indicate
pain or distress.
382

6.4 Prepare the client and the equipment.
6.4.1 Assist the client to a semi-Fowlers or Fowlers position.
6.4.2 Open the tracheostomy kit or sterile basins. Pour hydrogen peroxide and sterile
normal Republic of
saline into48Modern
separate containers.
Yemen
48
6.4.3 Establish a sterile field.
Hospital
6.4.4Open other sterile supplies as needed, including sterile applicators, suction

kit,
and
tracheostomy dressing.
6.5 Suction the tracheostomy tube.
6.5.1 Put a clean glove on your nondominant hand and a sterile glove on your dominant
hand (or
put on a pair of sterile gloves).
6.5.2 Suction the full length of the tracheostomy tube to remove secretions and ensure
a patent
airway.
6.6 Rinse the suction catheter and wrap the catheter around your hand, and peel the
glove off so that it
turns inside out over the catheter.
6.6.1 Using the gloved hand, unlock the inner cannula (if present) and remove it by
gently pulling
it out toward you in line with its curvature.
6.6.2 Place the inner cannula in the hydrogen peroxide solution.
6.6.3 Remove the soiled tracheostomy dressing. Place the soiled dressing in your
gloved hand and
peel the glove off so that it turns inside out over the dressing. Discard the glove
and the
dressing.
6.6.4 Put on sterile gloves. Keep your dominant hand sterile during the procedure.
6.7 Clean the inner cannula. Remove the inner cannula from the soaking solution.
6.7.1 Clean the lumen and entire inner cannula thoroughly, using the brush or pipe
cleaners
moistened with sterile normal saline.
6.7.2 Inspect the cannula for cleanliness by holding it at eye level and looking through
it into the
light.
6.7.3 Rinse the inner cannula thoroughly in the sterile normal saline. After rinsing,
gently tap the
cannula against the inside edge of the sterile saline container. Use a pipe cleaner
folded in
half to dry only the inside of the cannula; do not dry the outside. Using sterile
technique,
suction the outer cannula.
6.8 Replace the inner cannula, securing it in place.
6.8.1 Insert the inner cannula by grasping the outer flange and inserting the cannula in
the
direction of its curvature.
6.8.2 Lock the cannula in place by turning the lock (if present) into position to secure
the flange
of the inner cannula to the outer cannula.
6.9 Clean the incision site and tube flange.
6.9.1 Using sterile applicators or gauze dressings moistened with normal saline, clean
the incision
site. Handle the sterile supplies with your dominant hand. Use each applicator or
gauze
dressing only once and then discard.
6.9.2 Hydrogen peroxide may be used to remove crusty secretions.
6.9.3 Thoroughly rinse the cleaned area, using gauze squares moistened with sterile
normal saline.
6.9.4 Clean the flange of the tube in the same manner. Thoroughly dry the clients skin
and tube
flanges with dry gauze squares.
6.10Apply a sterile dressing.
383
6.10.1 Use a commercially prepared tracheostomy
dressing of nonraveling material, or
open and
refold a 4 x 4 gauze dressing into a V shape.
6.10.2 Place the dressing under the flange of the tracheostomy tube. While applying
the dressing,
Republic of
Yemen 48Modern
Hospital
48
other about 50 cm (20 in) long.

6.11.1.2Cut a 1-cm (0.5-in) lengthwise slit approximately 2.5 cm (1 in) from one end
of each
strip. To do this, fold the end of the tape back onto itself about 2.5 cm (1 in),
then cut a
slit in the middle of the tape from its folded edge.
6.11.1.3Leaving the old ties in place, thread the slit end of one clean tape through
the eye of the
tracheostomy flange from the bottom side; then thread the long end of the tape
through
the slit, pulling it tight until it is securely fastened to the flange.
6.11.1.4If the old ties are very soiled, or if it is difficult to thread new ties onto the
tracheostomy flange with the old ties in place, have an assistant put on a
sterile glove
and hold the tracheostomy in place while you replace the ties.
6.11.1.5Repeat the process for the second tie. Ask the client to flex his neck. Slip the
longer
tape under the clients neck, place two fingers between the tape and the
clients neck,
and tie the tapes together at the side of the neck. Tie the ends of the tapes,
using square
knots. Cut off any long ends, leaving approximately 1 to 2 cm (0.5 in).
6.11.1.6Once the clean ties are secured, remove the soiled ties and discard.
6.11.2 One-Strip Method
6.11.2.1Cut a length of twill tape 2.5 times the length needed to go around the
clients neck
from one tube flange to the other.
6.11.2.2Thread one end of the tape into the slot on one side of the flange. Bring both
ends of
the tape together, and take them around the clients neck, keeping them flat
and
untwisted.
6.11.2.3 Thread the end of the tape next to the clients neck through the slot from
the back to
the front.
6.11.2.4 Have the client flex his neck. Tie the loose ends with a square knot at the
side of the
clients neck, allowing for slack by placing two fingers under the ties, as with
the twostrip method. Cut off long ends.
6.11.3 Tape and pad the tie knot. Place a folded 4" x 4" gauze square under the tie knot,
and apply
tape over the knot.
6.11.4 Check the tightness of the ties. Frequently check the tightness of the
tracheostomy ties and
position of the tracheostomy tube.
SPECIAL
6.11.5 CONSIDERATIONS:
Document all relevant information.
7.1 Stabilization
6.11.5.1Record
of the
suctioning,
tracheostomy
tracheostomy
tube by acare,
tie should
and the
bedressing
done if possible
change, by
noting
two your
7
person to assessments.
prevent
6.12Variation:
accidental dislodgment
Using a Disposable
and to Inner
keep from
Cannula
irritation and coughing due to tube
manipulation
6.12.1 Check
atpolicy
a
for frequency of changing inner cannula.
6.12.2
minimum.
Open new cannula package.
7.2
6.12.3
If theUsing
patient
a gloved
with double
hand, lumen
unlock tracheostomy
the current inner
tubecannula
has arrested
(if present)
or in respiratory
and remove it
by
distress
gentlyand in need
of mechanical
pulling it out
ventilation,
toward you
theintracheostomy
line with its curvature.
tube should be changed to a cuffed
(portex)
6.12.4 type
Check
bythe cannula for amount and type
of secretions, and discard properly.
384
6.12.5
ENT doctor.
Pick up the new inner cannula, touching only the outer locking portion.
7.3
6.12.6
For portex
Insert type
the new
of tracheostomy
inner cannulatube,
into the
the tracheostomy.
cuff should be deflated for 3 minutes every
hour.
6.12.7 Lock the cannula in place by turning the lock (if present).
Republic of
Yemen 48Modern
48
Hospital
8
REFERENCE:
7th Edition
385
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Urinary Catheter (Indwelling) Care
CONTENTS: This General Ward policy and procedure deals with the guidelines in the care of
urinary
(indwelling) catheter.
1 DEFINITION:
1.1 Management of indwelling catheter is a special nursing care provided to patients with
urinary
catheter for hygienic and medical reasons i.e.:
1.1.1 Care of indwelling catheter.
1.1.2 Irrigation of indwelling catheter.
1.1.3 Emptying a catheter bag.
2 PURPOSES:
2.2 To restore or maintain patency of catheter.
2.3 To prevent urinary tract obstruction by flushing out small blood clots formed after
prostate or bladder
surgery.
2.4 It creates a mild tamponade that prevents venous hemorrhage.
2.5 To treat an irritated, inflamed, or infected bladder lining.
2.6 To instill medicine for therapeutic purposes.
3.1 Antibacterial solution
3.2 Sterile gauze
3.3 Disposable/sterile gloves
3.4 Sterile kidney basin
3.5 Sterile irrigating solution
3.6 Wash cloth
3.7 Bedpan
3.8 Blue pads
3.9 Prescribed antibiotic cream (as ordered)
3.1020-50ml. Syringe
3.11Alcohol swab
POLICIES:
4
3.12Medication for irrigation (optional)
4.1.1 Urinary catheters shall be used only when absolutely necessary and for a short
period of time
as possible, the need for the indwelling catheter shall be reassessed every 72
hours in an
acute care, and monthly in long-term care.
4.2 Only trained personnel shall insert urinary catheters.
4.3 Aseptic technique shall be used in urinary catheter insertion and care.
4.4 All urinary catheters shall be properly secured or anchored to prevent movement and
urethral
traction.
4.5 Care of indwelling catheter shall be done every shift and as necessary.
386type used.
4.6 Catheter should be changed depending on the
4.6.1 Silicon Catheter - up to 3 months
PROCEDURES:
Republic of
Yemen 48Modern
48
5.2 Provide privacy. Explain procedure to the patient.
Hospital at bedside.
5.3 Gather all equipment

5.4 Wash hands. Wear gloves.
5.5 Management as follows:
5.5.1 Care of Indwelling Catheter:
4.6.2
Polyurethane
Catheter
- up to 1related
5.5.1.1 Utilize aseptic techniques in all
manipulations
or procedures
to
month
perineal care, the
catheter and the collecting system.
5
5.5.1.2 Place the patient in supine position exposing the perineal area and catheter.
5.5.1.3 Inspect the following:
5.5.1.3.1 catheter and urinary drainage for mucous shreds, blood clots, sediment
and
turbidity
5.5.1.3.2 tissues around the meatus for any signs of inflammation
5.5.1.4 Determine if catheter and drainage system is functioning properly.
5.5.1.5 Clean the area with antiseptic solution in circular motion from innermost
surface to the
outside.
5.5.1.6 Clean the catheter from meatus up to the end of catheter, use one stroke
from new
sterile gauze for each cleaning. Note: Take care not to pull the catheter.
5.5.1.7 Place used gauze and other disposable items in receptacle for proper
disposal.
5.5.2 Irrigation of Catheter:
5.5.2.1 Irrigate only when necessary to prevent obstruction.
5.5.2.2 Disinfect the catheter tubing junction before disconnection.
5.5.2.3 Palpate for full bladder and check current output.
5.5.2.4 Empty the urine collection bag.
5.5.2.5 Expose the indwelling catheter and place blue pads underneath.
5.5.2.6 Open sterile syringe and kidney basin and add 100-200cc sterile diluent
without
touching or contaminating tip of syringe or the inside of receptacle.
5.5.2.7 Wear sterile gloves.
5.5.2.8 Disinfect the connection between catheter and drainage tubing then loosen
end
connection.
5.5.2.9 Separate catheter and tube covering the tube tightly with sterile cap.
5.5.2.10Fill syringe with 20-50cc. of irrigating solution and insert the tip of syringe
into
catheter. Gently instill solution and allow the return drain fluid back to the
bedpan.
5.5.2.11If bladder or catheter is being irrigated to clear solid materials, repeat
irrigation until
return flow is clear.
5.5.2.11.1 For medicated solution, clamp the catheter and hold for a while.
5.5.2.12When irrigation is finished, reconnect system and remove sterile gloves.
5.5.2.13Monitor patient for pain, urine color and clarity, and any solid material
passed.
5.5.3 Urinary Flow:
5.5.3.1 Maintain an unobstructed downhill flow by keeping the drainage bags always
below the
bladder level.
5.5.3.2 Prevent kinks in the catheter and the collecting tube.
5.5.3.3 Empty collecting bag using an approved collecting vessel. Use separate
collection
containers for each client.
5.5.3.4 Prevent the collecting vessel from touching the spigot of the bag.
5.5.4 Emptying Catheter Bag:
5.5.4.1 Wipe with alcohol swab the outlet 387
valve.
5.5.4.2 Open the outlet valve, drain urine in bedpan or urinal, ensuring that outlet
valve does
not touch the rim of the container.
Republic of
Yemen 48Modern
48
Hospital
5.5.4.3 Empty catheter bag every 4 hours or as needed.

5.5.4.4 Close outlet valve and wipe again with alcohol swab.
5.5.5 Catheter Change and Type:
5.5.5.1 Change catheters according to the material type of the catheter in long-term
care.
5.5.5.2 Use catheters composed of materials that decrease the mobility and
adherence of
microorganisms to the inner wall of the catheter, when possible.
5.6 Discard disposable items used in yellow plastic bag.
5.7 Remove gloves. Wash hands.
5.8 Record the following:
5.8.1 procedure done
5.8.2 amount, color, odor, appearance, and other unusual characteristics
5.8.3 date and time of collection
5.8.4 observations made
5.8.5 tolerance to the procedure
5.9 Charge the procedure and supplies used in the Inpatient Charging Form.
6
REFERENCE:
6.1 IC008.2 Care of Foleys and indolent Urinary Catheters, SGH Infection Control Policies
and
Procedures Manual, 2007 Edition.
388
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Urinary Catheterization
CONTENTS: This General Ward policy and procedure deals with the guidelines in doing urinary
catheterization.
1 DEFINITION:
1.1 Urinary Catheterization - an introduction of a special rubber or plastic tube into the
bladder via the
urethra to drain
1.2 Types: urine, obtain a specimen, or instill fluids using strict aseptic technique.
1.2.1 Indwelling - remains in place until the patient is able to void completely and
voluntarily.
1.2.2 Intermittent - a straight single use catheter is introduced long enough to drain the
bladder
(5-10 minutes).
2 PURPOSES:
2.1 To relieve acute or chronic urinary retention and incontinence.
2.2 For pre and post operative urinary drainage.
2.3 To obtain urine specimen for analysis and culture.
2.4 To empty contents of bladder prior to instillation, irrigation, and delivery.
2.5 To provide a means of accurately recording output in critically ill or comatose patients.
2.6 To prevent skin breakdown in comatose patients who are incontinent or severely
disoriented.
3 INDICATIONS:
3.1 Indwelling
3.1.1 Obstruction to urine outflow like prostate enlargement and urethral stricture.
3.1.2 For patient undergoing surgical repair of the urethra and surrounding structures
(transurethral resection).
3.1.3 For urethral obstruction from blood clots due to bladder tumor and surgical repair
of urethra.
3.1.4 To determine amount of residual urine after voiding.
3.2 Intermittent
3.2.1 Immediate relief of acute bladder distention as follows:
3.2.1.1 Patient unable to void 8-12 hours after surgery.
3.2.1.2 Acute retention after trauma to the urethra.
3.2.1.3 Patients unable to void as a result of the effects of sedatives or analgesics.
3.2.2 For long-term
management of patient with incompetent bladder such as:
4
4.1cord
Sterile
catheter of appropriate size. An extra catheter should also
3.2.2.1 Spinal
injuries.
be at hand.
3.2.2.2 Progressive
neuromuscular degeneration.
4.2 Catheterization kit or individual sterile items:
4.2.1 12 pair sterile gloves
4.2.2 Waterproof drape(s)
4.2.3 Antiseptic solution
4.2.4 Cleansing balls
4.2.5 Forceps
389
Republic of
Yemen 48Modern
Hospital
48
4.2.7 Urine receptacle

4.2.8 Specimen container
4.3 For an indwelling catheter:
4.3.1 Syringe prefilled with sterile water in amount specified by catheter
manufacturer
4.3.2 Collection bag and tubing
4.4 2% Xylocaine gel (if agency permits)
4.5 Disposable clean gloves
4.6 Supplies for performing perineal
4.7 Bath blanket or sheet for draping
4.8 Insure that there is adequate cleansing the client lightingobtain a flashlight or
POLICIES:
lamp, if necessary.
5
5.2 Procedure to be done under aseptic technique.
5.3 Proper identification and assessment of patients condition prior to
procedure.
5.4 Procedure should be performed by a qualified nurse of the same
gender.
6
5.5 Infection control measures should be followed.
PREPARATIONS:
6.1 Assess:
6.1.1 The client's overall condition.
6.1.2 If the client is able to cooperate and hold still during the
procedure
6.1.3 If the client can be positioned supine, with head relatively flat
6.1.4 When the client last voided or was last catheterized
PROCEDURES:
6.1.5
Percuss
thegoing
bladder
to check
or distension.
7.1 Explain to the client
what
you are
to do,
why itfor
is fullness
necessary,
and how he or she
6.2 Determine:
can cooperate.
6.2.1 Theother
mostappropriate
appropriateinfection
method of
catheterization
7.2 Wash hands and observe
control
procedures.
7
6.3
Assemble
equipment
and
supplies.
6.4
routine perineal
to cleanse
the meatus
fromperineum.
gross
7.4 Place the client
inPerform
the appropriate
position care
and drape
all areas
except the
7.4.1 Female: Contamination.
supine, with knees flexed and externally rotated
7.4.2 Male: supine, legs slightly abducted
7.5 Establish adequate lighting. Stand on the client's right if you are right handed, on the
client's left if
you are left-handed.
7.6 If using a collecting bag not contained within the catheterization kit, open the drainage
package and
place the end of the tubing within reach.
7.7 If indicated, apply clean gloves and inject 1015 mL Xylocaine gel into the urethra.
7.7.1 In the male, wipe the underside of the shaft to distribute the gel up the urethra.
7.7.2 Wait at least 5 minutes for the gel to take effect before inserting the catheter.
7.8 Open the catheterization kit.
7.8.1 Place a waterproof drape under the buttocks (female) or penis (male) without
contaminating
the center of the drape with your hands.
7.9 Apply sterile gloves.
7.10Organize the remaining supplies: Saturate the cleansing balls with the antiseptic
solution.
7.10.1 Open the lubricant package.
7.10.2 Remove the specimen container and place it nearby, with the lid loosely on top.
7.11Attach the prefilled syringe to the indwelling catheter inflation hub and test the
balloon.
7.12Lubricate the catheter and place it with the390
drainage end inside the collection
container.
7.13If desired, place the fenestrated drape over the perineum, exposing the urinary
meatus.
7.14Cleanse the meatus.

7.14.1 The nondominant hand is considered contaminated once it touches the clients
skin.
7.14.2 Female
Republic
7.14.2.1Use
yourof
nondominant hand to spread the labia.
7.14.2.2Establish
a firm but gentle position.
Yemen 48Modern
48
7.14.2.3Pick up a cleansing ball with the forceps in your dominant hand and wipe
Hospital
one side of
the labia majora in an antero-posterior direction.
7.14.2.4Use a new ball for the opposite side. Repeat for the labia minora.
7.14.2.5Use the last ball to cleanse directly over the meatus.
7.14.3 Male
7.14.3.1Use your nondominant hand to grasp the penis just below the glans.
7.14.3.2If necessary, retract the foreskin.
7.14.3.3Hold the penis firmly upright, with slight tension.
7.14.3.4Pick up a cleansing ball with the forceps in your dominant hand and wipe
from the
center of the meatus in a circular motion around the glans.
7.14.3.5Use a new ball and repeat three more times.
7.15Insert the catheter.
7.15.1 Grasp the catheter firmly 23 inches from the tip.
7.15.2 Ask the client to take a slow deep breath, and insert the catheter as the client
exhales.
7.15.3 Advance the catheter 2 inches further after the urine begins to flow through it.
7.15.4 If the catheter accidentally contacts the labia or slips into the vagina, it is
considered
contaminated, and a new, sterile catheter must be used.
7.15.5 The contaminated catheter may be left in the vagina until the new catheter is
inserted to help
avoid mistaking the vaginal opening for the urethral meatus.
7.16Hold the catheter with the nondominant hand.
7.16.1 In males, lay the penis down onto the drape, being careful that the catheter
does not pull out.
7.17For an indwelling catheter, inflate the retention balloon with the designated volume.
7.17.1 Without releasing the catheter, hold the inflation valve between two fingers of
your
nondominant hand while you attach the syringe (if not left attached earlier when
testing the
balloon) and inflate with your dominant hand.
7.17.2 If the client complains of discomfort, immediately withdraw the instilled fluid,
advance the
catheter further, and attempt to inflate the balloon again.
7.17.3 Pull gently on the catheter until resistance is felt, to insure that the balloon has
inflated and to
place it in the trigone of the bladder.
7.18Collect a urine specimen if needed.
7.18.1 Allow 2030 ml to flow into the bottle without touching the catheter to the
bottle.
7.18.2 Allow the straight catheter to continue draining.
7.18.3 If necessary, attach the drainage end of an indwelling catheter to the collecting
tubing and
bag.
7.19Examine and measure the urine. In some cases, only 7501000 ml of urine are to be
drained from
the bladder at one time.
7.20Remove the straight catheter when urine flow stops.
7.20.1 For an indwelling catheter, secure the catheter tubing to the inner thigh for
females, or the
upper thigh/abdomen for males with enough slack to allow usual movement.
7.20.2 Also secure the collecting tubing to the bed linens and hang the bag below the
level of the
bladder. No tubing should fall below the top of the bag.
7.21Wipe the perineal area of any remaining antiseptic or lubricant. Return the client to a
comfortable
391
position.
7.22Discard all used supplies in appropriate receptacles and wash your hands.
7.23Document the catheterization procedure, including catheter size and results, in the
client record.
Republic of
Yemen 48Modern
48
Hospital
8
8.1 Urine to be drained should not be more than 750cc at one time as it may cause
hypotension, bladder
atony.
8.2 Identify patients at high risk for UTI like older adults, debilitated, malnourished,
chronically ill,
immuno-suppressed, and diabetic patients.
8.3 Prevent infection in catheterized patient by:
8.3.1 Clamp drainage tube when the urine bag is raised above the level of patients
bladder.
8.3.2 Ensure free flow of urine by preventing kinked/twisted tubing or allowing pools of
Empty
the urine bag at least every 4 hours and as needed.
REFERENCE:
8.3.3 Never change the
catheter unless there is a leakage, blockage, encrustation or9
less than one
7th Edition
month.
Barbara
Kozier,
Glenora
Erb, Audrey
Berman, Shirlee Snyder
8.3.4 Never irrigate the
catheter
routinely
unless
ordered.
392
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Urine Specimen Collection
CONTENTS: This General Ward policy and procedure deals with the guidelines in collecting
urine
specimen.
1 DEFINITION:
1.1 Part of the physical examination or at various times during hospitalization that
permits laboratory
screening for urinary and systemic pathologies.
1.1.1 Method
1.1.1.1 Routine urinalysis specimen
1.1.1.2 Clean catch or midstream specimen
1.1.1.3 Indwelling urinary catheter
1.1.1.4 U-bag collection
2 PURPOSES:
2.1 To provide a tentative diagnosis.
2.2 To indicate the need for further studies.
2.3 To monitor the progression of a disorder (e.g. Diabetes Mellitus)
3.1 Catheterization set (if patient is unable to void freely)
3.2 Perineal care set
3.3 Sterile/clean specimen bottle
3.4 Bed pan/Urinal
3.5 Underpad
4 POLICIES:
4.2 Ensure that proper method of collection and purpose is well understood by the
patient.
4.3 Observe infection control policy in collecting urine specimen.
5
PREPARATIONS:
4.4 Specimen
should be properly labeled with name, PIN, date and time.
5.1
Assess: collected should be sent immediately to laboratory.
4.5 Urine
specimen
5.1.1 Clients ability to provide the specimen
5.1.2 Color, odor, and consistency of the urine
5.1.3 For the presence of clinical signs of urinary tract infection
5.2.2 Antiseptic towelette, such as povidone-iodine
5.2.3 Sterile cotton balls or 2 x 2 gauze pads
5.2.4 Sterile specimen container
5.2.5 Specimen identification label
5.3 In addition, the nurse needs to obtain:
5.3.1 Completed laboratory requisition form
5.3.2 Urine receptacle, if the client is not ambulatory
5.3.3 Basin of warm water, soap, washcloth, and towel for the
nonambulatory client
393
PROCEDURES:
6.1 Check the doctors order.
6.2 Send the request through computer after charging.
6.3 Explain to the client what you are going to do, why it is necessary, and how he or she
Republic of
can
cooperate.
Yemen 48Modern
48
Hospital

6.6 For an ambulatory client who is able to follow directions, instruct the client how to
collect the
specimen:
6.6.1 Direct or assist the client to the bathroom.
6
6.6.2 Ask the client to wash and dry the genitals and perineal area with soap and
water.
6.6.3 Instruct the client how to clean the urinary meatus with antiseptic towelettes.
6.7 For Female Clients
6.7.1 Use each towelette only once. Clean the perineal area from front to back and
discard the
towelette.
6.7.2 Use all towelettes provided (usually two or three).
6.8 For Male Clients
6.8.1 If uncircumcised, retract the foreskin slightly to expose the urinary meatus.
6.8.2 Using a circular motion, clean the urinary meatus and the distal portion of the
penis. Use
each towelette only once, then discard. Clean several inches down the shaft of
the penis.
6.9 For a client who requires assistance, prepare the client and equipment.
6.9.1 Wash the perineal area with soap and water, rinse, and dry.
6.9.2 Assist the client onto a clean commode or bedpan. If using a bedpan or urinal,
position the
client as upright as allowed or tolerated.
6.9.3 Open the clean-catch kit, taking care not to contaminate the inside of the
specimen
container or lid.
6.9.5 Clean the urinary meatus and perineal area.
6.10Collect the specimen from a nonambulatory client, or instruct an ambulatory client
how to collect
it.
6.10.1 Instruct the client to start voiding.
6.10.2 Place the specimen container into the stream of urine and collect the
specimen, taking care
not to touch the container to the perineum or penis.
6.10.3 Collect 3060 mL of urine in the container.
6.10.4 Cap the container tightly, touching only the outside of the container and the
cap.
6.10.5 If necessary, clean the outside of the specimen container with disinfectant.
6.11Label the specimen, and transport it to the laboratory.
6.11.1 Ensure that the specimen label and the laboratory requisition carry the correct
information.
6.11.2 Attach them securely to the specimen.
6.11.3 Arrange for the specimen to be sent to the laboratory immediately.
6.12Document pertinent data.
6.12.1 Record collection of the specimen, any pertinent observations of the urine,
such as color,
odor, or consistency, and any difficulty in voiding that the client experienced.
6.12.2 Indicate on the lab slip if the client is taking any current antibiotic therapy, or
if the client
is menstruating.
6.13Urine Collection For Children
6.13.1 Wash the genitalia, perineum and surrounding skin with soap and water or
antiseptic
solution.
6.13.2 Dry the area, then attach the bag from back to front, first to the perineum and
394
then toward
the symphysis pubis
6.13.2.1Girls - perineum should be stretched tightly to ensure that the bag has a
leak-proof
fit.
Republic of
Yemen 48Modern
48
Hospital
6.13.2.2Boys - Apply and fix the collection bag to the base of the penis.
6.13.3 A diaper is placed over the bag and should be checked often and remove it as
soon as
urine is available.
6.13.4 Transfer the collected urine from the collection bag to the labeled specimen
container and
cap tightly.
6.13.5 Remove gloves and wash hands.
6.13.6 Send specimen to the laboratory as soon as collected.
6.13.7 Document the date and time specimen is collected, amount, color, clarity and
odor.
6.13.8 Variation: Collecting a Specimen from a Foley (Retention) Catheter or
Drainage
Tube
6.14Put on disposable gloves.
6.15If there is no urine in the catheter, clamp the drainage tubing for about 30 minutes.
6.16Wipe the area where the needle will be inserted with a disinfectant swab.
6.17Insert the needle at a 30- to 45-degree angle.
6.18Unclamp the catheter.
6.19Withdraw the required amount of urine.
6.20Transfer the urine to the specimen container.
6.21Without recapping the needle, discard the syringe and needle in an appropriate
sharps container.
6.22Cap the container.
6.23Remove gloves and discard appropriately.
6.24Label
the container, and send the urine to the laboratory immediately.
SPECIAL
CONSIDERATIONS:
7
6.25Record
of the specimen
and
any
pertinent
of theform.
urine on
7.1 If patientcollection
has menstruation,
it should
be
noted
in the observations
laboratory request
the For
appropriate
7.2
female patients, if she feels defecating instruct to void first so that feces do not
records.
contaminate the
6.26Note
that this procedure can be followed if needle-less port systems are being used.
specimen.
8
REFERENCE:
395
Republic of
Yemen 48Modern
48
Hospital
396
Republic of
Yemen 48Modern
Hospital
48
5.15Remove gloves and wash

hands. HOSPITAL
48 MODERN
5.16Document date and time voided urine is collected, color, odor, amount, and
consistency.
5.17Follow up results and notify the doctor.
6
Issued
Effective:Replaces:
6.1 The voided urine specimen is accidentally
discarded,
the 24 o urine collection must be
repeated from
Title:
the Urine
start.Collection for 24ODue for Review:Page 1 of 2
6.2 For patient on indwelling catheter:
CONTENTS:
This General
policy
andone
procedure
deals with
guidelines in doing 24-H
6.2.1 Change
the urineWard
bag with
new
before starting
thethe
collection.
urine
6.2.2 Empty urine bag frequently.
collection.
1 DEFINITION:
1.1 24o Urine Collection - collection of urine voided for 24 hours for laboratory screening of
urinary
and systemic pathologies.
2 PURPOSES:
2.1 To provide important clinical information on kidney function.
2.2 To help diagnose other non-renal diseases.
2.3 To detect any abnormalities that can lead to serious underlying diseases.
3.2 Bedpan/urinal
3.3 Basin with ice
3.4 24o urine specimen container (labeled with patients name, PIN, room number, time
started and
time due).
4 POLICIES:
4.2 Ensure that the patient understand proper instruction of collecting urine and the
purpose of
5
PROCEDURES:
examination.
5.1 Obtain doctors order and inform Laboratory staff for the procedure to be done.
5.4 Instruct patient the proper way of collecting urine and to drink more fluids.
5.5 Instruct patient to discard the first voided urine and note the time as the starting
time for 24o urine
collection.
5.6 Collect urine in the bedpan or urinal when patient starts to void again. In handling
urine specimen,
always wear gloves.
5.7 Transfer into the urine specimen container, cover tightly. Immerse the container in a
basin of ice.
5.8 Remind patient regarding the due time for the last voided urine.
5.9 Label the container properly as to:
5.9.1 Number of specimen container.
5.9.2 Patients name and PIN.
5.9.3 Requesting area/room number.
5.9.4 Date and time:
5.9.4.1 Started
5.9.4.2 Due
5.10Wipe urine that spill off the specimen container to prevent possible crosscontamination.
5.11Collect all urine specimen bottles during the397
24 hours.
5.12Enter request in the Computer to charge and send it to Laboratory online.
5.13Send the specimen to Laboratory.
5.14Wear disposable gloves and clean the urinal, bedpan, and basin. Return in place.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Urinary Catheter Removal

CONTENTS: This General Ward policy and procedure deals with the guideline procedure in
the removal
of urinary catheter.
1 DEFINITION:
1.1 Urinary Catheter Removal - an aseptic technique procedure of withdrawing or
removing
indwelling catheter in place.
2 PURPOSES:
2.1 When bladder decompression is no longer necessary.
2.2 When there is catheter obstruction, leakage or encrustation.
2.3 When patient can resume voiding.
3.1 Syringe 10cc.
3.3 Blue sheet
3.4 Soap
3.5 Towel/washcloth
3.6 Bedpan/urinal
3.7 Specimen container (optional)
3.8 Sterile gauze/cotton
4 POLICIES:
4.3 Bladder training should be done before removal for patients on long-term
5
PROCEDURES:
catheterization.
5.1 Check physicians order.
5.2 Identify patient and explain procedure.
5.3 Gather supplies needed.
5.5 Provide privacy and position patient in supine with legs flexed and knees separated.
5.6 Expose only the genitalia.
5.7 Place blue sheet under the thighs of patient.
5.8 Measure the amount of urine in the collection bag before discarding.
5.9 Empty urine bag.
5.10Remove the tape on the thigh securing the catheter.
5.11Insert syringe tip into balloon port and aspirate fluid from the balloon.
5.12Ensure to withdraw all solution from the balloon, as partially inflated balloon will
traumatize the
urethral canal when catheter is pulled.
5.13Collect the specimen from catheter, if needed.
5.14Grasp catheter with cotton/gauze.
5.15Ask patient to take deep breath, if able. Gently pull catheter on expiration.
5.16Offer bedpan. Catheter removal often creates a desire to void.
5.17Note any sediment, mucus or blood on the catheter.
398
Republic of
Yemen 48Modern
48
Hospital
5.18Clean perineal area.

5.19Discard all disposable contaminated items in the orange plastic bag.
5.20Cover patient and place in comfortable position.
5.23Instruct patient to drink more fluids as tolerated to stimulate urine production and
dilute urine.
5.24Assess patient for incontinence or dribbling, urgency, persistent dysuria, bladder
spasm, fever,
chills, palpable bladder distention and inability to void within 8 hours of catheter
removal. If any of
these is present, report to the physician.
5.25.1 Bleeding, pain or other complications caused by failure of balloon to deflate or
rupture
during removal.
5.25.2 Date and time catheter was removed.
5.25.3 Observations/assessment made during and after the procedure.
5.25.4 Patients tolerance to the procedure.
5.25.5 Vital signs.
5.25.6 Time, amount,
color,
consistency and any associated problem after removal.6
SPECIAL
CONSIDERATIONS:
5.25.7 Amount of urine
output.
6.1 For
bladder training, clamp catheter for 2 hours prior to
5.26Charge all supplies
used.
removal:
6.1.1 Allow urine to accumulate.
6.1.2 Release clamp for 15 minutes. Repeat procedure for 2-3
times.
399
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Urine Test for Sugar and KetonesDue for Review:Page 1 of 2
CONTENTS: This General Ward policy and procedure deals with the guidelines in testing
urine for sugar
and ketones.
1 DEFINITION:
1.1 Urine Test for Sugar and Ketones - a test that permits fast monitoring of urine glucose
and
ketone levels. It provides reliable screening for diabetes.
2 PURPOSES:
2.1 To monitor urine glucose and ketone level in the diabetic client.
2.2 To regulate insulin therapy.
3.1 Urine specimen container
3.2 Multistix strips
3.4 Multistix reference color chart
4 POLICIES:
4.3 Follow infection control policy in collecting and handling of urine specimen.
5 PROCEDURES:
5.1 Check the doctors order.
5.2 Explain the procedure to patient. Wash hands and wear gloves.
5.3 Provide privacy and give health-teachings on how to test his/her urine properly.
5.4 Check the expiry date on the container of the strip before use and close tightly after
removing the
strip.
5.5 For collection of urine sample:
5.5.1 A second voided specimen is collected after giving a glass of water to drink, if
possible.
5.5.2 For patient in foley catheter - follow procedure for urine collection.
5.6 With available specimen, dip the multistix strip in the urine and remove immediately.
Then tap off
the excess urine from the strip.
5.7 Hold the strip horizontally to avoid mixing reagents from adjacent test area on the
strip. Allow
time interval before interpreting results.
5.7.1 ketones = 40 seconds.
5.7.2 glucose = 30 seconds.
5.8 Compare the color result of the strip against standard color chart.
5.9 Discard the urine specimen and strip used. (If patients Input and Output is being
monitored,
measure the amount of urine discarded.)
5.10Remove gloves and wash hands thoroughly.
5.11.2 Result of the test in the Diabetic Worksheet
(Form M1026)
400
5.11.3 Health teachings given to patient
5.12Relay result to the physician concerned.
5.13Charge the procedure and supplies used in the Computer Charging Form.
Republic of
Yemen 48Modern
48
Hospital
6
6.1 For patient who are unable to pass urine inform the doctor. Catheterization might be
performed for
urgent test.
6.2 Patient should be able to test his/her urine properly before being discharged from
the hospital.
401
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Vaginal IrrigationDue for Review:Page 1 of 2
vaginal
irrigation.
1 DEFINITION:
1.1 Vaginal irrigation is a therapeutic measure of instilling fluid into the vaginal cavity.
2 PURPOSES:
2.1 To remove odor or foul discharge.
2.2 To disinfect vagina preoperatively.
2.3 To administer antiseptic drug.
2.4 To stop bleeding.
2.5 To relieve pain and inflammation.
3.1 During pregnancy
3.2 4-6 weeks after miscarriage or post partum
3.3 Untreated venereal disease
4.1 Disposable gloves, underpad
4.2 Wash cloth/cotton balls
4.3 Bed pan
4.4 Bath towel
4.5 Basin with warm water
4.7 Pick up forceps
4.8 OB pads + diapers
4.9 Lubricant + Irrigating vaginal nozzle
4.10Connecting tubes with clamps
4.11Prescribed solution
4.12IV Pole
4.13Container to mix solution
5 POLICIES:
5.1 Written order should be obtained prior to procedure.
5.2 Infection control measures should be observed.
5.3 Cultural and religious beliefs must be considered.
PROCEDURES:
6
6.1 Check the physicians order.
6.2 Follow procedures on Perineal Care.
6.3 Hang the prepared solution to the IV pole.
6.4 Lubricate nozzle tip.
6.5 Open clamp to allow some solution to flow through the tubing.
6.6 Insert the nozzle tip gently into the vagina (2 to 2.5 depth) at approximately 45 o
angle following the
vaginal curvature.
6.7 Open clamp to allow the solution to flow into the vagina. Gently rotate the nozzle tip
to ensure that
402
fluid reaches all areas of vagina.
Republic of
Yemen 48Modern
48
Hospital
6.8 When irrigating container is emptied, close clamp and remove the nozzle
from vagina.
6.9 Assist patient into sitting position on the bedpan for return flow.
6.10Offer toilet tissue to dry the perineum with an instruction to wipe from
front to back.
6.11Remove the bedpan and offer perineal pad.
6.14Record the procedure and observations made.
403
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Vital Signs TakingDue for Review:Page 1 of 10
CONTENTS: This General Ward policy and procedure deals with the guidelines in taking vital
signs.
1 DEFINITION:
1.1 Vital signs - are indexes that reflect body physiological functions. They represent
cardinal signs
to illness or disease condition. Vital signs includes:
1.1.1 Temperature is a measurement of heat expressed in degrees Fahrenheit ( o F) or
Centigrade (o C).
MethodDuration
oOral- 37 C3 minutes
oRectal - 37.5 C1 minute
oAxilla - 36.5 C5 minutes
oTympanic- 37.5 CAccording to calibration
1.1.2 Pulse is defined as the alternate expansion and contraction of an artery as the
wave of blood
is forced through it by the contraction of the left ventricle.
1.1.3 Respiration is the exchange of oxygen and carbon dioxide into the body. It
consists of a
process of inhalation and exhalation.
1.1.4 Blood Pressure is the force exerted by the blood against the walls of the vessels,
usually
expressed in millimeter of mercury (mmHg).
3
2 PURPOSES:
3.12.1
Temperature
To monitor fluctuations or deviations from normal.
3.1.1
2.2 To Thermometer
determine the effect of medicines affecting vital signs.
3.1.2
Thermometer
sheath
cover
2.3
Used
as an indicator
for or
pre
and post-operative management.
3.1.3 Water-soluble lubricant for a rectal temperature
3.1.5 Towel for axillary temperature
3.1.6 Tissues/wipes
3.2 Peripheral Pulse
3.2.1 Watch with a second hand or indicator.
3.2.2 If using Doppler ultrasound stethoscope (DUS), obtain the transducer probe, the
stethoscope headset, transmission gel, and tissues/wipes
3.3 Apical Pulse
3.3.1 Watch with a second hand or indicator
3.3.2 Stethoscope
3.3.3 Antiseptic wipes
3.3.4 If using DUS, the transducer probe, obtain the stethoscope headset,
transmission gel, and
tissues/wipes
3.4 Apical-Radial Pulse
3.4.1 Watch with a second hand or indicator
3.4.2 Stethoscope
404
Republic of
Yemen 48Modern
Hospital
48
3.4.3 Antiseptic wipes

3.5 Blood Pressure
3.5.1 Stethoscope or DUS
3.5.2 Blood pressure cuff of the appropriate
size
3.5.3 Sphygmomanometer
4
POLICIES:
4.1 Upon admission, vital signs should be taken immediately.
4.2 Vital signs are taken.
4.2.1 Routine - every 12 hours (5am-5pm).
4.2.2 Pre and post invasive/surgical procedure. (Refer to post-operative care GW-095).
4.2.3 Every 15 minutes or hourly as ordered for unstable vital signs depending upon
patients
condition.
4.2.4 As necessary (p.r.n.) - when patient reports non-specific symptoms.
4.2.5 Before and after administering medications that affect cardiovascular,
respiratory, and
temperature changes.
4.3 Handwashing before and after the procedure.
4.4 Proper recording on:
PROCEDURES:
4.4.1 Graphic and Treatment Record (Form M1042) - routine vital signs monitoring.
5.14.4.2
Explain
the procedure.
Ensure
that
patient
is comfortable.
Intensive
Vital Signs
Sheet
(Form
M1023)
- for monitoring critically ill patients.
5.2
equipment
and supplies
at bedside.
4.5 Assemble
Observe infection
control
measures.
5
5.3
hands
before and
afterdepending
the procedure.
4.6 Wash
Determine
accepted
method
on patients condition.
5.4 Assess:
5.4.1 Clinical signs of fever
5.4.2 Clinical signs of hypothermia
5.4.3 Site most appropriate for measurement
5.4.4 Factors that may alter core body temperature
5.5 Take body temperature as follows:
5.5.1 Mercurial:
5.5.1.1 Rinse the thermometer in tap water and dry it using a gauze or clean
alcohol swab
from the bulb upward.
5.5.1.2 Grasp the thermometer firmly with the thumb and forefinger. With strong
wrist
movement, shake the thermometer until the mercury line reaches 36 oC (95oF).
5.5.1.3 Read the thermometer by holding it horizontally at eye level, and rotate it
between the
fingers until the mercury line can be seen clearly.
5.5.1.4 Insert the plastic sheet in the mercurial thermometer.
5.5.2 Methods:
5.5.2.1 Oral:
5.5.2.1.1 Place the mercurial bulb of the thermometer under the tongue in
posterior
sublingual pocket lateral to the center of lower jaw.
5.5.2.1.2 Instruct the patient not to bite the thermometer rather close his/her
lips.
5.5.2.1.3 Leave the thermometer for 3 minutes.
5.5.2.2 Axilla:
5.5.2.2.1 Expose the axilla, and place the bulb of the thermometer into the
center.
5.5.2.2.2 Bring the patients arm down close to his/her body and place the
forearm over
405
his/her chest.
4.1.1.1.1. Leave the thermometer for 5 minutes.
4.1.1.2. Rectal:
Republic of
Yemen 48Modern
Hospital
4.1.1.2.1. Position the patient to Sims with upper knee flexed and
expose
the anal area.
4.1.1.2.2. Wash hands and wear gloves.
4.1.1.2.3. Lubricate the tip of thermometer and insert to the anus
approximately 3.8cm. (11/2 inches) in adult, 2.5cm (1 inch) in
children, and 1.25cm (1/2 inch) in infant.
4.1.1.2.4. Hold the thermometer in place for 1 minute.
4.1.1.2.5. Remove the thermometer and the plastic sheet.
4.1.1.2.6. Wipe it with alcohol swab from upward to mercury bulb
using
firm twisting motion.
4.1.1.2.7. Read the thermometer to the nearest tenth and inform
patient of
reading.
4.1.1.2.8. Wash the thermometer with soap and water. Rinse in cool
water,
dry and return to the container.
4.1.1.2.9. Remove gloves and wash hands.
4.1.1.3.Electronic:
4.1.1.3.1. Insert the probe into the disposable probe cover.
4.1.1.3.2. Methods:
4.1.1.3.2.1.Oral (Blue):
4.1.1.3.2.1.1. Place the tip of the thermometer under the
tongue.
4.1.1.3.2.1.2. Instruct the patient to close his lips and not to
bite the probe.
4.1.1.3.2.2.Axilla (Blue)
4.1.1.3.2.2.1. Place the tip of the thermometer at the center
of
the axilla.
4.1.1.3.2.2.2. Bring the patients arm down, close to his/her
body and place forearm over the chest.
4.1.1.3.2.3.Rectal (Red)
4.1.1.3.2.3.1. Wash hands, put on gloves.
4.1.1.3.2.3.2. Lubricate the tip of the probe cover.
4.1.1.3.2.3.3. Insert to anus approximately 3.8cm (11/2
inches)
in adult, 2.5cm (1 inch) in children, and 1.25cm
(1/2 inch) in infant.
4.1.1.3.2.3.4. Wait for the audible alarm to occur.
Temperature appears in digital display.
4.1.1.3.2.3.5. Remove the probe and inform patient of
reading.
4.1.1.3.2.3.6. Push ejection button on probe to discard
plastic
cover into appropriate container.
4.1.1.3.2.3.7. Insert probe to storage of recording unit.
4.1.1.3.2.3.8. Remove gloves and wash hands.
4.1.1.3.2.4.Tympanic:
4.1.1.3.2.4.1. Assist patient in comfortable position with
head
turned to side, (away from the nurse).
4.1.1.3.2.4.2. Remove thermometer from its charging base.
Note the equivalent setting on display. Ensure
tympanic mode is selected by pressing mode
button.
406
4.1.1.3.2.4.3. Slide disposable plastic cover over otoscopelike tip until it locks in place.
4.1.1.3.2.4.4. Follow manufacturers instruction for tympanic
48
Republic of
Yemen 48Modern
48
Hospital
an
probe positioning.
4.1.1.3.2.4.4.1.Pull ear pinna upward and back for
adult.
4.1.1.3.2.4.4.2.Downward and back for a child.
4.1.1.3.2.4.4.3.Place probe tip in ear canal and ear
opening.
4.1.1.3.2.4.5. Press and release scan button. Remove
probe
tip from ear as soon as triple bleep is heard
and
display flashes DONE.
4.1.1.3.2.4.6. Note the temperature reading in the
digital
display screen, and inform the patient.
4.1.1.3.2.4.7. Press blue release eject button to discard
the
used probe cover.
4.1.1.3.2.4.8. Press MODE button at the back of
thermometer
until it displays SCAN.
4.1.1.3.2.4.9. Press SCAN and replace back the
thermometer
to its charging base.
4.1.1.3.2.4.10. After 15 seconds it will be ready for next
use.
4.1.1.3.2.4.11. Aftercare of the genius tympanic
thermometer.
4.1.1.3.2.4.11.1.For base unit/main body, use water
and
mild detergent or less than 10% bleach
solution.
4.1.1.3.2.4.11.2.The digital display screen and base
door should be wiped with cloth dampen
with mild detergent or less than 10%
bleach solution. Do not use alcohol on
any of the clear plastic part.
4.1.1.3.2.4.11.3.Wipe using a lint-free cloth, if
remain
4.2. Take Pulse Rate:
soiled, slightly
dampen
swabssite.
4.2.1.
Locate cotton
the possible
with isopropanol.
With
the
lens
4.2.1.1.Temporal pointing
artery
down, gently clean
with a swab carotid artery
4.2.1.2.Common
followed by a lint-free
cloth.
4.2.1.3.Brachial
artery
4.1.1.3.2.4.11.4.Do not use
excessive
force.
4.2.1.4.Radial
artery (most commonly accessible
4.1.1.3.2.4.11.5.Return
site) thermometer to its base
unit and
4.2.1.5.Femoral artery
allow 45 minutes
drying time prior
to
4.2.1.6.Popliteal
artery
using the thermometer.
4.2.1.7.Posterior tibial artery
4.1.1.3.2.4.11.6.Return the
thermometer to
base
4.2.1.8.Dorsalis
pedis
artery
unit
4.2.2.
Peripheral Pulse
4.2.2.1.Assess:and keep in place for proper storage
4.2.2.1.1. Clinical signs of cardiovascular alterations, other than pulse
rate,
407
Republic of
Yemen 48Modern
Hospital
48
rhythm, or volume
4.2.2.1.2. Factors that may alter pulse rate
4.2.2.1.3. Site most appropriate for assessment
4.2.2.2.Palpate and count the pulse.
4.2.2.2.1. Place two or three middle fingertips lightly and squarely
over the
pulse point.
4.2.2.2.2. Count for 15 seconds and multiply by 4. Record the pulse in
beats
per minute on your worksheet. If taking a client's pulse for the
first
time, when obtaining baseline data, or if the pulse is irregular,
count for a full minute.
4.2.2.2.3. An irregular pulse also requires taking the apical pulse. Is
irregular, count for a full minute.
4.2.2.3.Assess the pulse rhythm and volume.
4.2.2.4.Document
the Using
pulse rate,
rhythm,
and volume
and your (DUS)
actions in
4.2.2.5.Variation:
a Doppler
Ultrasound
Stethoscope
the client4.2.2.5.1. If used, plug the stethoscope headset into one of the two
record.
output
light
to
aqueous
jacks located next to the volume control.

4.2.2.5.2. the plastic case housing the transducer or to the client's skin.
4.2.2.5.3. Press the "on" button.
4.2.2.5.4. Hold the probe against the skin over the pulse site. Use a
pressure, and keep the probe in contact with the skin.
4.2.2.5.5. Adjust the volume if necessary.
4.2.2.5.6. Distinguish artery sounds from vein sounds. If arterial sounds
cannot be easily heard, then reposition the probe.
4.2.2.5.7. After assessing the pulse, remove all the gel from the probe
prevent damage to its surface. Clean the transducer with
solutions.
4.2.3. Apical Pulse
4.2.3.1.Assess:
4.2.3.1.1. Clinical signs of cardiovascular alterations, other than pulse
rate,
rhythm, or volume
4.2.3.1.2. Factors that may alter pulse rate
4.2.3.2.Locate the apical impulse.
4.2.3.2.1. Palpate the angle of Louis, located just below the
suprasternal
notch and felt as a prominence.
4.2.3.2.2. Slide your index finger just to the left of the client's sternum,
and
palpate the second intercostal space.
4.2.3.2.3. Place your middle or ring finger in the third intercostal space,
4.2.3.3.1.
Use antiseptic wipes to clean the earpieces and diaphragm
and
of the
continue palpating downward until you locate the fifth
stethoscope.
intercostal
4.2.3.3.2. Warm space.
the diaphragm of the stethoscope by holding it in
the palm 4.2.3.2.4. Move your index finger laterally along the fifth intercostal
space of the hand for a moment.
408
4.2.3.3.3. Inserttowards
the earpieces
of the
stethoscope
into impulse
your ears
the MCL.
Normally,
the apical
isin
palpable at or
the
just medial to the MCL.
4.2.3.3.Auscultate and count heartbeats.
Republic of
Yemen 48Modern
Hospital
48
direction of the ear canals, or slightly forward, to facilitate

hearing.
4.2.3.3.4. Tap your finger lightly on the diaphragm to be sure it is the
active
side of the head.
4.2.3.3.5. Place the diaphragm of the stethoscope over the apical
impulse
and listen for the normal S1 and S2 heart sounds. If the rhythm
4.2.4. Apical-Radial Pulse
is
4.2.4.1.Locate the apical and radial pulse sites.
regular, count the heartbeats for 30 seconds and multiply by 2.
4.2.4.2.In the two-nurse technique, one nurse locates the apical impulse by
If
palpation
the rhythm is irregular, count the beats for 60 seconds.
or with the stethoscope while the other nurse palpates the radial pulse
4.2.3.4.Assess the rhythm and the strength of the heartbeat.
site.
4.2.3.4.1. Assess the rhythm of the heartbeat by noting the pattern of
4.2.4.3.Count the apical and radial pulse rates.
intervals between the beats.
4.2.4.4.Two -Nurse Technique
4.2.3.4.2. Assess the strengths (volume) of the heartbeat.
4.2.4.4.1. Place the watch where both nurses can see it. The nurse who is
taking the radial pulse may hold the watch.
4.2.4.4.2. Decide on a time to begin counting.
4.2.4.4.3. The nurse taking the radial pulse says "Start" at that time.
4.2.4.4.4. Each nurse counts the pulse rate for 60 seconds. Both nurses
end
the count when the nurse taking the radial pulse says "Stop."
4.2.4.4.5. The nurse who assesses the apical rate also assesses the apical
pulse rhythm and volume.
4.2.4.4.6. The nurse assessing the radial pulse rate also assesses the
radial
pulse rhythm and volume.
4.2.4.5.One-Nurse Technique
4.2.4.5.1. Assess the apical pulse for 60 seconds.
4.2.4.6. Assess the radial pulse for 60 seconds.
4.2.4.7.Document the apical and radial (AR) pulse rates, rhythm, volume, and
any
pulse deficit in the client record. Also record related data.
4.3.Take Respiration:
4.3.1. Assess:
4.3.1.1.Skin and mucous membrane color
4.3.1.2.Position assumed for breathing
4.3.1.3.Signs of cerebral anoxia
4.3.1.4.Chest movement
4.3.1.5.Activity tolerance
4.3.1.6.Chest pain
4.3.1.7.Dyspnea
4.3.1.8.Medications affecting respiratory rate
4.3.2. Observe or palpate and count the respiratory rate.
4.3.2.1.If you anticipate the clients awareness of respiratory assessment,
place a
hand against the client's chest to feel the chest movements with
breathing, or
place the client's arm across the chest and observe the chest movements
while
supposedly taking the radial pulse.
4.3.2.2.Count the respiratory rate for 30 seconds if the respirations are
regular.
409
4.3.2.3. Count for 60 seconds if they are irregular. An inhalation and an
exhalation
count as one respiration.
Republic of
Yemen 48Modern
Hospital
48
4.3.3. Observe
the depth, rhythm, and character of respirations.
4.4.Take
Blood Pressure:
4.3.3.1.Observe
the respirations for depth by watching the movement of the
4.4.1. Assess:
chest. 4.4.1.1.Signs and symptoms of hypertension
4.3.3.2.Observe
the respirations
regular or irregular rhythm.
4.4.1.2.Signs and
symptoms offor
hypotension
4.3.3.3.Observe
the
character
of
respirationsthe
sound they produce and
4.4.1.3.Factors affecting blood pressure
the4.4.2.
effortPosition the client appropriately.
they require.
4.4.2.1.The
adult client should be sitting unless otherwise specified.
4.3.4. Document
thefeet
respiratory
rate,
and character on the
4.4.2.2.Both
should be
flatdepth,
on the rhythm,
floor.
appropriate
4.4.2.3.The elbow should be slightly flexed with the palm of the hand facing
up andrecord.
the forearm supported at heart level.
4.4.2.4.Expose the upper arm.
4.4.3. Wrap the deflated cuff evenly around the upper arm. Locate the brachial
artery.
4.4.3.1.Apply the center of the bladder directly over the artery.
4.4.3.2.For an adult, place the lower border of the cuff approximately 2.5 cm
(1 inch)
above the antecubital space.
4.4.4. If this is the client's initial examination, perform a preliminary palpatory
determination of systolic pressure.
4.4.4.1.Palpate the brachial artery with the fingertips.
4.4.4.2.Close the valve on the pump by turning the knob clockwise.
4.4.4.3.Pump up the cuff until you no longer feel the brachial pulse. At that
pressure,
the blood cannot flow through the artery.
4.4.4.4.Note the pressure on the sphygmomanometer at which pulse is no
longer felt.
4.4.4.5.Release the pressure completely in the cuff, and wait one to two
minutes
before making further measurements.
4.4.5. Position the stethoscope appropriately.
4.4.5.1.Cleanse the earpieces with alcohol or recommended disinfectant.
4.4.5.2.Insert the ear attachments of the stethoscope in your ears so that
they tilt
slightly forward.
4.4.6. Ensure that the stethoscope hangs freely from the ears to the diaphragm.
4.4.6.1.Place the bell side of the amplifier of the stethoscope over the brachial
pulse.
4.4.6.2.Hold the diaphragm with the thumb and index finger.
4.4.7. Auscultate the client's blood pressure.
4.4.7.1.Pump up the cuff until the sphygmomanometer reads 30 mm Hg above
the
point where the brachial pulse disappeared.
4.4.7.2.Release the valve on the cuff carefully so that the pressure decreases
at the
rate of 23 mm Hg per second.
4.4.7.3.As the pressure falls, identify the manometer reading at each of the
five
phases, if possible.
4.4.7.4.Deflate the cuff rapidly and completely.
4.4.7.5.Wait one to two minutes before making further determinations.
4.4.8. Repeat the above steps once or twice as necessary to confirm the accuracy
of the
reading.
410
4.4.8.1.If this is the clients initial examination, repeat the procedure on the
clients
other arm.
Republic of
Yemen 48Modern
Hospital
48
4.4.9. Variation: Obtaining a Blood Pressure by the Palpation Method

4.4.9.1.If it is not possible to use a stethoscope to obtain the blood
pressure, or if the
Korotkoffs sounds cannot be heard, palpate the radial or brachial pulse
site as
the cuff pressure is released.
4.4.9.2.The manometer reading at the point where the pulse reappears
represents a
blood pressure
what Pressure
would be the auscultated systolic and
4.4.10. Variation:
Taking between
a Thigh Blood
diastolic
4.4.10.1.Help the client to assume a prone position.
values.the client cannot assume this position, measure the blood
4.4.10.2.If
pressure while
the client is in a supine position with the knee slightly flexed.
4.4.10.2.1. Slight flexing of the knee will facilitate placing the
stethoscope on
the popliteal space. Expose the thigh, taking care not to
expose the
client unduly.
4.4.10.2.2. Locate the popliteal artery.
4.4.10.2.3. Wrap the cuff evenly around the midthigh, with the
compression
bladder over the posterior aspect of the thigh and the bottom
edge
above the knee.
4.4.10.2.4. If this is the client's initial examination, perform a
preliminary
palpatory determination of systolic pressure by palpating the
4.4.11. Variation:
Using
an Electronic Indirect Blood Pressure Monitoring Device
popliteal
artery.
4.4.11.1.Place
the blood
cuff on the
extremity
according
4.4.10.2.5.
In adults,
the pressure
systolic pressure
in the
popliteal
artery isto the
manufacturers
guidelines.
usually 20
4.4.11.1.1.
Turn
on the
blood
switch.artery because of
30 mm Hg
higher
than
thatpressure
in the brachial
4.4.11.1.2.
If
appropriate,
set
the
device
for the desired number of
use of
minutes
a larger bladder; the diastolic pressure is usually the same.
between blood pressure determinations.
4.4.11.1.3. When the device has determined the blood pressure reading,
note
the digital results.
4.4.11.2.Remove the cuff.
4.4.11.3.Wipe the cuff with an approved disinfectant.
4.4.11.4.Document and report pertinent assessment data.
4.5.Report immediately to the treating doctor any abnormality noted.
4.6.Aftercare of equipment.
4.7.Record vital signs taken in the:
4.7.1. Graphic and Treatment Record (Form M1042) as routine.
4.7.2. Intensive Vital Signs Sheet (Form M1023) as indicated (for seriously ill
6
patients).
6.1the
Temperature:
4.8.Charge
supplies used.
6.1.1 Oral temperature is not allowed:
6.1.1.1 If patient is unconscious, disoriented, seizure-prone or extremely
weak.
6.1.1.2 For young children.
6.1.1.3 For infants with oral/nasal impairment and mouth breather.
6.1.1.4 For patients who have injuries, inflammation or operations of
the mouth.
411
6.1.1.5 Patients suffering from frequent
attacks of cough.
Republic of
Yemen 48Modern
48
Hospital
6.1.1.6 Oral temperature should not be taken immediately after patient has taken
hot or cold
drinks. Temperature is taken after 30 minutes of food intake or strenuous
activity.
6.1.2 Rectal temperature is contraindicated:
6.1.2.1 For newborn with imperforated anus.
6.1.2.2 Patients who had rectal surgery or inflammation of the rectum.
6.1.2.3 Patients who are have diarrhea.
6.1.2.4 Patients who are on treatment such as bowel wash and enema.
6.1.3 Ensure that probe lens is clean at all times as it alters the recording. Cleanse it
with lintfree cloth.
6.2 Blood Pressure:
6.2.1 It should not be taken on the site of AV fistula.
6.2.2 Breast or axillary surgery (affected site).
6.2.3 Injured or diseased limbs.
6.3 Vital signs must be recorded also in the nurses notes aside from Intensive Vital Signs
and Graphic
Sheet Form for the following conditions:
6.3.1 Admission
6.3.2 Trans-in (including special areas)
6.3.3 If abnormal, followed by nursing measures done
6.3.4 Post-partum and post-op conditions upon receiving in the floor
6.4 For Newborn:
6.5 Method of temperature taking is through axilla only except during admission
wherein rectal
thermometerREFERENCE:
is used to assess the patency of the anus.
7
7th Edition
412
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Wound Dressing
CONTENTS: This General Ward policy and procedure deals with the guidelines on how to do
wound
dressing.
1 DEFINITION:
1.1 Wound dressing - is a procedure done under aseptic technique where a material is
applied to the
surface of a wound to provide and maintain an environment in which healing can take
place at
maximum rate.
1.2 Types of Dressing :
1.2.1 Dry-to-dry dressing used primarily for wound closing by primary intention.
1.2.2 Wet-to-dry dressing used for untidy or infected wounds that must be debrided
and closed
by secondary intention.
1.2.3 Wet-to-wet dressing used on clean open wound or on granulating surfaces.
2 PURPOSES:
2.1 To prevent, eliminate, and control infection.
2.2 To absorb drainage or secretion.
2.3 To provide physical, psychological and aesthetic comfort.
2.4 To protect the wound from further injury.
2.5 To protect the skin surrounding the wound.
2.6 To maintain moist wound and environment.
2.7 To remove necrotic tissue.
2.8 To promote hemostasis as in pressure dressings.
3 INDICATIONS:
3.1 Surgical incision.
3.2 Insertion of central line or other invasive procedure.
3.3 Wounds with drain.
4 EQUIPMENTS:
4.1 Refer to dressing trolley contents
5 POLICIES:
5.3 Dressing should be done by the physician assisted by a nurse.
5.5 Dressing trolley should be checked for completeness of items at the start of each shift.
5.6 Solutions, ointment and spray should be labeled as to date of opening.
6
PROCEDURES:
5.7 During wound dressing, the
upper level of trolley should be kept free and the surface
6.1 Wash hands.
should be
6.2 Take the dressing trolley to the clients room.
disinfected before and after.
6.3 Provide
privacy
and explain
theused.
procedure.
5.8 Counting/Checking of dressing
instruments
before
and after
6.4
Wear
disposable
gloves
and
protective
apparel, if
indicated.
413
Republic of
Yemen 48Modern
48
Hospital
6.5 Expose the area to be dressed.

6.6 Hand-over the disposable gloves to the physician.
6.7 Assist to open the wound dressing.
6.8 Undo binder or adhesives securing the dressing. Lift dressing off by touching outside
portion only.
To loosen the tape, begin at the edge away from wound center. Then pull skin away
from the tape
moving in direction toward the wound.
6.9 Assess the amount, type, and odor of drainage.
6.10Wear a new disposable gloves. Open the cover of a sterile dressing tray.
6.11Offer sterile gloves to the doctor.
6.12Assist in wound dressing and anticipate his needs.
6.13Dispose soiled dressing, drains (if any), and used items in the yellow plastic bag.
6.15Cover the client and keep him in a comfortable position.
6.16.1 time of dressing
6.16.2 condition of wound and surrounding tissue
6.16.3 character and amount of drainage, if any
6.16.4 clients response to the procedure (emotional, local pain or generalized
discomfort)
6.17After
care of equipments should be done.
SPECIAL
CONSIDERATIONS:
7
6.18Charge
the procedure
and supplies
used.
7.1
Hasty removal
of dressings
can cause
trauma to wound. It is best to remove old
dressings one layer
at a time.
7.2 It is important to collect culture specimen before wound is cleansed.
7.3 The choice of anchoring depends on the wound size, location, drainage, frequency of
dressing
changes and the clients level of activity.
7.4 The choice of dressings and the method of wound dressing influence healing. Proper
dressing
should not allow a draining wound to become overly dry with extensive scab formation.
7.5 For surgical wounds that heal by primary intention, dressings are commonly removed
as soon as
drainage stops.
7.6 Any wound can be painful, depending on the extent of tissue injury. The following
techniques can
be used to minimize discomfort.
7.6.1 Careful removal of tape.
7.6.2 Gently cleaning of wound edges.
7.6.3 Careful manipulation of dressing and drains lessen stress on sensitive tissues.
7.6.4 Proper turning and positioning.
7.6.5 Administration of analgesic medications 30 to 60 minutes before dressing
change.
7.7 For septic/isolation cases.
7.7.1 Separate dressing trolley should be used.
7.7.2 Both doctor and nurse should wear disposable apron and mask during the
procedure.
7.8 If dressing is soaked, reinforcement can be done by the nurse.
414
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Central Venous Catheter Insertion

CONTENTS: This General Ward policy and procedure discusses the procedural guidelines in
the insertion
of central venous catheter.
1 DEFINITION:
1.1 Central Venous Catheter a sterile catheter inserted through the brachial, subclavian,
or jugular
vein into the superior vena cava.
2 PURPOSES:
2.1 To fluid replacement and therapy.
2.2 To monitor the pressure on the right atrium and central veins.
2.3 To administer blood products, TPN (Total Parenteral Nutrition) and drug therapy
contraindicated for
peripheral infusion.
2.4 To obtain venous access when peripheral vein sites are inadequate.
3 EQUIPMENT/SUPPLIES:
2.5 To insert a temporary pacemaker.
dressing
tray containing forceps, bowl, needle holder,
2.6 To obtain central venous 3.1
blood
sample.
scissor
3.2 sterile gloves/disposable gloves
3.3 sterile drapes
3.4 sterile gauze 10 x 10
3.5 antiseptic solution - betadine 10%
3.6 xylocaine 2%
3.7 syringe with needle
3.8 silk 3-0
3.9 blue sheet
3.10central line catheter
3.10.1 cavafix
3.10.2 single-lumen
3.10.3 double-lumen
3.10.4 triple-lumen
3.10.5 hydrocath (Adult French 7 Triple-Lumen)
3.11heparin flush (NSS 500cc + heparin 500 IU)
3.12adhesive tape, alcohol swab
3.13mepore
3.14steristrip
3.15IV solution with administration set prepared (NSS)
3.16armboard, IV pole
3.17razor
3.183 way stopcock
3.19rolled towel
3.20cardiac monitor
415
Republic of
Yemen 48Modern
Hospital
48
4 POLICIES:
4.1 There should be a written order for the procedure.
4.2 Infection control policy must be followed:
4.2.1 Central catheter line should be changed within 7-10 days.
4.2.2 Daily dressing should be done under aseptic technique.
4.2.3 Date of insertion should be written.
4.3 Consent should be obtained.
4.4 Strict aseptic technique should be followed throughout the
procedure.
5 PROCEDURES:
5.2 Identify correct patient by checking his/her ID band and asking his/her name.
5.3 Wash hands.
5.4 Assemble equipments and supplies needed.
5.5 Provide privacy; explain the procedure to the patient.
5.6 Place the patient in appropriate position with blue pad under the site of insertion.
5.6.1 Antecubital vein - in supine position with arm extended and secured by an
armboard.
5.6.2 Jugular/subclavian vein - in Trendelenburg position unless contraindicated. Place a
small
log towel under the shoulder.
5.6.3 Femoral vein - in supine position with leg straight.
5.7 Wash hands again. Wear disposable gloves.
5.8 Attach to cardiac monitor. Check for vital signs. Monitor continuously all throughout the
procedure.
5.9 Prepare the site and expose. Prepare the CVP scale. Attach to the medifix, one tube
goes to the
patient, another tube to the NSS and the side tube to be connected to the CVP scale.
5.10Assist the physician in inserting the central venous line.
5.11Check for the patency of the catheter by heparin flush.
5.12Flush the 3-way stopcock with NSS and attach to the catheter of secalon and cavafix.
Assist the
doctor in suturing the catheter using silk 3-0. Apply steristrip in cavafix catheter.
5.13Apply mepore dressing after the doctor has secured the catheter. Write the date of
insertion on
mepore dressing. Watch for bleeding on the site.
5.14Assist the patient in a comfortable position.
5.15Dispose used items.
5.17Obtain Chest X-ray as ordered. Follow-up and inform the doctor.
5.18.1 vital signs
5.18.2 site of insertion
5.18.3 time and date of insertion
6 SPECIAL
5.18.4CONSIDERATIONS:
type of catheter used
6.15.18.5
A CVP tolerance
line is potential
source of septicemia that the health care team must be aware of.
to procedure
Strict5.18.6 any unusual occurrences or observations
infection control
precautions
should
be observed.
5.19Charge
procedure
and supplies
used
6.1.1 Hand-washing proper employing correct technique should be implemented at all
times.
6.2 Observation for following complications should be made:
6.2.1 From catheter insertion:
6.2.1.1 pneumothorax, hemothorax
6.2.1.2 fluid overload
6.2.1.3 air embolism, thrombosis
416
6.2.1.4 dysrhythmias
Republic of
Yemen 48Modern
48
Hospital
6.2.1.5 hematoma
6.2.1.6 cardiac tamponade
6.2.2 From indwelling catheter:
6.2.2.1 infection
6.2.2.2 air embolism
6.3 Ensure that all connections are tight to avoid blood loss or air embolism.
6.4 Always maintain patency of the catheter when used for intermittent therapy, the
catheter should be
flushed after each use with appropriate flushing solution.
6.5 Insertion site should be checked regularly for local inflammation or phlebitis. Dressing
should be
changed daily under aseptic technique and must be labeled always to show date when
catheter was
inserted.
6.6 Send the catheter tip for bacteriologic culture when needed after removal.
6.7 Avoid BP measurement taking on the involved arm
417
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Central Venous Line Removal
CONTENTS: This General Ward policy and procedure deals with the procedures of removing
central
venous line.
1 DEFINITION:
1.1 Removal of Central Line - a method of withdrawing the central venous catheter under
strict aseptic
technique.
2 PURPOSES:
2.1 Completion of therapy
2.2 Onset of complications
2.3 A leaking or damaged catheter
3.1 Sterile gloves
3.2 Alcohol spray
3.3 Sterile gauze
3.4 Blue sheet
3.5 Mepore
3.6 Surgical blade
3.7 Orange bag
3.8 Sharp container
3.10Sterile specimen container (if needed)
4 POLICIES:
4.2 Must be done under strict aseptic technique.
5
4.3 Compression
of the site for 10 minutes must be done or as needed.
PROCEDURES:
5.2 Prepare the needed equipments and supplies.
5.4 Provide privacy. Explain the procedure.
5.5 Assist the patient in supine position.
5.6 Wash hands. Wear disposable gloves.
5.7 Assist the doctor in removing the central line.
5.8 Apply pressure to the site for a minimum of 10 minutes or until bleeding
stops.
5.9 Inspect the site for the following:
5.9.1 Signs of infection
5.9.2 Bleeding and hematoma
5.9.3 Discoloration of the skin
5.9.4 Peripheral pulse
5.9.5 Sensation and temperature of the extremity
5.10Cleanse the area of insertion site with alcohol spray and apply
418
transparent dressing.
Republic of
Yemen 48Modern
48
Hospital
5.11If infection is suspected, keep catheter tip in sterile container and send to laboratory
for culture and
sensitivity test as ordered.
5.12Dispose supplies and catheter to appropriate container.
5.14.1 Date and time of removal
5.14.2 Condition of the site
5.14.3 Observations made
5.14.4 If catheter tip is sent for culture and sensitivity test
5.15Charge the used supplies.
Filename: central_venous_line_removal
419
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Central Venous Pressure Monitoring

CONTENTS: This General Ward policy and procedure deals with the procedures of monitoring
central
venous pressure.
1 DEFINITION:
1.1 Central Venous Pressure Monitoring the measurement of right atrial pressure or the
pressure of
the great veins within the thorax.
2 PURPOSES:
2.1 Measures the ability of the right side of the heart to systemic fluid load.
2.2 To estimate the circulating blood volume.
2.3 To serve as a guide to fluid balance in critically ill patients.
2.4 To assist in monitoring circulatory failure.
3.1 NSS 500cc
3.2 IV Pole
3.3 CVP set (medifix pressure line set)
3.4 3 way stopcock
4 POLICIES:
4.3 Patency of the catheter should be maintained.
PROCEDURES:
4.4
CVP manometer
should be positioned pointing at the level of the heart.
5
5.1
Verify
doctors order.
5.2 Identify the patient properly.
5.3 Assemble all equipment needed, fixed the manometer to IV pole.
5.4 Explain the procedure to the patient, provide privacy.
5.5 Wash hands and wear gloves
5.6 Place patient in supine position (if not contraindicated). If contraindicated, ensure
that all CVP
reading are performed with the person in the same position.
5.7 Position the zero point of the manometer at the level of right atrium (4 th intercostal
space at the midclavicular line).
5.8 Flush the IV tubings with normal saline.
5.9 Connect the CVP manometer to the upper port of stopcock.
5.10Connect the CVP tubing from the patient to the second side of port of the stopcock.
5.11Allow normal saline to drip rapidly into patient for a few seconds, with stopcock
closed to
manometer.
5.12Turn stopcock off to patient and fill manometer with normal saline.
5.13Hold manometer at the mid-axilliary line and 4th ICS and turn the stopcock off to the
normal line.
5.14Watch as the fluid falls in the manometer. Take
420 the central venous pressure reading
when the fluid
stabilizes.
5.15Turn the stopcock off to the manometer.
Republic of
Yemen 48Modern
48
Hospital
5.16Keep the manometer in upright position hanging from the IV pole to prevent air
bubbles from
entering the fluid column or to the patient and to prevent contamination of manometer.
5.17Assist patient in comfortable position.
5.19Document the CVP reading date and time and notify the physician.
6
6.1 If the patient is connected to ventilator and receiving positive end expiratory pressure
(PE EP),
expect high CVP readings.
6.1.1 Normal range of CVP
6.1.1.1 2-6 mm of Hg
6.1.1.2 6-12 cm of H2O
6.1.2 Accepted range of CVP for patient on ventilator is normal range of CVP + PE EP
rate 1
6.2 Avoid taking CVP measurements when the patient is sitting-up. Since it will cause
false low results.
6.3 Patient with Chronic Obstructive Pulmonary Disease (COPD) usually has a high CVP.
6.4 A low CVP is an indicator of hypovolemia generally calling for an increase in IV fluid.
6.5 A high CVP can be caused by hypervolemia or by poor cardiac function.
6.6 Any variation on the measurement should be informed to the physician at once.
421
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
CONTENTS: This General Ward policy and procedure serves as a guideline procedure during
implantation
Title:
Chemotherapy: Implanted Venous Access
of venous access device to be used during
chemotherapy.
Device
1 DEFINITIONS:
1.1 Venous Access Device (VAD) - an implanted catheter or device that remains in place for
an
extended period of time (weeks, months or even years). It maybe tunneled or
implanted.
2 PURPOSES:
2.1 For administering
2.1.1 blood or blood products
2.1.2 chemotherapy
2.1.3 fluid replacement therapy
2.2 For blood sampling
3 INDICATIONS:
3.1 Limited peripheral venous access due to extensive previous IV therapy, surgery and/or
previous
tissue damage.
3.1.1 Long term therapy.
4.1 obesity
4.2 chest wall disease
4.3 superior vena cava abnormalities
5.1 Sterile gloves
5.2 90o sterile Huber needle with winged infusion set attached.
5.3 NSS 10cc
5.4 Sterile 10cc syringe (2)
5.5 Clinipad dressing set
5.6 Sterile drape, steri strip
5.7 Opsite dressing
5.8 Heparin 10 IU/1ml - 5ml vial
5.9 Heparin 100 IU/1ml - 5ml vial
5.10Xylocaine gel 2%, mask
6 POLICIES:
6.1 Obtain doctors order
6.2 When VAD is used for intermittent usage, it must be flushed well before and after
therapy with NSS
and then heparinized using heparin 10 IU/ml + 5ml NSS every 8 hours to maintain
patency.
6.3 When VAD is deaccessed and is not to be used for a period of time, it must be flushed
with heparin
100 IU/5ml NSS every 4 weeks to maintain patency. Maintain positive pressure while
flushing to
avoid reflux of blood in the portal septum as it may block the catheter.
6.4 Only non-coring needles (Huber) are to be used when accessing the port with
appropriate gauge and
length according to patients size.
6.5 Strict aseptic technique should be maintained.
422
6.6 Huber needle and dressing should be changed every 7 days and as necessary if there
is any drainage
from the porta site. A swab must be taken for C/S and notify physician.
Republic of
Yemen 48Modern
Hospital
48
7 PROCEDURES:
7.2 Review the prescribed order for blood sampling or medication administration.
7.3 Gather supplies needed.
7.4 Wash hands.
7.5 Identify the correct patient and explain the procedure.
7.6 Place patient in slightly elevated supine position.
7.7 Wear disposable gloves.
7.8 Expose skin and palpate port septum and assess for any signs and symptoms of
infection or
swelling.
7.9 Prime needle and extension set with NSS.
7.10Remove disposable gloves and put on sterile gloves.
7.11Observing sterile technique, clean the inlet septum injection site with betadine using
an outward
circular motion, extending prepped over beyond peripheral of the port and allow to dry.
Then prep
with alcohol swab and allow the area to dry.
7.12Apply sterile drape over prepped porta site, palpate the port site to locate the septum.
7.13Stabilize port and firmly insert needle at a right angle to the skin, through the skin and
septum until
needle touches the back of the port.
7.14Aspirate blood to verify needle placement and function of port.
7.15Obtain blood samples as ordered. Aspirate 4-5ml of blood then discard it, and withdraw
the desired
amount of blood for analysis.
7.16Flush the line with normal saline to clear blood and establish patency of the line.
Observe for
swelling or complain of pain.
7.17Proceed with medication administration as ordered.
7.18For continuous infusion, connect and regulate flow rate.
7.19If needle will be left in place, secure needle with sterile dressing.
7.20For intermittent infusion, use heparin locked and clamped extension set and remove
straight needle
for heparin plug and leaving tube needle in place within septum.
7.21If needle will be removed, flush needle with heparin solution to establish heparin lock,
maintaining
positive pressure at the end of heparin instillation. Positive pressure maybe created by
clamping the
tubing while instilling the last ml of heparin solution
7.22Remove needle by stabilizing the port. Press down on the port with 2 fingers and
remove Huber
needle with a firm and straight motion.
7.23Apply pressure and dressing to insertion site.
7.24Dispose all supplies used.
7.26.1 Function of VAD
7.26.2 Medications administered
7.26.3 Blood samples drawn
7.26.4 Patient response to procedure
7.26.5 Any unusual observations
423
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Extravasation
CONTENTS: This General Ward policy and procedure serves as a guideline in the management
of
cytotoxic extravasation.
1 DEFINITIONS:
1.1 Extravasation - leakage of a vesicant drug from the vein into the subcutaneous tissue
that may
result in pain, necrosis or sloughing of tissues.
2 PURPOSES:
2.1 To prevent damage to underlying tissues, tendons, and nerves that may lead to joint
contracture.
2.2 To avoid chronic damage to skin and underlying tissues that can only be healed by
surgical
intervention.
3.1 Long sleeved impervious closed gown
3.2 Non-sterile powderless gloves
3.3 1cc syringe (5)
3.4 Heparin lock
3.5 Sterile needle
3.6 2 x 2 gauze
3.7 Alcohol swabs
3.8 Necessary equipment for antidote administration
3.9 Compresses (hot or cold dependent upon drug extravasation)
4 POLICIES:
4.1 All antidote therapy requires a physicians order.
4.2 Patient and family should be educated regarding the signs and symptoms of
extravasation and the
need for immediate follow-up. These s/s include:
4.2.1 blisters
4.2.2 pain
4.2.3 ulceration
4.2.4 necrosis
4.2.5 swelling
4.2.6 erythema
4.3 Once extravasation is discovered, an incident report should be made immediately.
4.4 When venous access is a problem, those patients still needing therapy with vesicant
agent
should
PROCEDURES:
5
haveinfusion
central immediately.
line such as hickman line or infusoport.
5.1 Stop
Chemotherapy
should not
be given
to a recent
venipuncture
orhandling
extravasation
5.24.5
Withdraw
chemotherapy
syringe
and needle
fromsite
the of
port
utilizing safe
might occur and
precautions
where
vein and
was alcohol
recentlyprep
penetrated.
place
2 x the
2 gauze
swab between skin and IV cannula.
Site should
monitored
every 24-48
hours following
extravasation
and usually
5.34.6
Discontinue
IVbe
tubing
from cannula
and attach
syringe directly
to IV cannula
and till
resolution.
attempt
to gently
aspirate 3-5cc of drug or blood from the site. 424
5.4 IV cannula is maintained till physicians decision is made regarding antidote
administration.
Republic of
Yemen 48Modern
48
Hospital
5.5 Elevate extremities for 48 hours and apply hot or cold compress, avoid applying
direct manual
pressure to the site. Compresses should be applied for 20 minutes every 4-6 hours for
24 hours as
ordered.
5.6 Administer antidote as ordered by physician, inject appropriate amount of antidote
SQ in divided
doses into the extravasated site using on needle technique then discontinue IV
cannula. If no
antidote is ordered, IV cannula maybe removed immediately.
5.7 Mark the area of erythema and swelling.
5.8 Documentation should be done at the time extravasation was noted. The following
should be
documented:
5.8.1 Date and time of occurrence
5.8.2 Type and gauge of venous access device inserted on the site.
5.8.3 Number and location of venipuncture attempts
5.8.4 Drug being administered, sequence and technique.
5.8.5 Amount of drug given (to estimate amount of drug extravasated).
5.8.6 Description of extravasation site.
5.8.7 Patients complaints, statement and nursing management.
5.8.8 Physician notification and implementation.
5.8.9 Patient
education.
SPECIAL
CONSIDERATIONS:
6
5.9
Assess
patient
for
pain
and
medicate
as
ordered.
6.1 Cold compress is indicated for extravasation caused by antibiotic, antitumor,
5.10Write an
incident
alkylating
agents
and report.
antimetabolites, while warm compress is for vinca alkaloids only.

6.2 Extravasation may be recognized immediately but it is more often recognized
between one or four
hours after drug administration.
6.3 A few patients will not have signs or symptoms until 24-48 hours after infusion. Also
pain may
short lived and damage may continue without pain present.
6.4 Before considering antidote administration, note that only 1/3 of known vesicant
extravasations will
produce ulcers when conservative local management is used (ice and/or elevation of
the affected
limb).
425
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Spills
CONTENTS: This General Ward policy and procedure serves as a guideline and safety
measures in the
management of cytotoxic spills.
1 DEFINITIONS:
1.1 Cytotoxic Spill a dripping of cytotoxic agents during chemotherapy preparations.
2 PURPOSES:
2.1 To reduce potential risk associated with exposure to cytotoxic agents.
3.1 Chemo spill kit containing:
3.1.1 Long sleeved impervious gown
3.1.2 2 pairs of chemo-approved gloves
3.1.3 Aerosol mask, goggles, absorbent towels, spills control pillows, cytotoxic plastic
bag (2),
scoop and brush
3.2 Chemo spill caution sign
3.3 One blue absorbent pad
3.4 Sharps container with lid or rigid chemo container
4 POLICIES:
4.1 Chemo spill kits are kept on all units where chemotherapy is routinely administered.
4.2 If cytotoxic agents come in contact with skin, the area must be washed with copious
amount of
soap and water for minimum of 5 minutes.
4.3 If the affected areas are the mucous membranes and eyes flush with copious amount of
PROCEDURES:
water or
5.1 Secure the area by alerting other staff a chemo spill has occurred. Instruct the family,
isotonic eyewash for at least 5 minutes.
sitters and
4.4 If linen is involved in the spill, dispose in water resistant isolation bag and place in
5
patient to move away from spill area. Put a chemo spill sign.
double orange
5.2 Obtain chemo spill kit.
cytotoxic plastic bag.
5.3 Put on protective apparel. Two pairs of chemo gloves are to be worn, one with cuffs
4.5 Initial clean up (drugs, excretion) is a nursing responsibility, and housekeeping will
under gown
perform the
cuffs, and one pair over the gown cuffs.
second clean up.
5.4 Place one orange plastic bag inside the other to provide double thickness. Turn the
tops of the bags
outward to form cuff.
5.5 Carefully pick-up any broken glass and place inside sharp container or chemo
container.
5.6 Using absorbent paper towels, begin cleaning the spill outside and moving towards
inside.
Continue until area is dry.
5.7 Place soiled paper towels and other contaminated items into the double orange
plastic bag.
5.8 Cover the spill area with blue absorbent pad.
5.9 Remove outer pair of gloves and place inside the double orange plastic bag. Remove
gown and
other protective apparel and place in another426
double orange plastic bag, remove
remaining inner
pair of gloves last.
5.10Place hands on outside of double orange plastic bag under cuff, close and tie bag.
Republic of
Yemen 48Modern
48
Hospital
5.11Place close bag in dirty utility room.

5.12Wash hands; notify housekeeping that final clean of chemo spill area
is required.
5.13Document chemotherapy spill and appropriate interventions on
incident report.
6
6.1 A chemotherapy spill requires immediate attention due to the potential risk
associated with
exposure.
6.2 Most cytotoxic drugs are irritating to the skin, eyes and mucous membrane. If
mishandled, these
drugs can result in local toxic or allergic reactions.
427
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Chemotherapy: Preparation and Administration of
Cytotoxic Drugs
CONTENTS: This General Ward policy and procedure serves as a guideline in the preparation
and
administration of cytotoxic drugs.
1 DEFINITIONS:
1.1 Chemotherapy - the use of anti-neoplastic drugs to promote tumor destruction by
interfering with
cellular function and reproduction. It includes the use of various chemotherapy agents
and
hormones. (Chemotherapy may be combined with surgery or radiation therapy or
both)
1.2 Cytotoxic Drugs and agent capable of specific destructive action on certain cells;
usually used
in reference to kill anti-neoplastic drugs that selectively kill dividing cells.
2 PURPOSES:
2.1 To destroy as many tumor cells as possible with minimal effect on healthy cells.
2.2 To treat systemic disease rather than lesions that are localized and amenable to
surgery or
radiation.
2.3 To cure, control and palliation.
2.4 To reduce tumor size pre operatively to destroy any remaining tumor cells post
operatively.
2.5 To treat some forms of leukemia.
3.1 Abnormal hepatic & kidney profile
3.2 Fever due to infection
3.3 Intolerance to chemotherapy
3.4 Uncooperative patient
3.5 Bone marrow suppression
3.5.1 Neutropenic patient low WBC <500/mm3
3.5.2 Thrombocytopenia low platelet count <10,000 mm3
3.5.3 Anemia
4.1 Biological Safety cabinet
4.2 Infusion pump
4.3 IV pole
4.4 Goggles, hepa filtered mask/dust mist, blue pads
4.5 Non-sterile powder less gloves
4.6 Long sleeve impervious chemo gowns
4.7 Plastic emesis basin
POLICIES:
5
4.8 IV set alcohol swab, sterile gauze 2x2
5.1 Physicians order should be written.
4.9 IV 3000 transparent dressing, cannula of different sizes
5.2 Consent for the procedure should be
4.10Syringes & needles of different sizes
obtained.
4.11IVF & medications as ordered
428
4.12Chemo precaution sign for patients door
4.13Nonprolleak plastic container for syrine/needle.
Republic of
Yemen 48Modern
Hospital
48
5.3 7 rights in medication administration should be observed.

5.4 Trained nurses are allowed to administer cytotoxic drugs.
5.5 Intrathecal, intraperitoneal, intrapleural to be administered by the physician
assisted by chemo
nurse.
5.6 All chemotherapy doses should be recalculated & verified by two nurses.
5.7 Medicines available in dark vials should be protected from light and sun-rays.
5.8 Before starting chemotherapy, make sure that all medicines needed for the entire
sessions should
be available.
5.9 Infusion pumps are to be used as much as possible especially for pediatric patients,
clients with
central line and for continuous infusion.
5.10Safety precautions during preparation and administration should be followed:
5.10.1 All cytotoxic agents including tablet which requires crushing must be
prepared in
Biological Safety Cabinet.
5.10.2 Pregnant or breastfeeding nurse should not be allowed to prepare or
administer cytotoxic
drugs or handle the body fluids of a client who received chemotherapeutic
agents within
72 hours.
5.10.3 Chemo gloves, goggles and gown should be worn during preparation and
administration
of cytotoxic drugs. If chemo gloves are not available, double latex gloving
maybe done.
5.10.4 Wrap gauze or alcohol swab.
5.10.4.1Around the neck of ampules when opening to decrease droplet
contamination.
5.10.4.2Around injection sites when removing syringes or needles for IV injection
ports.
5.10.4.3Wrap with gauze around the tip of needle while expelling air after
preparing the
medicine.
5.10.5 Keep all foods and drinks away from preparation area when changing the IV
bottle.
5.10.6 Place a disposable; absorbent pad under the area while the drug is being
administered.
PROCEDURES:
6
All tubing
must
securely
taped unless a luer lock is utilized.
6.15.10.7
Preparation
andconnections
administration
of be
cytotoxic
drugs.
5.10.8
Chemotherapy precaution sign must be displayed on patients door from
6.1.1 Oral
initiation
of
6.1.1.1
Verify doctors order and review patients laboratory results.
chemotherapy
until 72patient.
hours post administration.
6.1.1.2
Identify correct
5.10.9
Label
all syringes
andgeneral
IV tubings
containing chemotherapeutic agents as
6.1.1.3
Assess
patients
condition
hazardous
6.1.1.4 Check vital signs.
material.
6.1.1.5
Gather and arrange all equipments/supplies needed.
5.10.10Wear
gloves
and wear
gowns
for handling
soiled linens
and for disposing of body
6.1.1.6 Wash
hands;
mask,
gown, goggles
and gloves.
excreta.
6.1.1.7 Prepare the medicine observing the following steps:
Toilet
should
be flushed
twice
close cabinet,
bowl after
disposing
body
excreta
6.1.1.7.1
Locate
medicine
onthen
medicine
read
label ofof
the
medicine
at
from 3
least
patient who
have
received
chemotherapy
within
theand
past
72 hours.
times
together
with
the medication
sheet
card.
5.10.11Discard
gloves,
gown
and
disposable
diapers
with
other
hazardous wastes in
6.1.1.7.1.1 when removing from medicine cabinet
yellow
6.1.1.7.1.2 before pouring medicine
double
bag and should
be marked
as contaminated
or hazardous waste.
6.1.1.7.1.3
after pouring
medicine
and returning.
6.1.1.7.2 Drop the number of pill or capsule directly in the medication cap
without
429
touching it.
6.1.1.7.3 Tablet or capsule in the strip should be cut by using scissors and
place in the
medication cap (open only at the time of administering). Break scored
tablets Republic of
only.48Modern
Yemen
48
6.1.1.7.4 When giving liquid medicine. Shake bottle well.
Hospital
6.1.1.7.5 Remove cork, unscrew cap from bottle and pour medicine with label
toward
your hand palm in front of the patient when administering.
6.1.1.7.6 Hold medicine glass at eye level pointing thumbnail on the line
indicating
the desired dose.
6.1.1.7.7 If excess drug is poured, discard it in double orange plastic bag.
Never return
to the bottle.
6.1.1.7.8 After preparing the medicine, remove gloves, gown, goggles and
mask and
dispose properly.
6.1.1.7.9 Wash hands and wear new pair of gloves.
6.1.1.7.10 Take the prepared medicine in the medication tray with the
medication card
to patients bedside.
6.1.1.7.11 Explain the purpose, action and the common expected side effects
of each
medication.
6.1.1.7.12 Ensure that 5 rights of medication administration are observed.
6.1.1.8 Place patient in sitting position (if not contraindicated).
6.1.1.9 Place a napkin or towel under the chin of the patient. Administer drug
either with the
use of spoon or medication glass.
6.1.1.10Stay with the patient until he/she swallows the medicine.
6.1.1.11If the only way to administer the drug is through NGT because of certain
conditions
(See in Special Consideration), the tablet should be crushed, capsule should
be
opened and dissolve with 20 to 30cc of water.
6.1.1.12Dispose used supplies in double orange plastic bag including gloves.
6.1.1.13Wash hands.
6.1.1.14Observe if the patient tolerated the medicine. If vomiting noted within 60
minutes,
inform the physician.
6.1.1.15Document the following:
6.1.1.15.1 Date and time medication given.
6.1.1.15.2 If medication was tolerated or not.
6.1.1.15.3 Vital signs.
6.1.1.15.4 Any unusual observation and intervention made.
6.1.1.16Charge supplies used.
6.1.2 Intravenous Push
6.1.2.1 Verify doctors order and review patients laboratory results.
6.1.2.2 Identify correct patient.
6.1.2.3 Assess patients general condition and check vital signs.
6.1.2.4 Assess IV site, patency, and placement of cannula including blood return.
6.1.2.5 Assemble equipment/supplies needed.
6.1.2.6 Wash hands; wear mask, gown, goggles and gloves.
6.1.2.7 Verify the dosage of drugs based on BSA (Body Surface Area).
6.1.2.8 In aspirating medicine from the ampoule/vial, observe the following steps.
6.1.2.8.1 Tap gently the top of ampoule if the medicine is trap on the neck of
the
ampoule.
6.1.2.8.2 Place a small gauze and alcohol swab around the neck of ampoule
and snap
off the top in an outward motion.
6.1.2.8.3 Keep the gauze and the alcohol swab while aspirating the
430
medication.
6.1.2.9 Place a piece of gauze around the tip of needle while expelling air after
preparing the
medicine.
6.1.2.10Remove gloves, mask, goggles and gown and dispose to double orange
plastic bag.
Wash hands and wear new gloves.
6.1.2.11Place
Republic
the prepared
of
injectable medicine in the tray together with the
medication card,
Yemen
48Modern
48
and take to patients bedside.
Hospital
6.1.2.12Explain
the purpose, action and the common expected side effects of
each
medication. Assist patient to comfortable position. Administer premeds prior
to
administration of chemo agent.
6.1.2.13Ensure that the 5 rights of medication administration is observed.
6.1.2.14Vigorously cleanse with alcohol swab the IV port of flush tubing nearest
to IV site.
Allow to dry.
6.1.2.15Insert needle to the IV port and wrap with 2x2 gauze around the port and
hub of
needle.
6.1.2.16Check for blood return prior to injecting medication and every after each
2-3cc of
medicine has been pushed. Inject the drug slowly.
6.1.2.17Ask patient, periodically if he/she is experiencing any discomfort through
out the
procedure.
6.1.2.18After the medicine is administered, pinch the tubing between IV port and
cannula.
Gently aspirate 2-3cc of flushing solution into the empty syringe. Release
pinched
tubing, slowly inject flushing solution. Repeat 3-6 times.
6.1.2.19Slowly withdraw needle from IV port keeping 2x2 gauze in place.
6.1.2.20Discard syringe with needle in the sharp container.
6.1.2.21Dispose used supplies in double orange plastic bag including gloves.
6.1.2.22Wash hands.
6.1.2.23Observe for immediate side effects such as nausea and vomiting and
monitor the
severity and inform the doctor.
6.1.2.24.1 Date and time medication given.
6.1.2.24.3 Any unusual observation made.
6.1.2.24.4 Intake and output if ordered.
6.1.2.25Charge the procedure and supplies used.
6.1.3 Continuous Infusion
6.1.3.1 Verify doctors order and review patients laboratory results.
6.1.3.2 Identify correct patient.
6.1.3.3 Assess patient general condition and check vital signs.
6.1.3.4 Assess IV site, patency, placement of cannula including blood return.
6.1.3.5 Assemble equipments/supplies needed.
6.1.3.6 Wash hands, wear mask, gown, goggles and gloves.
6.1.3.7 Verify the dosage of drugs based on BSA (Body Surface Area).
6.1.3.8 In aspirating medicine from ampoule or vial, cover the neck with alcohol
swab and
gauze.
6.1.3.9 Incorporate the aspirated cytotoxic drugs to the IV solution, and label
with the
following:
6.1.3.9.1 Cytotoxic agent incorporated.
6.1.3.9.2 Date and time infusion started and to be consumed.
6.1.3.9.3 Flow rate.
6.1.3.10Prime IV line with NSS and connect to prepared IV fluid incorporated with
cytotoxic agents.
6.1.3.11Medicines available in dark vials should be protected from light by means
of
covering the infusion bottle and tubings
431 with black plastic.
6.1.3.12Remove gloves, mask, gown and goggles and dispose to double orange
plastic bag.
Wash hands and wear new pair of gloves.
Republic of
Yemen 48Modern
Hospital
48
6.1.3.13Take the equipment and prepared chemotherapy IVF to patients

bedside.
6.1.3.14Explain the purpose, action and the common side-effects of
chemotherapy.
6.1.3.15Assist patient in comfortable position. Administer premeds.
6.1.3.16Ensure that 5 rights in medication administration is observed.
6.1.3.17Hang the IVF to IV pole, and connect to IV infusion pump.
6.1.3.18Program pump for correct flow rate.
6.1.3.19Connect the primary line to IV access and start the infusion.
6.1.3.20While the infusion is going on check, the following:
6.1.3.20.1 IV site for extravasation, inflammation, infiltration,
thrombophlebitis.
6.1.3.20.2 Common side effects:
6.1.3.20.2.1nausea and vomiting
6.1.3.20.2.2headache
6.1.3.20.2.3joint discomfort
6.1.3.20.2.4hypersensitivity reaction
6.1.3.20.2.5seizure (in rare cases)
6.1.3.21After completion of last bottle of chemotherapy IVF, hooked normal
saline to flush
IV line.
6.1.3.22Disconnect primary line from IV access, and reconnect maintenance IV if
previously
ordered or attach heparin lock to close the IV access.
6.1.3.23Discard supplies used in double orange plastic bag.
6.1.3.24Wash hands.
NURSING
MANAGEMENT
APPLIED
TO PATIENT RECEIVING CHEMOTHERAPY:
6.1.3.25Document
the
following:
7.1 Assessment
6.1.3.25.1 Date and time the infusion was started and completed.
7.1.1
ObserveAny
for the
side observations.
effects and/or toxicity
6.1.3.25.2
unusual
7
7.1.1.1 Side
Effects
- usually
life-threatening but can be annoying (e.g.
6.1.3.25.3
Intake
and
output not
(if ordered)
alopecia,
change Vital signs
6.1.3.25.4
in taste the
sensation,
skinand
reaction).
6.1.3.26Charge
procedure
supplies used.
7.1.1.2 Toxic Effects - refer to a life-threatening reaction usually graded on a scale
of 0 to 4
with increasing severity (4 is life threatening) (e.g. nephrotoxicity, severe
bone
marrow depression or anemia).
7.1.2 Integumentary System
7.1.2.1 Assess for any open wounds or signs of infection.
7.1.2.2 Areas that have undue pressure due to edema on bony prominences.
7.1.2.3 Assess if pressure sores exist on scapulae, elbows, iliac crests, vertebrae,
ankle,
knees or heels.
7.1.2.4 Check for evidence of stomatitis, erythematous areas, infection,
complaints of pain or
burning of the oral mucosa.
7.1.3 Gastrointestinal System
7.1.3.1 Nausea and Vomiting
7.1.3.1.1 Assess for frequency, duration and severity before and after
chemotherapy.
7.1.3.1.2 Monitor and record the amount of emesis to prevent dehydration and
electrolyte imbalance.
7.1.4 Diarrhea or Constipation
432
7.1.4.1 Assess for hemorrhoids or potential areas of infection on the anus. Use
stool
softeners to minimize constipation.
Republic of
7.1.4.2 Monitor for the frequency and duration of diarrhea.

Yemen 48Modern
48
7.1.5 Anorexia
7.1.5.1 Hospital
Discuss taste changes and changes in food preferences.
7.1.5.2 Ask about daily food intake and normal eating patterns.
7.1.5.3 Evaluate if there are any changes in daily eating patterns.
7.1.6 Hematopoietic System
7.1.6.1 Neutropenia - absolute granulocyte count less than 500/mm 3
7.1.6.1.1 Determine if patient has productive cough or shortness of breath.
7.1.6.1.2 Monitor for an elevation of temp. > 38.3oC (> 101oF).
7.1.6.2 Thrombocytopenia - Platelet count less than 50,000/mm 3 (mild risk) <
20,000/mm3
(severe risk)
7.1.6.2.1 Assess skin and oral mucous membranes for petechiae
7.1.6.2.2 Determine if patient has episodes of bleeding (including nose,
urinary, rectal
or hemophysis).
7.1.6.2.3 Observe for signs and symptoms of intracranial bleeding such as
changes in
level of responsiveness somnolence, coma.
7.1.6.3 Anemia
7.1.6.3.1 Ascertain if patient has experienced dyspnea upon exertion.
7.1.7 Respiratory and Cardiovascular System
7.1.7.1 Signs and symptoms of congestive heart failure and/or irregular apical or
radial
pulses.
7.1.7.2 Assess for pulmonary fibrosis evidenced by a dry, non-productive cough
with
increasing dyspnea.
7.1.8 Neuromuscular System
7.1.8.1 Determine the presence of paresthesias or difficulty with fine motor
activities such as
zipping pants, tying shoes or buttoning a shirt.
7.1.8.2 Evaluate patients for weakness, ataxia or slapping gait.
7.1.9 Genito Urinary System
7.1.9.1 Evaluate any changes in order, color or clarity of urine sample.
7.1.9.2 Observe for hematuria, urinary frequency, oliguria or anemia.
7.1.10 Sexuality, Body Image and Self Esteem.
7.1.10.1Discuss body image changes and the impact on the individuals life
7.1.10.2Discuss risks to reproductive potential and the patients emotion.
7.2 Nursing Intervention
7.2.1 Discuss the method of administration, expected side effects and the overall
goal of
chemotherapy.
7.2.2 Instruct patient to report any discomfort, pain or burning during administration
of IV
chemotherapy.
7.2.3 Avoid infections by observing the following:
7.2.3.1 Avoid performing invasive procedures as much as possible (e.g. rectal
temp, enemas,
insertion of indwelling catheter).
7.2.3.2 Stress importance of strict hand washing.
7.2.3.3 Check for reduction in the number of leukocytes and differential count.
7.2.3.4 Reinforce good personal hygiene.
7.2.3.5 Instruct patient about signs and symptoms of infection including:
7.2.3.5.1 Mouth lesions, swelling or redness.
7.2.3.5.2 Redness, pain or tenderness or hemorrhoids at rectum.
7.2.3.5.3 Any changes on bowel habits.
7.2.3.5.4 Any areas of redness, swelling indication or pain in the surface of the
skin.
7.2.3.5.5 Any pain or burning when urinating
or odor from urine.
433
7.2.3.5.6 Any cough or shortness of breath.
7.2.3.5.7 If patient develop fever, administer antibodies within 1 hour per
hospital
Republic of
Yemen 48Modern
Hospital
48
policy.
7.2.4 Avoid bleeding due to thrombocytopenia
7.2.4.1 Avoid invasive procedure when platelet count < 100,000 mm 3, including
IM
injections, enemas, suppositories and indwelling catheter insertion.
7.2.4.2 Avoid aspirin containing products.
7.2.4.3 Monitor and test all urine, stools and emesis for blood.
7.2.4.4 Minimize nausea and vomiting by:
7.2.4.4.1 Administering anti emetics on scheduled basis prior and during 24
hour
period of chemotherapy as prescribed.
7.2.4.4.2 Monitoring I & O including emesis.
7.2.4.4.3 Encouraging patient to eat bland highly nutritious foods (high
protein and
high carbohydrate).
7.2.4.4.4 Offering soda crackers and ice chips to relieve nausea.
7.2.4.4.5 Discouraging smoking and use of alcoholic beverages since these
irritate
mucous membrane.
7.2.4.5 Promote Oral Comfort
7.2.4.5.1 If No White Patches Are Present:
7.2.4.5.1.1 Encourage prophylactic oral hygiene after meals and at night,
more
frequently if needed.
7.2.4.5.1.2 Use soft toothbrush.
7.2.4.5.1.3 Avoid spicy and hot foods.
7.2.4.5.1.4 Assess need for oral antifungal or antibacterial agents.
7.2.4.5.1.5 Avoid commercial mouthwash that may irritate sensitive
tissues.
7.2.4.5.2 If oral cavity erythematous or white patches are present:
7.2.4.5.2.1 Monitor weight and encourage bland finger foods - less painful.
7.2.4.5.2.2 Increase frequency of oral care.
8
7.2.4.5.2.3 Use normal saline mouth rinses
8.1 7.2.4.6
Risks toReassure
personnel
involved
in
the
reconstitution
and
administration
of
cytotoxic
patient that hair will usually grow back.
drugs
fall into
7.2.4.7
Discourage use of hair coloring during treatment period.
two categories:
8.1.1 Local effects caused by direct contact with the skin, eyes and mucous
membranes include
the following:
8.1.1.1 Dermatitis
8.1.1.2 Inflammation of mucous membranes
8.1.1.3 Excessive Lacrimation
8.1.1.4 Pigmentation
8.1.1.5 Blistering
8.1.1.6 Other miscellaneous, allergic reaction
8.1.2 Systemic effects include the following:
8.1.2.1 Lightheadedness
8.1.2.2 Dizziness
8.1.2.3 Nausea
8.1.2.4 Headache
8.1.2.5 Alopecia
8.1.2.6 Coughing
8.1.2.7 Pruritus
8.1.2.8 General malaise
8.2 Safety measures in handling Cytotoxic Anticancer Drugs.
434the following:
8.2.1 Personal safety to minimize exposure to
8.2.1.1 Via Inhalation

8.2.1.1.1 Prepare chemotherapy in well ventilated area while wearing gloves,
mask,
goggles and gown with cuffed long sleeves and close front. (If possible
Republic of
it
should
be prepared in vertical laminar flow hood).
Yemen
48Modern
48
8.2.1.1.2 Vent vials with filter needle to equalize the internal pressure or use
Hospital
negative
pressure technique.
8.2.1.1.3 Wrap gauze or alcohol pads around the neck of ampules when
opening to
decrease droplet contamination.
8.2.1.1.4 Wrap gauze or alcohol pads around injection sites when removing
syringes
or needles from IV injection ports.
8.2.1.1.5 Do not dispose materials by clipping needles or removing needles
from
syringes.
8.2.1.2 Via Skin Contact
8.2.1.2.1 Wash hands before and after the procedure.
8.2.1.2.2 Double gloving and change frequently.
8.2.1.2.3 Wear gown with long sleeves.
8.2.1.2.4 Label all syringes and IV tubing containing chemotherapeutic agents
as
hazardous material.
8.2.1.2.5 Place an absorbent pad directly under the injection site to absorb
accidental
spillage.
8.2.1.2.6 If any contact with the skin occurs, immediately wash the area
thoroughly
with soap and water.
8.2.1.2.7 If eye contact is made, immediately flush the eye with water and
seek
medical attention.
8.2.1.3 Via Ingestion
8.2.1.3.1 Do not eat, drink, chew gum or smoke while preparing or handling
chemotherapy.
8.2.1.3.2 Keep all food and drinks away from preparation area.
8.2.1.3.3 Wash hands before and after handling chemotherapy.
8.2.1.3.4 Avoid hand to mouth or hand to eye contact while handling
chemotherapeutic agents or body fluids of the person receiving
chemotherapy.
8.2.2 Safe disposal of Antineoplastic Agents
8.2.2.1 Discard gloves and gown into a leak proof container, which should be
marked as
contaminated or hazardous waste.
8.2.2.2 Use puncture and leak proof containers for non-capped, non-clipped
needles and
other sharp or breakable objects.
8.2.3 Safe handling of body fluids and excreta
8.2.3.1 Wear gloves for disposing excreta.
8.2.3.2 Wear gloves and gowns for handling soiled linens.
8.2.4 Oral
8.2.4.1 Do not use a medication that has an unpleasant taste, (i.e. Prednisone)
teach patient
how to swallow.
8.2.4.2 Enteric-coated tablets should never be crushed.
8.2.4.3 Mix crushed tablets in a small amount of juice or food with a strong taste
(i.e. peanut
butter, maple syrup, fruit flavored syrup or jelly) and the patient must take
all of the
mixture to receive full dose.
8.2.4.4 Oral medications that are irritating to gastrointestinal mucosa
(prednisone) should be
435
given with milk or food. Administer antacid
as ordered.
8.2.4.5 With single daily doses, administer all tablets at one time to achieve
maximum blood
level.
8.2.4.6 Prevent or minimize vomiting by administering anti-emetic prior to
Republic of
Yemen 48Modern
48
Hospital
8.2.4.7 Some medications should be given between meals on an empty stomach,

consults
pharmacist (i.e. 6 - MP, 6 T 6)
8.2.4.8 Nasogastric tube placement may need to be considered in certain
situations. These
are:
8.2.4.8.1 Intolerance to drug demonstrated by nausea/vomiting during
administration.
8.2.4.8.2 Dose requires swallowing large quantities of pills (Busulfan)
8.2.4.8.3 Refusal of patient to take oral medications.
8.2.5 Intravenous
8.2.5.1 Maintain constant supervision during administration of intravenous push
vesicantchemotherapy.
8.2.5.2 Use a running IV (flush solution) while administering a vesicant (blistering
or
necrotic) chemotherapeutic agent IV push.
8.2.5.3 If any doubt exists regarding vein patency or safety of chemotherapy
administration,
discontinue the administration and treat as an extravasation if a vesicant
chemotherapeutic agent has been used.
8.2.5.4 When injecting a vesicant to a side arm of a peripheral IV line, the line
should not be
infusing with the aid of an infusion pump because of the increased potential
for
extravasation and the impossibility of quickly reversing the direction of drug
flow in
the event of possible extravasation.
436
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Chest Tube Insertion and Management
CONTENTS: This General Ward policy and procedure serves as a guideline in the insertion
and
management of chest tube.
1 DEFINITION:
1.1 Chest Tube Insertion - the insertion of one or more flexible tubes into the pleural or
mediastinal
space following an aseptic technique.
1.2 Types of Drainage System:
1.2.1 One - Bottle System -water seal and collection of drainage occurs in the same
bottle used
for simple pneumothorax.
1.2.2 Two - Bottle System - water seal and collection of drainage are in separate
bottles. The
first bottle directly attached to the patient serves as a collection container for the
fluid.
The second bottle serves as a water seal container as in the one-bottle system.
1.2.3 Three - Bottle System - water seal, collection of drainage, and suction control are
in
separate bottles. This is indicated when significant amounts of drainage are
expected and
the patient requires suction to the chest tubes.
1.2.4 Pleur Evac - same as the three-bottle system but incorporated into a single,
easily
movable unit.
2 PURPOSES:
2.1 To re-expand a collapsed lung by restoring negative intrapleural pressure.
2.2 To measure drainage from the intrapleural space.
2.3 To re-establish an adequate ventilation-perfusion ratio.
2.4 To restore normal cardio-respiratory function after surgery, trauma or medical
conditions by
establishing negative pressure in the pleural cavity.
2.5 To allow sclerosing agents to be placed in the pleural cavity for the treatment of
malignant
4
effusions.
4.1 Drainage bottle set according to type of drainage
2.6 To evacuate blood, air or fluid
collections.
system
3 INDICATIONS:
4.2 Suturing set
3.1 Hemothorax or pleural effusion
4.3 Trocar (different sizes)
3.2 After cardiothoracic surgery
4.4 Sterile and disposable gloves
3.3 Emphyema
3.4 Pneumothorax
4.6 Disposable scalpel size 11
4.7 2% Xylocaine
4.8 Syringe with needles
4.9 Underpad, alcohol swab
4.10Sterile gauze 10 x 10
4.11Adhesive tape, mepore
437
Republic of
Yemen 48Modern
Hospital
48
4.12Silk 3-0
4.13Puncture towel
4.14Normal saline 500ml
4.15Suction tubings
4.16Sterile specimen container
4.17Clamp (2 forceps)
4.18Milker
4.19Spirometer
4.20Y connector (for two chest tubes on the same
side)
POLICIES:
5
5.3 Consent must be signed prior to the procedure.
5.4 Infection control policy must be strictly followed.
5.5 Nurses should be knowledgeable of the principle of close
drainage system.
5.6 Procedure should be done under strict aseptic technique.
5.7 Keep the patency of the tubing throughout the procedure.
PROCEDURES:
5.8 Observe and monitor for the oscillation of fluid frequently.
6.2 Check the following:
6
6.2.1 Identity of the client.
6.2.2 Consent
6.3 Explain the procedure. Provide privacy.
6.5 Prepare the needed equipments and supplies.
6.6 Assemble the drainage system and fill with sterile water or normal saline according
to the system.
6.7 Take and record vital signs as baseline. Assess clients general condition.
6.8 Position the client according to doctors order.
6.9 Carry out physicians order prior to the procedure such as use of analgesics.
6.10Assist the physician during the procedure and continuously monitor the vital signs,
oxygen
saturation until procedure is completed. Check for respiratory pattern and general
condition.
6.11After the tube is inserted, clamp and connect to the drainage system and attach to
the bed below
chest level.
6.12Assist in suturing and apply dressing.
6.13Remove the sterile drape from the client.
6.14Place client in semi-sitting position, and make client comfortable.
6.15Instruct the client to take a deep breath, hold and slowly exhale to assist drainage
of the pleural
space and lung re-expansion.
6.16After care of equipments should be done.
6.18Send the request for portable chest X-ray.
6.19Immediate care:
6.19.1 Mark the original fluid level with tape outside the bottle.
6.19.2 Check and mark the drainage every 15 minutes for the first 4 hours and every
hour
thereafter.
6.19.3 Check vital signs every 15 minutes for 1 hour, then every hour for 2 hours or
as
necessary.
438
6.19.4 Inform physician if the following is observed:
6.19.4.1If the drainage is more than 100ml/hr.
6.19.4.2Change in vital signs.
Republic of
Yemen 48Modern
Hospital
48
6.19.4.3Color and amount of fluid.

6.19.4.4Sudden cessation of drainage.
6.19.4.5Bleeding from the insertion site.
6.19.4.6Change in fluctuation of fluid in the tubing.
6.19.4.7Change in respiratory pattern (e.g. rapid shallow breathing, pressure in
the chest).
6.19.4.8Signs of tension pneumothorax
6.19.4.8.1 Pallor, vertigo, faintness, diaphoresis
6.19.4.8.2 Weak rapid pulse, dyspnea, blood tinged sputum, excessive
coughing.
6.19.4.8.3 Tachypnea, chest pain
6.19.5 Administer prescribed medicine per physicians order (e.g. analgesic,
antibiotics).
6.19.6 Instruct the client to take a deep breath, then put the arm and shoulder of
affected site in
range of motion exercises several times.
6.20Check the connection tube periodically. The tube should be approximately 2.5cm
below the
water level.
6.21Short tube should be left open to the atmosphere.
6.22Connect the suction to the drainage system if needed.
6.23.1 Date and time of insertion
6.23.2 Site of insertion, condition of dressing
6.23.3 Type of drainage system
6.23.4 Amount of suction applied
6.23.5 Initial amount and type of drainage
6.23.6 Condition of drainage system
6.23.7 Hourly output, color consistency
SPECIAL
CONSIDERATIONS:
6.23.9
Unusual manifestation during and after the procedure
7.16.23.10Vital
Ensure that signs
the drainage
tubing should
notthe
kink,
loop or interfere with clients
before, during
and after
procedure
movement.
6.23.11Instruction given to the client
7
7.2 Make sure
there isand
fluctuation
of fluid
level during inspiration and expiration.
6.24Charge
thethat
procedure
all supplies
used.
7.3 Observe for air leak in the drainage system as indicated by constant bubbling in the
water seal
bottle.
7.4 If the tubing is disconnected from bottle, instruct the client to exhale as much as
possible and to
cough to get rid of the air in the pleural space.
7.5 Chest drainage should progressively decrease after first 12 hours.
7.6 Maintain the patency of tube by gently milking according to the physicians order for
hemothorax
cases.
7.7 Keep 2 clamps at bedside for clamping the tube when needed.
7.8 Ensure that respiratory therapist is assisting the client in doing respiratory exercises
according to
physicians order.
7.9 If client is to be transported to another area,439
place the drainage bottle below the
chest level.
7.10Never clamp the chest tube unless drainage system breaks or without physicians
order.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Chest Tube Removal
CONTENTS: This General Ward policy and procedure serves as a guideline in the removal of
chest tube.
1 DEFINITION:
1.1 Removal of Chest Tube - is an aseptic procedure of withdrawing a chest tube from the
pleural/mediastinal space without introducing air or infectious microorganism
2 PURPOSES:
2.1 To regain and establish normal lung function
2.2 To establish normal pattern of respiration.
3 INDICATIONS:
3.1 Once the lung has re-expanded (confirmed by chest X-ray) and with minimal drainage.
3.2 The risk of fluid collection in mediastinum post-cardiac surgery.
4.1 When the X-ray shows incomplete lung expansion.
4.2 When clamping the tube induces respiratory distress.
5.1 Clamp
5.2 Dressing tray
5.3 Surgical gloves
5.4 Surgical blade
5.5 Underpad
5.7 Sterile gauze
5.8 Mepore
5.9 Analgesic (PRN)
5.10Syringe with needle g. 22 as needed
5.12Orange bag
5.13Stethoscope and sphygmomanometer
5.14Thermometer
6 POLICIES:
6.2 Proper identification of patient is a must.
6.4 Chest x-ray before and after insertion must be obtained.
PROCEDURES:
7
7.3 Provide privacy, explain the procedure.
7.4 Assemble equipments.
7.5 Assess the depth and quality of patients respiration and obtain
baseline vital signs.
7.6 Wash hands. Give analgesic as ordered prior to removal of chest tube.
7.7 Keep the patient on semi-fowlers position or on his unaffected side.
440
Republic of
Yemen 48Modern
48
Hospital
7.8 Put underpad on the affected side.

7.9 Assess for the effects of the pre-medication or respiratory status.
7.10Put on disposable gloves and remove chest tube dressing carefully not to dislodge
chest tube.
7.11Discard soiled dressing in orange bag.
7.12Hold chest tube in place with sterile forceps and cut the suture anchoring the tube.
7.13Make sure that the chest tube is securely clamped according to doctors order and
instruct the
patient to exhale/inhale deeply and hold his breath.
7.14Hand over the airtight dressing to the doctor. Once tube is removed by the doctor
cover the
insertion site with airtight dressing, secure dressing with tape. If a purse-string
suture is used, it is
retied and sterile dressing to be placed over the insertion site.
7.15Keep patient in comfortable position.
7.16Dispose the chest tube, soiled gloves and used supplies to the appropriate
container.
7.18.1 Date and time of removal.
7.18.2 Amount, color, consistency, and odor (if any) of drainage in bottle.
7.18.3 Vital signs, depth and quality of respiration before and after the procedure.
7.18.4 Any specimen obtained for culture.
7.19Assess the patient for 30 minutes. Observe for signs and symptoms of
pneumothorax such as:
7.19.1 Increase shortness of breath.
7.19.2 Decrease oxygen saturation
7.19.3 Chest pain, or pain with inspiration
7.19.4 tachycardia
7.19.5 Cyanosis
7.19.6 Restlessness
7.19.7 Absence of breath sound in affected area
7.19.8 Subcutaneous emphysema
7.19.9
Assess the dressing site for sounds of air leakage, oozing and infection. 8
SPECIAL
CONSIDERATIONS:
7.19.10Check
if the
ordered
chest X-ray
post chest
tube removal
toand
confirm
8.1 Dressing
should
not doctor
be removed
for for
24 hours.
If dressing
is soaked,
reinforce
full lung
notify
the
doctor.re-expansion.
7.19.11Charge
the
supplies
used.
8.2 Teach
the patient
the
signs and
symptoms of pneumothorax and complications like
subcutaneous
emphysema and infection. Report to the doctor immediately.
8.3 If the chest X-ray confirms full lung expansion.
8.4 The tube is clamped according to doctors order before removal.
8.5 Observe for signs of respiratory distress which indicates that air or fluid is trapped in
the pleural
space.
8.6 Chest X-ray is obtained after clamping.
8.7 The clamp is immediately removed if respiratory distress or recurrent pneumothorax
is observed.
441
Republic of
Yemen 48Modern
48
Hospital
DIAGNOSTIC
PROCEDURES
442
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Abdominal and Pelvic Ultrasonography
abdominal
and pelvic ultrasonography.
1 DEFINITION:
1.1 Abdominal Ultrasonography a noninvasive test focuses high frequency sound waves
over an
abdominal organ to obtain an image of the structure as displayed on the oscilloscope.
1.2 Pelvic Ultrasonography a noninvasive test that uses high frequency sound waves to
form
images of the interior pelvic cavity as displayed on the oscilloscope.
2 PURPOSES:
2.1 Abdominal Ultrasonography
2.1.1 To detect small abdominal masses, fluid-filled cysts, gallstones, dilated bile
ducts, ascites
and vascular abnormalities.
2.2 Pelvic Ultrasonography
2.2.1 To detect uterine, tubal, organ and pelvic cavity pathology.
2.2.2 To measure organ size.
2.2.3 To evaluate pregnancy.
3 POLICIES:
PROCEDURES:
4
3.3 Patient should be properly prepared for the procedure.
3.4 The patient should be aware of the purpose of the procedure.
4.2 Fill-up laboratory Form M3019 and give to ward secretary for charging.
4.3 Enter X-Ray request through computer on line.
4.4 Explain the procedure to the patient to allay anxiety.
4.5 Ask appointment from the X-Ray Department.
4.6 Prepare the patient according to the type of procedure to be done:
4.6.1 Abdominal Ultrasonography
4.6.1.1 Keep patient NPO (Nothing Per Orem) for at least 6 hours.
4.6.2 Pelvic Ultrasonography
4.6.2.1 Instruct patient to increase oral fluid intake to keep bladder full as soon as
possible.
If patient has an on-going IVF, give rapid infusion as ordered.
4.6.2.2 Clamp indwelling catheter if present.
4.6.2.3 If there is an urge to urinate, instruct patient to inform the nurse.
4.6.3 Abdominal and Pelvic Ultrasonography
4.6.3.1 Keep patient NPO (Nothing Per Orem) except water. Once bladder is full,
instruct to
inform the nurse.
4.7 Confirm appointment from X-Ray if patient is for abdominal ultrasonography and
send to X-Ray
Department according to the time schedule given. If for pelvic or combined
ultrasonography, once
443
patient feels the urge to urinate, inform X-Ray Department.
4.8 Send patient to X-Ray Department per wheelchair or stretcher depending on his/her
condition.
Republic of
Yemen 48Modern
48
Hospital
4.9 Endorse patient to X-Ray Department staff and inform to call the nursing unit once
procedure is
completed.
4.10As soon as the patient arrives in the unit, call the pantry to serve the prescribed
diet previously
ordered.
5
5.1 The chief advantage of the abdominal ultrasonography is the spatial reproduction of
masses in
transverse and longitudinal directions. This is useful in studying the liver, spleen,
pancreas,
gallbladder and retroperitoneal tissue. However, this procedure is cannot be used
when a structure
to be examined lies behind bony tissues. Also gas in the abdomen or air in he lungs
presents a
problem, as ultrasound is not well transmitted through gas or air.
5.2 Transvaginal approach for pelvic ultrsonography will be performed, inform the
patient that a
vaginal probe will be inserted to obtain more accurate measurements from internal
organs.
5.3 During the third trimester of pregnancy, a full bladder is no longer necessary for
pelvic
ultrasonography.
444
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Abdominal Paracentesis
abdominal
paracentesis.
1 DEFINITION:
1.1 Abdominal Paracentesis - aspiration of fluid from the peritoneal space through a
needle (trocar
or cannula) inserted in the abdominal wall, under sterile condition. This procedure is
performed
for therapeutic and diagnostic purposes.
2 PURPOSES:
2.1 To determine the cause of ascites.
2.2 To relieve pressure cause by ascites that can lead to respiratory distress.
2.3 To diagnose intra-abdominal bleeding following trauma.
2.4 To provide peritoneal fluid specimen for laboratory analysis.
3.1 Peritonitis
3.2 Hypovolemia
3.3 Platelet count below 100,000 units
4.1 cannula g. 14, 16
4.2 sterile and disposable gloves
4.3 sterile gauze
4.4 blue pads
4.5 syringe 50ml, 5ml
4.6 needle g. 23
4.7 IV tubing
4.8 specimen container
4.9 drainage bag or bottle
4.10betadine solution
4.11sharp disposal container
4.12forceps
4.13mask (optional)
4.14plaster (durapore)
4.15xylocaine 2% or per doctors order
4.16sterile drape
4.17razor (optional)
4.18measuring tape
4.19sphygmomanometer
4.20stethoscope
4.21thermometer
POLICIES:
445
Republic of
5.2 Secure consent for procedure.

Yemen
48Modern
5.3 Follow
standard
infection control procedure.
Hospital
446
48
Republic of
Yemen 48Modern
Hospital
48
5.4 Measurement of abdominal girth and weight is taken before and after
procedure.
PROCEDURES:
6
6.2 Identify the correct patient. Explain the procedure to the patient and check if
consent is signed.
6.3 Assess patients allergic reaction to local anesthesia.
6.4 Instruct the patient to void as completely as possible.
6.5 Measure the patients. abdominal girth and weight.
6.6 Check vital signs and assess patients general condition.
6.7 Assist patient in comfortable position (as ordered by doctor.)
6.9 Assemble all equipments and prepare for the procedure.
6.10Place BP cuff on one of the patients arm to monitor BP during the procedure.
6.11Assist the doctor and anticipate his needs during the procedure.
6.12Monitor vital signs at least every 15 minutes and observe for signs of pallor or
sweating during
the drainage procedure.
6.13When the procedure is completed, assist the patient in comfortable position.
6.14Monitor the patients vital signs, urine output, dressing and drainage every 15
minutes or as
ordered, and record.
6.15Measure abdominal girth and weight (if condition allows).
6.16Label the specimen with patients complete data and send to laboratory with
charged request form
through computer.
6.17Dispose used items properly.
6.19.1 time the procedure was done.
6.19.2 site of puncture.
6.19.3 laboratory analysis ordered.
6.19.4 patients response to procedure.
6.19.5 pressure dressing on assessment of drainage.
6.19.6 amount, consistency, color and opacity of fluid drained.
6.20Charge all supplies used and procedure.
6.21Follow
up results of laboratory analysis and notify physician.
SPECIAL
CONSIDERATIONS:
7
7.1 Explain to patient that he/she will experience only minimal discomfort during the
procedure.
7.2 If patient shows any signs of hypovolemic shock, reduce the vertical distance
between needle and
collection bag to slow drainage rate. If necessary, stop the drainage and notify
physician.
7.3 If patient is on continuous drainage, verify to the physician the amount of fluid to be
collected
prior to termination of procedure.
7.4 Instruct patient to report any changes in his/her condition (e.g. shortness of breath,
dizziness and
increase perspiration).
447
7.5 Reposition the patient to facilitate the flow of peritoneal fluid if the drainage stop,
as ordered by
the doctor.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Angiography
angiography procedure.
DEFINITION:
1
1.1 Angiography - a procedure wherein a contrast medium is injected into the vascular
system (to
outline the heart and the vessels) accompanied by cineangiograms (rapidly changing
films or
movies on an intensified fluoroscopic screen) which record the passage of contrast
medium
through the vascular tree.
1.2 Types of Angiography:
1.2.1 Selective angiocardiography contrast medium is injected through a catheter
directly into
one of the heart chambers, coronary arteries, or greater vessel.
1.2.2 Aortography form of angiography that outlines the lumen of the aorta and
major arteries
PURPOSES:
2
arising
from it.
2.1 To provide
information
regarding coronary anatomy, structural abnormalities
1.2.3 Coronary
(occlusions,
defects,Arteriography (most common form of selective angiocardiograophy).
1.2.1
Peripheral
Arteriography
fistulae) or abnormal
heart valve function.
2.2 To serve as an evaluation tool before coronary artery surgery or myocardial
revascularization and
3
after surgery to evaluate graft patency.
2.3 To determine arterial patency of extremities.
3.1 Stethoscope with BP apparatus
3.2 IVAC machine
3.3 Blue sheet
3.4 Razor
3.6 Fucidin ointment
4
3.7 Tensoplast dressing
3.8 Sandbag 1kg.
POLICIES:
4.2 Obtain written consent from the patient.
PROCEDURES:
5
4.3 Have appointment from X-ray department/Cathlab prior to procedure.
5.2 Secure consent as witnessed by the treating doctor.
5.4 Preparatory phase:
5.4.1 Let the doctor fill-up X-ray request form (Form M3015).
5.4.2 Give the X-ray request to the ward secretary to charge the procedure and send
request
through computer online to X-ray department. If patient is for coronary
448
angiography, send
Republic of
Yemen 48Modern
48
Hospital
OR manual request Form M1029 properly filled up by the treating doctor.

5.4.3 Keep patient Nothing Per Orem (NPO) for at least 8 hours.
5.4.4 Prepare the area for insertion by shaving both groin (most commonly used)
(Refer to
shaving Procedure GW-115) and disinfect it.
5.4.5 Confirm appointment to X-ray department/Cathlab prior to procedure.
5.4.6 Check vital signs of patient before sending to X-ray/Cathlab Department.
5.4.7 Transfer patient to stretcher for X-ray dept/bed for Cathlab and put on safety
strap/siderails,
5.4.8 Send patient along with the file, laboratory results, X-ray films if any,
tensoplast dressing,
sandbag 1kg. and fucidin ointment.
5.4.9 Endorsed to X-ray/Cathlab personnel responsible to the procedure.
5.5 Post-Procedure phase:
5.5.1 Receive the patient and file with complete endorsement from X-ray
department/Cathlab
staff.
5.5.2 Transport patient to the ward. Observe safety precautions.
5.5.3 Check for post angiography order.
5.5.4 Monitor and record vital signs every 15 minutes four times. (or more often as
patient
condition indicate until stability verified).
5.5.5 Check for bleeding at puncture or cutdown site.
5.5.6 Check distal extremity for normal color and palpable pulses.
5.5.7 Maintain pressure dressing with sandbag over the puncture site for 24 hours.
5.5.8 Observe for increased tenderness, or hematoma formation at the catheter
insertion site for
24 hours.
5.5.9 Observe patient for possible delayed reactions to contrast materials such as:
5.5.9.1 Itchiness
5.5.9.2 Headache
5.5.10 Ensure that the patient maintains bedrest and check for special fluid
instructions.
5.5.11.1Date and time of transfer to X-ray/Cathlab department
5.5.11.2Mode of transport
SPECIAL5.5.11.3Time
CONSIDERATIONS:
returned back to ward
6
6.1 The 5.5.11.4Tolerance
patient may complain
to the
mild
procedure
headache and/or discomfort in the groin or other site
depending
5.5.11.5Vital
on
signs before and after the procedure
route5.5.11.6Any
by which contrast
untoward
medium
observation
was administered.
made after the procedure
449
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Barium Enema
CONTENTS: This General Ward policy and procedure deals with the guidelines during
Barium enema
procedure.
1 DEFINITION:
1.1 Barium Enema - a procedure in which a barium mixture is introduced in the large
intestine via
rectal catheter for fluoroscopic visualization of the entire colon (large intestine).
2 PURPOSES:
2.1 To demonstrate the presence of polyps, tumors, and other lesions of large intestine.
2.2 To reveal any abnormal anatomy or malfunction of the bowels.
2.3 To aid in diagnosis of colorectal cancer and inflammatory disease.
2.4 To attempt to reduce non-strangulated ileocolic intussusception in children.
3.1 Tachycardia
3.2 Ulcerative colitis
3.3 Suspected perforation or obstruction
3.4 Toxic megacolon
4.2 Blue pad
4.3 Fleet enema
4.4 Thermometer
5 POLICIES:
5.2 Appointment must be obtained a day before the procedure.
5.3 Patient must sign consent form for diagnostic procedure. Ensure that patient is well
informed of
the purpose of the procedure.
5.4
Physical and psychological preparation is a must.
PROCEDURES:
6
5.5
Provide privacy.
6.1 Preparatory
Phase:
6.1.1 Check for doctors order.
6.1.2 Send request to X-Ray Dept. after charging through computer.
6.1.3 Take appointment from X-Ray Department.
6.1.4 Inform and explain procedure to the patient.
6.1.5 One day prior to examination:
6.1.5.1 Instruct patient to take only fluids (e.g. water or juice but not milk) about
2-3 liters.
6.1.5.2 Take vital signs before and after giving enema.
6.1.5.3 Fleet Enema at 12:00 midnight.
6.1.6 Keep patient nothing by mouth on the day of procedure.
6.1.7 Give fleet enema 2 hours prior to appointment time.
6.1.8 Prepare patient and transport to Radiology Department via wheelchair or
stretcher with
450
safety straps depending on patients condition after proper documentation.
Republic of
Yemen 48Modern
48
Hospital
6.1.8.1 For female patient, keep hair and face fully covered.
6.1.9 Endorse patient to X-Ray Technician.
6.1.10 Request X-Ray Technician to inform the ward when procedure is finished.
6.2 Post Procedure Phase:
6.2.1 Receive patient from X-Ray Department with complete endorsement including
special
instructions relating to patients condition.
6.2.2 Take note of the time patient was received from the X-ray department,
patients
condition and tolerance to the procedure.
6.2.3 Transport patient back to the room. Transfer to the bed, if in
wheelchair/stretcher.
6.2.4 Assess patients condition. Take vital signs.
6.2.5 Instruct patient to resume diet and take more fluids.
6.2.6 Administer the prescribed cathartic or cleansing enema to promote elimination
of barium,
in order to prevent impaction and bowel obstruction.
6.2.7 Explain to patient that the barium will lighten color of stool.
6.2.8 Document:
6.2.8.1 Time received
6.2.8.2 Tolerance to the procedure
6.2.8.3 Objective/subjective
observations
7
6.2.8.4 Vital signs 7.1 If barium is not eliminated within 2-3 days notify the
6.2.9 Charge the procedure
and supplies used.
physician.
451
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Barium Meal / Barium Swallow
barium
meal/barium swallow.
1 DEFINITION:
1.1 Barium Meal/Barium Swallow is a radiographic study of the gastro-intestinal tract and
associated organs by administering a contrast medium. The procedure is safe and
consists of
giving a radiopaque substance called barium to drink. It flows through the upper GI
and
monitored by series of x-rays taken at varying intervals. It is takes 10-30 minutes.
2 PURPOSES:
2.1 Evaluates patients ability to swallow.
2.2 Reveals any abnormalities of the pharynx or esophagus.
2.3 Helps to diagnose hiatal hernia, diverticula and varices.
2.4 To detect strictures, ulcers, tumors, polyps, and motility disorders (esophagus,
stomach and
duodenum).
3 INDICATIONS:
3.1 Patient suffering from dysphagia.
3.2 Gastroesophageal reflux.
3.3 To rule out a tumor of esophagus, stomach or duodenum.
4.1 Pregnancy
4.2 Intestinal obstruction
4.3 Patient with suspected gastrointestinal perforation (water soluble contrast media
should be used
safely)
5.1 IVAC thermometer with probe cover
5.2 BP apparatus
6 POLICIES:
6.2 Ensure patient is well informed of procedure and its purpose.
6.3 Consent for Diagnostic Procedure (Form M1141) must be signed by the patient and
PROCEDURES:
7
witnessed by
7.1 Preparatory Phase:
treating doctor.
6.4 Appointment must be obtained day before the procedure.
6.5 Follow safety measures during transfer.
7.1.3 Enter the request through the computer after charging.
7.1.4 Get appointment from X-Ray Department.
7.1.5 Keep patient Nothing Per Orem (NPO) after midnight.
7.1.6 Assess patients condition. Take and record vital signs.
7.1.7 Verify and confirm from X-Ray Dept. the patients appointment
time.
452
Republic of
Yemen 48Modern
48
Hospital
Transport patient to X-Ray Dept. by stretcher or wheelchair per patients

7.1.8
condition. Put
on safety strap.
7.1.9 Endorse patient to the X-Ray Technician. Request X-Ray Technician to notify the
ward
by telephone once the procedure is finished.
7.2.1 Receive patient with complete endorsement from X-Ray Technician
7.2.2 Take note of the time and patients condition.
7.2.3 Send back to the room and transfer to bed.
7.2.4 Assess patients condition. Check vital signs. Notify the physician of any
deviation from
normal.
7.2.5 Let patient resume oral intake when procedure is done.
7.2.6 Give cathartic or cleansing enema as ordered to prevent fecal impaction and to
promote
elimination of the barium.
7.2.7 Inform patient that stools will appear chalky for 24 to 72 hours after test.
7.2.8.1 Time returned back to the ward.
7.2.8.2 Tolerance to procedure.
7.2.8.3 Any untoward manifestations observed after the procedure and notify the
physician.
7.2.8.4 Vitals signs taken.
7.2.8.5
Enema given and observations made (if any).
SPECIAL
CONSIDERATIONS:
8
8.1 If patient is a smoker withhold cigarettes because nicotine stimulates peristalsis
and increases
gastric secretions, which when diluted to contrast agent can result to inaccurate test
result.
8.2 Withhold anticholinergic and narcotics for 24o hours per doctors order because they
may
decrease peristalsis and impede elimination of barium from the GI tract after
procedure.
453
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Bronchoscopy
bronchoscopy
procedure.
1 DEFINITION:
1.1 Bronchoscopy is the direct inspection and examination of the larynx, trachea and
bronchi through
either a flexible fiberoptic or rigid bronchoscope.
1.1.1 Diagnostic Bronchoscopy
1.1.2 Therapeutic Bronchoscopy
2 PURPOSES:
2.1 Diagnostic
2.1.1 To examine tissues or collect secretions.
2.1.2 To determine the location and extent of the pathologic process.
2.1.3 To obtain a tissue sample for diagnosis.
2.1.4 To determine if a tumor can be resected surgically.
2.1.5 To locate the source of hemoptysis.
2.2 Therapeutic
2.2.1 To remove foreign bodies from the tracheobronchial tree.
2.2.2 To remove secretions obstructing the tracheobronchial tree when the patient
cannot clear
them.
2.2.3 To treat Post-op atelectasis.
2.2.4 To destroy and excise lesions.
3.1 Recent Myocardial Infraction
3.2 Cerebral Hemorrhage (less than 6 weeks)
3.3 O2 saturation less than 90% with oxygen
4.1 BP apparatus
4.2 IVAC machine with probe cover
4.3 Syringes and needle
4.4 Alcohol pads
4.5 Band-aid
4.6 Small sharp container
4.7 Pulse Oximeter
5 POLICIES:
5.2 Secure written consent.
PROCEDURES:
6
5.3 Observe fall precautions.
6.1 Preparatory phase
5.4 Ensure that patient is NPO for 6-12 hours6.1.1
to prevent
aspiration
when reflexes are
Verify doctors
order.
blocked.
6.1.2 Identify the correct patient.
6.1.3 Explain the procedure to the
patient.
454
Republic of
Yemen 48Modern
48
Hospital
6.1.4 Keep patient on NPO for 6-12 hours.

6.2 Performance phase
6.2.1 Check for the following:
6.2.1.1 Signed consent
6.2.1.2 ECG
6.2.1.3 Chest x-ray/lab investigations as ordered by doctor
6.2.2 Ensure that patient is kept NPO for 6-12 hours.
6.2.3 Remove dentures, contact lenses, and other prosthesis.
6.2.4 Wash hands. Check vital signs as baseline.
6.2.5 Administer premeds (usually 1 ampoule Atropine Sulphate is given
intramascularly) or as
prescribed by the doctor to reduce secretions 30 minutes prior to the procedure.
6.2.6 Transport patient per stretcher together with the complete file, pin card and 1
ampoule of
Dormicum, put on safety straps.
6.2.7 Endorsed to OPD staff and remind her to notify the ward once the procedure is
finished.
6.2.8 Post procedure phase:
6.2.8.1 Received complete endorsement from OPD staff.
6.2.8.2 Assess patients condition. Check level of consciousness.
6.2.8.3 Transports back the patient per stretcher. Observe fall precautions.
6.2.8.4 Transfer the patient to bed, kept warm and comfortable.
6.2.8.5 Check vital signs and oxygen saturation.
6.2.9 Ensure safety of the patient until fully awake. Observe aspiration precautions.
6.2.10 If the physician obtained specimen for cytology/biopsy send specimen bottle
together with
the laboratory request Form M2048 and histopath form filled-up by the doctor to
laboratory after charging and label with the following:
6.2.10.1Name and PIN
6.2.10.2Type of specimen
6.2.11 Monitor patients condition and report immediately to the physician if the
following
occurs:
6.2.11.1Hypotension
6.2.11.2Hemoptysis
6.2.11.3Cyanosis
6.2.11.4Dyspnea
6.2.11.5Hypoxia
6.2.11.6Dysrhythmias
6.2.11.7Tachycardia
6.2.12.1mode of transport
6.2.12.2date and time the procedure is finished
6.2.12.3vital signs before and after the procedure
6.2.12.4any medication given
6.2.12.5pertinent observations made
7
6.2.12.6tolerance to the procedure
7.1 The following are the possible complications after
6.2.13 Maintain the patient NPO until gag/swallowing reflex return.
bronchoscopy:
6.2.14 Charge the medicines and supplies used.
7.1.1 reaction to the local anesthesia
7.1.2 infection
7.1.3 aspiration
7.1.4 bronchospasm
7.1.5 pneumothorax
455
Republic of
Yemen 48Modern
48
Hospital
7.1.6 bleeding and perforation

7.2 Sedation given to patients with respiratory insufficiency may precipitate respiratory
arrest.
7.3 Assess patients gag reflex before giving oral intake. Once the patient demonstrates
that he/she can
cough, ice chips and eventually fluids maybe given.
456
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Colonoscopy

colonoscopy
procedure.
1 DEFINITION:
1.1 Colonoscopy the visualization of the entire large intestine, sigmoid colon, rectum
and anal
canal, with the use of a colonoscope. It is more extensive procedure than
proctosigmoidoscopy
that requires one-day preparation of the bowel under conscious sedation during the
procedure.
2 PURPOSES:
2.1 Diagnostic
2.1.1 To evaluate for malignancy, diverticulosis, inflammatory bowel disease, polyps,
stricture
and bleeding.
2.1.2 Used for surveillance in patients with history of chronic ulcerative colitis,
previous colon
cancer or colon polyps.
2.2 Therapeutic
2.2.1 To provide therapeutic management such as polypectomy.
2.2.2 To provide dilatation of colonic stricture in selected patients.
3INDICATIONS:
3.1 Lesion in the proximal colon, chronic constipation, bleeding/ rectum.
3.2 To coagulate actively bleeding vessels.
4.1 Uncooperative patient
4.2 Abdominal surgery
4.3 Ascites
4.4 Pregnancy
4.5 Myocardial infarction and severe cardiac decompensation
4.6 Profuse rectal bleeding
5 EQUIPMENTS:
5.1 Video Colonoscope
5.2 Biopsy forceps
5.3 Blue pads
5.4 Gauze pads
5.5 Plastic apron
POLICIES:
6
6.1 Procedure should be explained to the patients level of understanding.
5.7 IV set kit
6.2 Informed consent should be signed (Form M1141).
5.8 Bowel preparation
6.3 Assess patients history of any known allergies and current medications. Certain
5.8.1 Cololyt or coloprep ( given night of the procedure )
medication such
5.8.2 Fleet enema
as anticoagulants may be held before the procedure.
457
Republic of
Yemen 48Modern
48
Hospital
6.4 Results of laboratory and radiologic investigations should be made available prior to
the
procedure.
PROCEDURES:
7
7.3 Assess patients condition and review current treatment (i.e. anti-coagulant should
be hold before
the test as per doctors order).
7.4 A Day Prior to Procedure:
7.4.1 Mix 3 sachets of cololyte in 3 liters of water.
7.4.2 Instruct patient to fast (NPO) after lunch except water or juice.
7.4.3 Instruct patient to start drinking the prepared solution 3 hours after lunch.
7.4.4 Ensure that patient consumes the whole amount of prepared solution within 3-5
hours.
7.4.5 Administer fleet enema at 12:00 midnight and 6:00 a.m.
7.5 On the day of the procedure:
7.5.1 Confirm time of appointment from Endoscopy nurse.
7.5.2 Allow patient to take some juice or water but not food or milk.
7.5.3 Take and record vital signs prior to procedure.
7.5.4 Insert IV cannula, if there is any premeds to be given.
7.5.5 Coordinate with Endoscopy nurse before sending the patient.
7.5.6 Transport the patient to Endoscopy Unit per stretcher along with file and X-ray
results,
PIN card. Observe fall precautions, apply safety straps.
7.5.7.1 mode of transfer
7.5.7.2 condition of patient
7.5.7.3 date and time of procedure
7.5.7.4 patients tolerance to bowel preparation
7.6 Post procedure phase:
7.6.1 Prepare the room where patient is admitted:
7.6.2 Keep the following ready:
7.6.2.1 oxygen with accessories
7.6.2.2 IV stand
7.6.2.3 blue sheet
7.6.2.4 kidney basin
7.6.2.5 disposable gloves
7.6.3 Receive patient with complete endorsement from the nurse of Endoscopy unit.
7.6.4 Assess patients condition after the procedure.
7.6.5 Transfer patient to bed. Place in comfortable position. Put siderails up.
7.6.6 Monitor vital signs and record.
7.6.7 Observe for signs of perforation, pain, abdominal rigidity, distention,
respiratory distress
and inform the doctor, if any.
7.6.8 Resume diet per doctors order and instruct patient to increase fluid intake.
7.6.9 Document the specific procedure performed, patients tolerance to procedure,
and
REFERENCES:
8
observations
made.
8.1 Rex DK Colonoscopy . Gastrointest Endosc Clin North AM 2000;10:
7.6.10 Charge
the procedure and supplies used in the Inpatient Charging Form.
135-60
8.2 Sivak MV Jr, ed. Gastrointerologic endoscopy, 2nd edn. Philadelphia:
WB Saunders, 1995
8.3 Waye JD, Rex DK., Williams CB. Colonoscopy . Oxford: Blackwell
Publishing 2003
458
Republic of
Yemen 48Modern
48
Hospital
8.4 Nelson DB. Technical assessment of direct colonoscopy

screening:
Procedural success, safety, and feasibility. Gastrointest
Endosc Clin
North Am 2002;12:77-84
8.5 Rex DK, Bond JH, Feld AD. Medical-legal risks of incident cancers
After clearing colonoscopy AM J Gastroenterol 1997;112:24-28
8.6 Rex DK. Rationale for colonoscopy screening and estimated
effectiveness
In clinical practice. Gastrointest Endosc Clin North AM
2002;12:65-75
8.7.Waye JD, Bashkoff E. Total colonoscopy: is it always possible
Gastointest Endosc 1991; 37:152-4
Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13,580 colonoscopies.
Reevluation
of credentials guidelines. Surg endosc 2002; 15: 251-612
459
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Endoscopic Retrogade Cholangiopancreatography
(ERCP)
CONTENTS: This General Ward policy and procedure deals with the guidelines during ERCP
procedure.
1 DEFINITION:
1.1 Endoscopic Retrograde Cholangiopancreatography (ERCP) is the technique of
visualization
of the biliary and pancreatic duct systems underfluoroscope, which involves injection
of radio
opaque fluid into the biliary systems through the catheter.
2 PURPOSES:
2.1 To determine intra-hepatic or extra-hepatic obstructive jaundice.
2.2 To visualize the biliary tree when the bilirubin level is greater than 3.5mg /dl.
2.3 Helpful to provide mapping of the duct systems before surgical operation.
2.4 Prominent in the therapy of known established pancreato-biliary disease.
2.5 Diagnostic approach to suspected biliary tract/pancreatic diseases with symptoms of
jaundice,
abdominal pain and laboratory tests.
2.6 Must be done before endoscopic papillotomy, biliary/pancreatic drainage or dilatation
of duct
stricture.
3 INDICATIONS:
3.1 Biliary stone, benign stricture, cyst and malignant tumors
3.2 Chronic pancreatitis
3.3 Obstructive jaundice
3.4 Pre and post cholecystectomy
4.1 Acute cardio-respiratory disease.
4.2 Stricture or obstruction of esophagus or doudenum.
4.3 Acute recent attack of pancreatitis (within 3 weeks) because of risk of inducing
another attack.
4.4 Acute cholangitis.
4.5 Severe upper gastro-intestinal bleeding.
4.6 Patients with esophageal diverticula, and with pancreatic pseudocyst.
4.7 Patient with glaucoma.
5.1 IVAC Thermometer with probe cover
5.3 Syringes
5.4 Needles
5.5 IV cannula
5.6 Alcohol swab
5.7 Tourniquet
5.9 Band aid
460
5.11Underpad
5.12Distilled water
Republic of
Yemen 48Modern
Hospital
48
POLICIES:
6
6.3 Obtain a written consent and explain procedure to the client.
6.4 Proper assessment of clients condition prior and after the procedure.
6.5 X-ray request should be send to radiology, endoscopy and anaesthesia
department.
PROCEDURES:
7
7.1.1 Check doctors order.
7.1.2 Send the request to Endoscopy, X-Ray Dept., and Anesthesia.
7.1.3 Explain the preparation to be done and carry out doctors order.
7.1.4 Instruct patient to keep fasting from 12:00 midnight.
7.1.5 Inform Anesthesiologist for premeds evaluation. Carry out order, if any.
7.2 Day of the Procedure:
7.2.1 Follow up for the results of laboratory investigations and x-rays to be sent with
patient.
7.2.2 Ensure that Consent for Diagnostic Procedure (Form M1141) is signed.
7.2.3 Insert cannula if not present, and administer prescribed antibiotic as ordered.
7.2.4 Check patients preparation against OR Checklist.
7.2.5 Take and record vital signs before sending for procedure.
7.2.6 Coordinate with Endoscopy nurse before sending the patient.
7.2.7 Send patient by stretcher or bed together with x-rays, lab results, file and PIN
card to XRay Department. Observe safety precautions.
7.2.8 Endorse patient and documents to Endoscopy Nurse.
7.2.9 Request Endoscopy Nurse to notify the ward by telephone once the procedure
is done.
7.3 Follow Up Phase:
7.3.1 Receive the patient and file from X-Ray Department with complete endorsement
from
Endoscopy Nurse.
7.3.2 Check patients condition upon receiving from X-Ray Department.
7.3.3 Check the file for doctors order and instructions.
7.3.4 Take patient back to the room and transfer back to the bed with side rails up.
7.3.5 Check and monitor vital signs. Notify the physician of any deviation.
7.3.6 Instruct patient or relative to maintain Nothing Per Orem (NPO) according to
doctors
order.
7.3.7 Observe for signs and symptoms of complication that may arise such as:
7.3.7.1 Bleeding
7.3.7.2 Fever
7.3.7.3 Mild to severe epigastric pain
7.3.7.4 Dysphagia, nausea, and vomiting
7.4 Notify the physician if any of the symptoms above arise.
7.5.1 Time came back to the ward.
7.5.2 Condition of the patient.
7.5.3 Pertinent observations.
461
7.5.5 Vital signs taken.
7.6 Charge the procedure done as endorsed by the Endoscopy Nurse in Form M5091.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Intravenous Pyelography (IVP)
CONTENTS: This General Ward policy and procedure deals with the guidelines during IVP
procedure.
1 DEFINITION:
1.1 Intravenous Pyelography - a non-invasive procedure that provides visualization of
renal
parenchyma and pelvis, and outline the ureters,bladder, and urethra by injecting
intravenous
radiopaque dye into the vascular system.
2 PURPOSES:
2.1 It is conducted as part of initial assessment of any suspected urologic problem,
especially lesion in
kidneys and ureters.
2.2 To provide a rough estimate of renal function.
2.3 To reveal the position, shape, and dimensions of the kidney, anatomic peculiarities of
the urinary
system and ureters.
2.4 To assess congenital absence or malposition of kidneys.
3.1 A client who is sensitive to iodine compounds.
3.2 History of allergy, serious kidney damages, cardiac arrythmias and liver diseases.
3.3 A severely dehydrated patient, unless appropriate measures have been taken.
4.1 Alcohol pads
4.2 IV 3000 - transparent dressing
4.3 IV cannula gauge 18 or 20
4.4 Blue pads
4.6 Medications (as ordered i.e.):
4.6.1 Disflatyl
4.6.2 Castor oil
4.7 Fleet enema
5 POLICIES:
PROCEDURES:
6
Proper
assessment
6.15.2
Check
doctors
order. and history-taking especially when patient is sensitive to iodine
compound
6.2
Identify correct patient.
prior to
procedure.
6.3 Explain
the
procedure to the patient.
an informed
Consent
for
Diagnostic
Procedure
(Form
M1141).
6.45.3
LetObtain
the doctor
fill up the
request
form.
Send request
through
computer.
6.5 Seek appointment from X-Ray Department and confirm the time.
6.6 Preparatory and post-procedure phase.
6.6.1 Preparatory Phase:
6.6.1.1 A day before the procedure, give 3 tablets of Disflatyl to be chewed every
3 hours
from 3:00 p.m. of the day preceding the examination.
6.6.1.2 Give 60cc Castor oil at 6:00 p.m.
462
Republic of
Yemen 48Modern
48
Hospital
6.6.1.3 Keep patient Nothing Per Orem (NPO) starting from 12:00 midnight.
6.6.1.4 Give fleet enema at 12:00 midnight and 6:00am.
6.6.1.5 Let patient void before the procedure.
6.6.1.6 Insert cannula choosing the big veins.
6.6.1.7 Check vital signs before sending to X-Ray Department.
6.6.1.8 Inform X-Ray Department before sending patient.
6.6.1.9 Transfer patient to stretcher or wheelchair (per patients condition). Put
safety straps.
6.6.1.10.1 condition of patient
6.6.1.10.2 mode of transfer
6.6.1.10.3 patients tolerance to the preparation
6.6.1.11Send the patient and endorse to X-Ray Department personnel.
6.6.1.12Charge the supplies used in the Inpatient Charging Form.
6.6.2 Post Procedure Phase:
6.6.2.1 Receive the patient from X-Ray Department and transfer back to the bed
in
comfortable position.
6.6.2.2 Assess patients condition when received.
6.6.2.3 Check vital signs and cannula site.
6.6.2.4 Instruct patient to take meal.
6.6.2.5 Inform the Pantry Staff to serve the food.
6.6.2.6 Observe and inform the physician for any reaction to the contrast medium
such as
rash, nausea, and hives.
6.6.2.7 Document the following:
6.6.2.7.1 time the patient came back to the ward
6.6.2.7.2 patients condition
6.6.2.7.3 mode of transfer
6.6.2.7.4 any untoward observation or manifestation
7.5 Elderly, debilitated or young patient may not tolerate the dehydration and
compromises may need
to be made.
463
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Kidney, Ureter, Bladder

CONTENTS: This General Ward policy and procedure deals with the guidelines in assisting
KUB
procedure.
1 DEFINITION:
1.1 KUB - is a radiological visualization of the kidney, ureter and bladder.
2 PURPOSES:
2.1 To delineate the size, shape and position of the kidneys.
2.2 To reveal any abnormalities, such as calculi (stones) in the kidneys or urinary tract,
hydronephrosis, cysts, tumors, or kidney displacement by abnormalities in the
surrounding tissues.
2.3 Preliminary to IV urography, voiding cystourethrogram and video urodynamic test
3 POLICIES:
3.2 Ensure that patient understands the procedure and its purpose.
4 PROCEDURES:
4.2 Explain the procedure to the patient and its purpose.
4.3 Fill-up the X-Ray Request Form and give to ward secretary for charging.
4.4 Send request to X-ray Department through computer online.
4.5 Arrange for appointment in the X-ray Department.
4.6 Send patient to X-ray Department by wheelchair or stretcher according to his/her
condition. Put on
safety strap.
4.7 Endorse patient to the X-ray Technician and inform to notify the ward once procedure
is finished.
5 SPECIAL CONSIDERATION:
5.1 There is no special preparation for this procedure.
464
Republic of
Yemen 48Modern
Policy No.
48
Hospital
48 MODERN HOSPITAL
Title: Lithotripsy Procedure (ESWL)
IPP-NR-118
465
Republic of
Yemen 48Modern
Hospital
48

lithotripsy
procedure (ESWL).
1 DEFINITION:
1.1 Lithotripsy Procedure (ESWL) - a non-invasive procedure use to fragment the renal
stones
primarily located in the kidney, ureter, and bladder by repeated shock waves.
2 PURPOSES:
2.1 To disintegrate the stones (KUB) into minute particles to pass in the urine.
3.2 Syringes size 5ml, 10ml, 20ml
3.3 Needle g. 18
3.4 Blue sheet
3.5 Kidney Basin
3.7 IV cannula/IV set
3.8 Alcohol swab
3.9 Band-aid
3.10NSS 500ml
3.11Medication as ordered (i.e. Pethidine)
4 POLICIES:
4.2 Appointment must be obtained one day prior to procedure.
4.3 KUB and IVF film should be ready before the procedure.
4.4 Ensure that instruction given to patient prior to procedure is well understood.
PROCEDURES:
5
5.1 A day prior to procedure:
5.1.3 Get appointment for the procedure.
5.1.4 Instruct patient to keep fasting after 12 midnight.
5.1.5 Keep KUB and IVP film ready before the procedure (if ordered).
5.2 On the day of procedure:
5.2.1 Maintain patient on NPO.
5.2.2 Confirm appointment for the procedure.
5.2.3 Wash hands. Prepare all supplies needed.
5.2.4 Insert IV cannula.SS
5.2.5 Prepare the patient, send to medical tower per wheelchair/stretcher together
with complete
file, x-ray films, x-ray request Form M3015 and MSF Form M1013. Put on safety
straps.
5.3.1 Transport back the patient to ward.
5.3.2 Transfer back the patient to bed and place in comfortable position.
466
5.3.3 Assess patients condition.
Republic of
Yemen 48Modern
48
Hospital
Check vital signs.

5.3.4
Check the file for any doctors order.
5.3.5
Inform the pantry staff to serve the prescribed diet.
5.3.6
If sedative was administered, let the patient sleep.
5.3.7
If patient has Foley catheter, observed for presence of blood in the urine.
5.3.8
Watch
for any
stones that are passing spontaneously in the urine bag before emptying it and
notify the
doctor for any pertinent observations.
5.3.9.1 Date and time patient came back to ward
5.3.9.2 Mode of transport
5.3.9.3 Any observations made
5.3.9.4 Tolerance to the procedure
5.3.10 Health teachings should be given as follows:
5.3.10.1Explain to the patient that bloody urine output is normal after ESWL.
5.3.10.2He/She may experience pain after procedure.
5.3.10.3To increase intake of oral fluids.
SPECIAL
CONSIDERATIONS:
6
5.3.11
Charge the procedure and supplies used.
6.1 If the lithotriptor uses high total shock wave energy, a general, spinal, or epidural
anesthetic is
administered to the patient. If the lithotriptor uses low total shock wave energy, the
treatment can
be administered without anesthesia; however, more shocks must be used with this
equipment
before stones are fragmented.
6.2 Because the procedure requires no incision and no hospitalization, patients maybe
admitted
overnight or maybe treated as outpatients. (Most of them return to their usual
routines within 48
hours of treatment).
6.3 Side effects of lithotripsy includes cutaneous petechiae (14%) and gross hematuria
(3%) probably
caused by microscopic injury to the right kidney from passage of shock waves through
it.
467
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Liver Biopsy
during liver
biopsy procedure.
1 DEFINITION:
1.1 Liver Biopsy the sampling of liver tissue by needle aspiration for the purpose of
histologic
study. The procedure can be performed by either transthoracic (intercostals) or
transabdominal
(subcostal) methods.
2 PURPOSES:
2.1 To determine anatomic changes in liver tissue.
2.2 To facilitate the diagnosis of most hepatic disorders.
3.1 IVAC machine with probe cover
3.2 BP apparatus with stethoscope
4 POLICIES:
4.1 Written consent should be obtained.
5 PROCEDURES:
5.1
doctors
4.3Verify
Identify
correctorder.
client.
5.2
Identify
the
patient.
4.4 Ensure thatcorrect
all results
of laboratory investigations that has been ordered are
5.3 Explain
procedure to the patient.
complete
andthe
reported.
5.4
for signed
consent.
4.5Check
Thorough
assessment
of patients condition.
5.5 Send X-ray request Form M3019 to X-ray department through computer online after
charging.
5.6 If the procedure is to be done under anesthesia, send OR request through computer
online or
manual request (if urgent) properly filled-up by the treating doctor and send to
anesthesiologist.
Keep patient on NPO at least 6-8 hours.
5.7 Follow-up for the results of laboratory investigation that has been ordered if available.
5.8 Communicate with X-ray department about the schedule time of the procedure.
5.9 Take and record vital signs before sending patient to X-ray/OR department.
5.10Counter check for the signed consent. Provide emotional support.
5.11Send patient to X-ray/OR department per stretcher/bed together with the complete
file and PIN
card. Observe safety precautions.
5.12Endorsed to X-ray/OR department staff.
5.13Post procedure phase:
5.13.1 Received patient from X-ray/OR department with complete endorsement from Xray/RR
staff.
5.13.2 Assess patients condition.
5.13.3 Check the file for doctors order and specific instructions.
5.13.4 Transfer back the patient to ward, put on safety straps/side rails-up.
5.13.5 Transfer the patient in bed, turn him/her
468 onto his right side, place a pillow under
his costal
margin, and instruct to remain in this position, recumbent and immobile for
several hours.
Republic of
Yemen 48Modern
48
Hospital
5.13.6 Monitor vital signs every 10-20 minutes intervals or as ordered by the
physician until
stability verified. Notify the doctor for any deviation.
5.13.7 Checked frequently the biopsy site for signs of bleeding.
5.13.8 Maintain pressure dressing on biopsy site.
5.13.9.1Date and time the procedure is finished
5.13.9.2Condition of patient
5.13.9.3Pertinent observations
5.13.9.4Tolerance to the procedure
5.13.9.5Vital signs before and after the procedure.
6.1 Be alert and report promptly any increase in pulse rate, decrease in BP, any complain
of pain, or
manifestation of apprehensions. These signs may indicate the presence of and the
progress of
hepatic bleeding, severe hemorrhage, or bile peritonitis, the most frequent
complications of liver
biopsy.
469
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Lumbar Puncture
CONTENTS: This General Ward policy and procedure deals with the guidelines in assisting in
lumbar
puncture procedure.
1 DEFINITION:
1.1 Lumbar puncture - a medical procedure carried out by inserting a needle into the
subarachnoid space through the 3rd and 4th or 4th and 5th lumbar interspace to withdraw
cerebrospinal fluid (CSF).
2 PURPOSES:
2.1 To obtain cerebrospinal fluid (CSF).
2.2 To diagnose brain or spinal cord neoplasm, meningitis, encephalitis, hemorrhage, and
degenerative
brain disease.
2.3 To measure and reduce CSF pressure.
2.4 To determine the presence or absence of blood in the CSF.
2.5 To detect spinal sub-arachnoid block.
2.6 For therapeutic purposes.
2.7 To introduce contrast media for radiological examination.
3.2 Increased intracranial pressure.
3.3 Severe degenerative spinal joint disease.
3.4 Psychosomatic illness because such patient may occasionally associate a lumbar
puncture with
potential paraplegia.
3.5 Local skin infection on the puncture site.
3.6 Suspected cord compression.
4.1 Physical Preparation (Optional)
4.1.1 Razor
4.1.3 Blue pad
4.2 Thermometer
Sphygmomanometer
54.3
POLICIES:
4.4
5.1Stethoscope
Obtain doctors order.
4.5
as ordered
5.2Medications
Secure consent
for the procedure.
5.3 Ensure patient is psychologically, emotionally, and physically prepared.
5.4 Thorough assessment of the following:
5.4.1 ability of patient to maintain fetal position
5.4.2 ability to understand and follow instructions necessary to assume the
required position
5.4.3 allergy to any local anesthetic agent
5.4.4 vital signs
470
Republic of
Yemen 48Modern
Hospital
48
neurologic reactions of legs specifically movement, sensation, and muscle

5.4.5
strength as
baseline
5.6 Follow safety measures while transfer.
6 PROCEDURES:
6.1 Pre-Procedure Phase:
6.1.2 Make sure a consent is signed prior to the procedure. Form M1141
6.1.3 Send OR Request through computer or manual request, if urgent.
6.1.4 Explain the procedure to the patient to ease anxiety and ensure cooperation.
6.1.5 Shave the lumbar area to remove hair, if present.
6.1.6 Keep patient on NPO at least 6 hours prior to the procedure.
6.1.7 Assess patients condition, check vital signs and record. Let patient to void
before sending
to ER-OR or RR for the procedure.
6.1.8 Complete Pre-Operative Checklist (Form M1003).
6.1.9 Transport/send the patient to ER-OR or RR per bed with siderails up.
6.1.10 Endorse patient to ER-OR/RR staff.
6.1.11.1patients condition
6.1.11.2mode of transport
6.1.11.3date and time
6.2.1 Receive the patient from ER-OR or Recovery Room.
6.2.2 Take complete endorsement.
6.2.3 Check for doctors order.
6.2.4 Assess patients general condition.
6.2.5 Transport the patient back to the room.
6.2.6 Check vital signs.
6.2.7 Position the patient as ordered by the physician.
6.2.7.1 Lie flat on bed for 6-8 hours to avoid headache and decrease possibility of
brainstem
herniation due to reduction of CSF pressure.
6.2.8 Give analgesic medication, as ordered.
6.2.9 Encourage increased fluid intake of 2-3 liters in 24 hours to replace lost fluid and
assist
patient to micturate.
6.2.10 Monitor patient for:
6.2.10.1leakage from the puncture site
6.2.10.2headache or backache
6.2.10.3neurological observation/vital signs
6.2.11 Inform the doctor if any complication arises.
6.2.12.1date and time procedure was done
6.2.12.2color and character of spinal fluid (if sample is sent to the ward)
6.2.12.3time of sending specimen to Laboratory
6.2.12.4condition and reaction of patient
6.2.12.5puncture site
6.2.12.6tolerance to procedure
7.1 Procedure and supplies used during lumbar puncture are charged in the area/unit
where it is done.
471
7.2 If specimen is for testing in Laboratory, request is sent and charged through computer
online from
the ward (where patient is admitted).
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Myelogram
during
myelogram procedure.
1 DEFINITION:
1.1 Myelogram - a radiography of spinal cord, nerve roots and spinal canal after injecting
a
radiopaque substance into the spinal subarachnoid space through a spinal puncture.
2 PURPOSES:
2.1 For diagnostic evaluation of neurologic disease.
2.2 To detect any distortion of spinal cord.
2.3 To detect tumor or cyst in the dorsal sac, herniated intervertebral discs, or other
lesion.
3.1 BP apparatus
3.2 IVAC thermometer
4 POLICIES:
4.2 Obtain written consent from the patient.
4.3 Have appointment from X-Ray Department prior to procedure.
PROCEDURES:
5
4.4 Follow safety measures during transfer.
5.1.1 Let the doctor fill up X-Ray Request Form M3015.
5.1.2 Give the X-Ray Request (Form M3015) to the Ward Secretary to charge the
procedure
and send request through computer online to X-Ray Department.
5.1.3 Let patient (or relative) sign the consent, witnessed by the Treating Doctor.
5.1.5 Keep patient on Nothing Per Orem (NPO) 6 hours prior to procedure.
5.1.6 Check vital signs of patient before sending to X-Ray Department.
5.1.7 Confirm appointment from X-Ray Department.
5.1.8 Transfer patient to stretcher. Put on safety straps and side rails.
5.1.9 Send patient to X-Ray Department along with the file.
5.1.10 Endorse to X-Ray personnel responsible for the procedure.
5.1.11 Remind X-Ray personnel to call the ward once procedure is finished.
5.2 Post-Procedure Phase:
5.2.1 Receive the patient and file with complete endorsement from the X-Ray Staff.
5.2.2 Check post myelogram order.
5.2.3 Transport patient to the ward.
5.2.4 Transfer to bed and position the patient by elevating the head of the bed at 3045 o for 4-6
hours or as recommended by the doctor.
5.2.5 Monitor vital signs.
5.2.6 Encourage the patient to have fluid intake for rehydration and replacement of
cerebrospinal fluid and to decrease the incidence of post lumbar headache.
5.2.7 Watch for any untoward signs of headache, fever, stiff neck, and inform the
472
doctor
immediately.
Republic of
Yemen 48Modern
48
Hospital

5.2.8.1 Date and time of transfer to X-ray
department.
5.2.8.2 Time returned back to the ward.
5.2.8.3 Tolerance to the procedure.
5.2.8.4 Observations made after the procedure.
5.2.8.5 Vital signs prior and after the procedure.
473
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Pulmonary Function Test
pulmonary function test.
1 DEFINITION:
1.1 Pulmonary Function Tests used to obtain in formations on lung mechanics and lung
volumes.
1.1.1 Lung Mechanics uses a spirometer to measure flow of an in and out of the
lungs and
thus evaluate respiratory muscle strength, compliance of the lungs and chest
wall, and
resistance to airflow.
1.1.1.1 Forced Vital Capacity (FVC) the greatest volume of air that can be exhaled
when
the person breathes out forcefully.
1.1.1.2 Forced Expiratory Volume (FEVt) greatest amount of air a person can expel
in a
given time interval (t) FEV1 the amount of air that a person can forcefully
exhale
in (1) second.
1.1.1.3 Forced Expiratory Flow (FEF) rate at which a person can forcibly expel air
form
the lungs.
1.1.1.4 Peak Expiratory Flow Rate (PEFR) maximum flow rate when patient
perform a
FVC maneuver.
1.1.1.5 Maximal Voluntary Ventilation (MVV) greatest volume of air a patient can
voluntarily breathe in 15 seconds.
1.1.1.6 Maximal Inspiratory Pressure (MIP) peak amount of inspiratory pressure a
patient
can generate.
1.1.1.7 Maximal Expiratory Pressure (MEP) peak amount of expiratory pressure a
patient
can generate.
1.1.2 Lung Volumes and Capacities
1.1.2.1 Tidal Volume (VT) amount air inhaled or exhaled during normal respiratory
effort
(normally 400-700ml/breath).
1.1.2.2 Total Lung Capacity (TLC) amount of air contained in the lungs after
maximal
inhalation.
1.1.2.3 Vital Capacity (VC) maximum amount of air a person can expire after
maximal
inspiration.
PURPOSES:
2
1.1.2.4
Residual Volume (RV) amount of air remaining in the lungs after maximal
2.1exhalation.
To measure the ability of the chest and lungs to move air into and out of
the
alveoli.
1.1.2.5 Inspiratory Capacity (IC) amount of air a person can inhale after normal
2.2exhalation.
To measure the factors on which ventilatory function depends such as:
2.2.1
Lung compliance
or elasticity
1.1.2.6 Expiratory
Reserve Volume
(ERV) - amount of a person can forcibly exhale
2.2.2
Chest
wall
stability
from
the end-expiratory phase.
474
1.1.2.7 Funtional Residual Capacity (FRC) amount of air remaining in the lungs
after
normal exhalation.
Republic of
Yemen 48Modern
Hospital
48
2.2.3 Adequacy of diaphragmatic and intercostals muscle strength.

2.3 To determine the patients readiness to be weaned from a mechanical ventilator.
2.4 To determine the need for intubation or evaluate the patients response to
bronchodilator therapy.
2.5 Preoperatively useful for patients scheduled for thoracic and abdominal surgery,
patients with
history of smoking and cough, obese patients, older patients and patients with
pulmonary
disease.
3.1 Pulmonary
function test machine
3.2 Weighing scale
POLICIES:
4.2 Height and weight should be taken prior to procedure.
3
4.3 Proper breathing technique should be instructed to patient to ensure accurate
results.
PROCEDURES:
4
5.1 Checked for doctors order.
5.3 Explain the procedure to the patient. Instruct him/her the correct way of breathing
technique.
5
5.4 Take height and weight of the patient.
5.5 Send MSF request (Form M1013) to OPD indicating patients name, PIN, height and
weight, age,
gender, and diagnosis of the patient.
5.6 Verify to OPD staff the scheduled time given for the procedure.
5.7 Send patient per wheelchair together with the file and pin card, put on safety
straps.
5.8 Endorsed to OPD nurse and instruct her to call the ward once the procedure is
finished.
5.9 Received patient with complete endorsement. Assess patient condition.
5.10Transport back the patient to ward.
5.11Transfer patient to bed, assist in comfortable position.
5.12Check vital signs.
5.13.1 Time and date the procedure is finished.
5.13.2 Mode of transport.
6
6.1 A reduction in the vital capacity alone may indicate a restrictive form of lung
disease (disease
due to increased lung stiffness).
6.2 A reduction in several parameters usually indicates an obstructive form of lung
disease
(obstruction to flow due to bronchial obstruction or loss of lung elastic recoil).
6.3 Instruct patient not to use oral or inhaled bronchodilator, caffeine, or tobacco 4
hours before the
test.
6.4 The patient with respiratory symptoms (dyspnea, wheezing, cough, sputum
production) usually
475
undergoes a complete diagnostic evaluation, eventhough the result of pulmonary
function test are
normal.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Renal Biopsy
during renal
biopsy procedure.
1 DEFINITION:
1.1 Renal Biopsy Needle biopsy of the kidney is performed by percutaneous needle
biopsy through
renal tissue. The procedure can be performed by either percutaneous (closed) or
surgical (open)
methods.
2 PURPOSES:
2.1 To determine the nature, extent and diagnosis of renal disease.
2.2 To obtain specimens for electron and immunoflourescent microscopy particularly for
glomerular
disease.
3.1 IVAC machine with plastic cover
3.2 Stethoscope and sphygmomanometer
3.3 Sand bag
4 POLICIES:
4.2 Written consent should be signed.
PROCEDURES:
4.3 Thorough assessment of patients condition after the procedure should be strictly
5
5.1
Verify doctors order.
observed.
5.2 4.4
Explain
thefor
procedure
to the patient.
Ensure
the completeness
of all investigations that has been ordered and if
5.3
Let
the
patient
sign
the
consent form as witness by the doctor.
reported.
5.4 4.5
Send
X-raythat
request
Form M3019
toinformed
X-ray department
through
computer
online.
Ensure
the patient
is well
of the purpose
of the
procedure.
5.5 If the procedure is to be done under anesthesia send OR request through computer
online or
manual request (if urgent) properly filled-up by treating doctor.
5.6 Keep patient on nothing per orem (NPO) at least 6-8 hours.
5.7 Day of the procedure:
5.7.1 Follow-up for the laboratory results that has been ordered, if complete and
available such
as prothrombin time, platelet count, type and crossmatch blood for possible
blood
transfusion.
5.7.2 Maintain patient on NPO. Countercheck for signed consent.
5.7.3 Confirm with X-ray/OR department about the schedule of the procedure (if
under
sedation).
5.7.4 Take and record vital signs before sending the patient to X-ray/OR department.
5.7.5 Provide emotional support.
5.7.6 Send patient to X-ray/OR department per stretcher/bed together with the file
and PIN
card. Put on safety straps/side rails-up. 476
5.7.7 Endorse to X-ray/OR department staff.
5.8.1 Receive patient from X-ray/RR staff with complete endorsement.
Republic of
Yemen 48Modern
48
Hospital
Assess patient condition.

5.8.2
Check the file for doctors order or any instructions.
5.8.3
Transfer back the patient to ward, observe fall precautions.
5.8.4
Transfer the patient to bed, place in prone position immediately and put
5.8.5
sandbag under
abdomen.
5.8.6 Monitor vital signs every 5-15 minutes for the first 1-hour until stability
verified. Notify
physician for any deviation.
5.8.7 Monitor frequently the biopsy site for bleeding. Maintain bed rest for 24 hours
to
minimize risk of bleeding.
5.8.7.1 Rise or fall in blood pressure
5.8.7.2 Anorexia
5.8.7.3 Vomiting
5.8.7.4 Development of a dull, aching discomfort in the abdomen.
5.8.8 Maintain pressure dressing on biopsy site. Any symptoms of backache,
shoulder pain, or
dysuria are to be reported to physician.
5.9.1 Date and time the procedure is finished
5.9.2 Condition of patient
5.9.3 Pertinent observations
5.9.4 Tolerance to the procedure
5.9.5 Vital signs before and after the procedure
SPECIAL
CONSIDERATIONS:
6
5.10Charge
the supplies used.
6.1 All urine voided by the patient is scrutinized for evidence of bleeding and compared
with the
prebiopsy specimen and subsequent voiding samples.
6.2 If bleeding occurs, the patient is prepared for blood transfusion and surgical
intervention for
control of hemorrhage, which may necessitate surgical drainage or rarely
nephrectomy (removal
of kidney).
6.3 If bleeding persists, as indicated by an enlarging hematoma, palpating or
manipulating of the
abdomen is avoided.
6.4 Delayed hemorrhage can occur several days after biopsy. The patient is instructed to
avoid
strenuous activity and sports and heavy lifting for at least 2 weeks.
6.5 Observe for hematuria which may appear soon after biopsy. The kidney is highly
vascular organ
and approximately one fourth of the entire cardiac output circulates through it. The
passage of
biopsy needle punctures the kidney capsule, and bleeding can occur in the perirenal
space.
477
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Sigmoidoscopy
during
sigmoidoscopy procedure.
1 DEFINITION:
1.1 Sigmoidoscopy - the visualization of the anal canal , rectum, sigmoid colon through a
sigmoidoscope.
2 PURPOSES:
2.1 To diagnose malignancy, polyps, inflammation or strictures.
2.2 To aid in the detection of hemorrhoids, polyps, fissures, fistulas and abscesses within
the rectum
and anal canal.
3.1 Uncooperative client.
3.2 Severe rectal bleeding.
3.3 Painful advanced stage of anorectal conditions, such as fissures, fistula, or
hemorrhoids.
4 EQUIPMENTS:
4.1 Flexible sigmoidoscope
4.2 KY Jelly
4.3 Gloves
4.4 Biopsy Forceps
4.5 IV insertion set
4.6 Oxygen cylinder with accessories
4.7 Plastic Apron
4.8 Face mask
5 POLICIES:
5.1 Obtain informed consent for the procedure ( Form M1141 )
5.2 Proper instruction and health teachings should be given to the patient to the
procedure.
PROCEDURES:
6
5.3
Infection
control
policies
and
practices
should
be
employed
at
all
times.
5.4
No procedure
be done without proof of payment.
6.2
Identify
correct to
client.
6.3 Let patient to sign an informed Consent for Diagnostic Procedure (Form M1141)
witnessed by the
treating physician.
6.4 Preparatory and Post Procedure Phase to be done:
6.4.1 Preparatory Phase :
6.4.1.1 Keep supplies and equipment ready at bedside.
6.4.1.2 Explain to client the purpose of bowel preparation.
6.4.1.3 Keep client on Nothing Per Orem (NPO) starting at 12:00 midnight before
the
procedure.
6.4.1.4 Administer fleet enema at 12:00 midnight and at 6:00 a.m. prior to
procedure.
6.4.1.5 Send the request form to Endoscopy
478Unit a day prior to the procedure.
6.4.1.6 Assess clients condition. Take vital signs.
6.4.1.7 Confirm time of appointment in Endoscopy Unit.
Republic of
Yemen 48Modern
48
Hospital
6.4.1.8 Transfer client with the file to Endoscopy Unit per stretcher with
safety strap.
6.4.1.9 Document the following:
6.4.1.9.1 Condition of client.
6.4.1.9.2 Mode of transfer.
6.4.1.9.3 Date and time of procedure.
6.4.1.9.4 Tolerance to bowel preparation.
6.4.1.9.5 Vital signs taken.
6.4.2 Post Procedure Phase :
6.4.2.1 Receive client and file endorsed completely by Endoscopy Nurse.
6.4.2.2 Assess clients condition when received after the procedure.
6.4.2.3 Transfer client to bed and place in comfortable position. Put side
rails up.
6.4.2.4 Check vital signs and record.
6.4.2.5 Observe client and notify the physician if any of these are observed:
6.4.2.5.1 Fever.
6.4.2.5.2 Bleeding.
6.4.2.5.3 Abnormal distention.
6.4.2.5.4 Any unusual complain of pain.
6.5 Record:
6.5.1 Clients preparation.
6.5.2 Specific procedure performed.
6.6 Resume diet per physicians order.
6.7 Charge the procedure and supplies used.
REFERENCES:
7
7.1 Rex DK Colonoscopy . Gastrointest Endosc Clin North AM 2000;10:
135-60
7.2 Sivak MV Jr, ed. Gastrointerologic endoscopy, 2nd ed. Philadelphia:
WB Saunders, 1995
7.3 Waye JD, Rex DK., Williams CB. Colonoscopy . Oxford: Blackwell
Publishing 2003
7.4. Nelson DB. Technical assessment of direct colonoscopy screening:
Procedural success, safety, and feasibility . Gastrointest
Endosc Clin
North Am 2002;12:77-84
7.5 Rex DK, Bond JH, Feld AD. Medical-legal risks of incident cancers
After clearing colonoscopy AM J Gastroenterol 1997;112:24-28
7.6 Rex DK. Rationale for colonoscopy screening and estimated
effectiveness
In clinical practice. Gastrointest Endosc Clin North AM 2002;12:65-75
7.7 Waye JD, Bashkoff E. Total colonoscopy: is it always possible.
Gastointest Endosc 1991; 37:152-4
7.8 Waye JD, Kahn O, Averbach ME. Complications of Colonoscopy
And flexible sigmoidoscopy. Gastrointest Endosc Clin North AM
1996; 343-77.
479
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Thoracentesis
during
thoracentesis procedure.
1 DEFINITION:
1.1 Thoracentesis - the aspiration of fluid or air from the pleural space.
2 PURPOSES:
2.1 To remove fluid or air from the pleural cavity for diagnostic or therapeutic purposes.
2.2 To obtain diagnostic aspiration on pleural fluid.
2.3 To obtain pleural biopsy.
2.4 To instill medication into the pleural space.
3 CONTRAINDICATION:
3.1 Contraindicated in patients with bleeding disorder.
4.1 Syringes 50cc, 20cc, 5cc
4.2 Needles gauge 18, 23, 22
4.3 Cannula gauge 16, 18
4.5 Local anesthetic
4.6 Sterile towel, drape, and gown
4.7 Sterile specimen container
4.8 IV tubing and 3-way stopcock
4.9 Large container for fluid
4.10Medication, if ordered
4.11Face mask, adhesive tape, transparent dressing, disposable gloves
4.12Equipment for taking vital signs
4.13Oxygen cylinder with O2 devices
4.14Pulse oximeter
5 POLICIES:
5.1 Procedure should be done under strict aseptic technique.
5.2 Patient should be well prepared physically, psychologically, physiologically, and
legally.
5.3 Follow standard infection control precautions.
5.4 Consent is obtained prior to procedure.
PROCEDURES:
6
6.1 Explain the procedure and obtain baseline assessment and history with close
attention to
respiratory status and vital signs.
6.2 Assemble equipment.
6.3 Ascertain the availability of X-ray films and laboratory result before the procedure.
6.4 Make the patient comfortable with adequate supports.
6.5 Position the patient:
6.5.1 Sitting on the edge of the bed, feet supported and head on a pillow over the
bedside table.
6.5.2 Straddling a chair with his/her arms and
head resting in the back of the chair.
480
Republic of
Yemen 48Modern
48
Hospital
6.5.3 If patient is unable to sit in a chair or side of bed, elevate head of the bed 3045o or place
on the affected side and elevate head of bed.
6.6 Support and reassure the patient during the procedure and encourage to refrain
from any
movement and coughing.
6.7 Wash hands and put on gloves.
6.8 Prepare the skin over the area where needle will be inserted.
6.9 Provide the physician with the available anesthetic, as needed.
6.10Provide all necessary equipment/supplies needed for aspiration, assist in the
procedure and
anticipate the doctors needs.
6.11If a considerable quantity of fluids is to be removed, the needle is held in place with
an adhesive
tape.
6.12After the needle is withdrawn, pressure is applied over the puncture site and a
small sterile
dressing is fixed in place.
6.13Place patient on bed rest in a comfortable position.
6.14Chest X-ray to be done as ordered.
6.15Administer oxygen prn.
6.18Send labeled specimen to the laboratory with charged request form.
6.19Monitor and record vital signs every 15 minutes for 1 hour. Check for asymmetry in
respiratory
movement, faintness, vertigo, tightness in chest, uncontrolled cough, blood tinge
frothy mucus,
and signs of hypoxemia. If noted, inform the doctor immediately.
6.20Document on the Nurses Notes:
6.20.2 Name of physician
6.20.3 Amount and character of fluid obtained
6.21Charge the procedure and supplies used in the Inpatient Charging Form.
481
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Upper GI Endoscopy

during upper
GI endoscopy procedure.
1 DEFINITION:
1.1 Upper GI Endoscopy a procedure in which a flexible tube (endoscope) is gently
passed into the
esophagus to visualize gastrointestinal tract down to the duodenum and to perform
certain
diagnostic and therapeutic procedures.
2 PURPOSES:
2.1 To diagnose bleeding site.
2.2 To determine locations whether a tumor can be resected surgically.
2.3 To collect specimen for histopathology of helicobacter pylori.
3 INDICATIONS:
3.1 Diagnostic
3.1.1 Dyspepsia or abdominal pain
3.1.2 Hematemesis
3.1.3 Weight Loss
3.1.4 Iron deficiency anemia
3.1.5 Gastric Ulcer
3.1.6 Persistent vomiting
3.1.7 Heartburn
3.2 Therapeutic
3.2.1 Sclerotherapy of bleeding oesophageal varices
3.2.2 Sclerotherapy for gastric varices
3.2.3 Positioning of percutaneous gastrostomy feeding tube
3.2.4 Dilatation of oesophageal or pyloric strictures
3.2.5 Endoscopic mucosal resection
3.2.6 Endoscopic polypectomy
3.2.7 APC of bleeding lesions
4 EQUIPMENTS:
4.1 Endoscope
4.2 Mouthpiece
4.3 KY Jelly
4.4 Gloves
4.5 Biopsy Forceps
4.6 IV insertion set
4.7 Oxygen cylinder with accessories
4.8 Plastic Apron
4.9 Face Mask
5 POLICIES:
5.1 Obtain informed consent for the procedure (Form M1141).
5.2 Proper instruction and health teachings should be given to the patient prior to the
482
procedure.
5.3 Infection control policies and practices should be employed at all times.
5.4 No procedure to be done without proof of payment.
Republic of
Yemen 48Modern
Hospital
48
PROCEDURES:
6
6.1.1 Verify the doctors order.
6.1.2 Obtain consent from the patient/ patients relative as witnessed by the doctor
who will
perform the procedure.
6.1.3 Make an assessment of the patient including allergies and medications taken by
that
patient.
6.1.4 Give health teachings regarding the procedure, instructs the patient not to take
any foods
or drinks at least 8 hours before the procedure (usually fasting over night).
Evaluate if
she/he fully understands the instruction given.
6.1.5 Give appointment.
6.2 On the Day of the Procedure:
6.2.1 Check the proof of payment.
6.2.2 Countercheck if the consent is signed.
6.2.3 Ask the patient if she/he is fasting.
6.2.4 Ensure that the dentures are removed.
6.2.5 Evaluate the patient if she/ he fully understands the procedure to be done.
6.2.6 Assist the patient and keep him comfortable in the procedure room. Provide
privacy.
6.2.7 Do hand washing . Wear disposable gloves.
6.2.8 Check instruments, accessories & equipments if functioning properly to prevent
the
delay of the procedure.
6.2.9 Establish intravenous ( IV) access.
6.2.10 Instruct the patient to swallow topical anesthetic or spray the throat to
decrease gag
reflex, as ordered.
6.2.11 Put the mouth guard with strap.
6.2.12 Assist the doctor during the procedure. Anticipate his needs.
6.2.13 Prepare biopsy forceps for possible biopsy taking
6.2.14 For helicobacter in CLO-test
6.2.15 Histopathology in Formalin
6.2.16 Monitor the patient and write in the documentation sheet.
6.2.17 Administer antibiotic prophylaxis ( if indicated )
6.3 Post Procedure:
6.3.1 Remove the mouth guard and clean the patient.
6.3.2 Monitor patients vital signs
6.3.3 Suction the secretions and provide airway
6.3.4 Continue to monitor and documents patients vital signs, including the return of
gag
reflex.
6.3.5 Observe for any abdominal distension, neck pain, signs of suggestive
perforation, gastro
intestinal bleeding, dysphagia, vomiting and notify the doctor at once.
6.3.6 Maintain NPO status until gag reflex returns.
6.3.7 Check for gag reflex by applying pressure on tongue depressor placed on the
back of the
tongue.
6.3.8 Make the necessary documentation including proper biopsy labeling.
6.3.9 After care of instrument and equipments.
483
6.3.10 Discharge the patient when fully recovered. Give the following instructions.
6.3.10.1 Date and time of next visit to revise result.
6.3.10.2Special instructions from the doctor , if any.
Republic of
Yemen 48Modern
48
Hospital
REFERENCES:
7
7.1 Blades EW, Chak A, eds. Upper Gastrointestional Endoscopy. In:
Gastrointestinal
Endoscopies Clinics of North America, Vol, 4(3) ( series ed. Sivak MV).
Philadelphia: WB Saunders, 1994
Sivak MV. Gastroenterologic Endoscopy. Philadelphia: WB Saunders,
1987
484
Republic of
Yemen 48Modern
MACHINES
Hospital
48
485
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Anderlift Plus
CONTENTS: This General Ward policy and procedure deals with the guidelines in operating
Anderlift
plus.
1 DEFINITION:
1.1 Anderlift Plus a complete bedside devise that lifts, transports, bathes, and weighs
acutely
ill/debilitated patient.
2 PURPOSES:
2.1 To make moving/lifting convenient for patients.
2.2 To monitor body weight for an elderly patient.
2.3 For bathing purpose.
3.1 For patients weighing more than 200 kg.
3.2 For violent patients.
4.1 Lifter strap
4.2 Safety strap
4.3 Transport sheet
4.4 IV pole (optional)
4.5 Bathing unit:
4.5.1 Bathinette
4.5.2 Shower handle
4.5.3 Bathing sheet
4.5.4 Drain hose, dirater hose
4.5.5 Mesh storage bag
4.5.6 Gallon waste container (optional)
5 POLICIES:
5.1 Ensure safety of patient while using the device.
5.3 Ensure that the device is in good working condition before using it.
5.4 The staff should be knowledgeable about the proper way of operating the machine.
5.5 It should be plugged always to power supply when not in use.
PROCEDURES:
6
6.1 Lifting/Weighing:
6.1.1 Place the lift sheet with the smooth side against patient - webbing side down.
6.1.2 Place the machine parallel to the patients bed.
6.1.3 Collapsed leg (option) must be folded out to LOCKED position prior to lifting
the
patient.
6.1.4 Activate the lifter by pulling RED STOP button.
6.1.5 Raise the lifter to clear the patient by pressing the hand control in the UP
position.
6.1.6 Lift top frame over and around the patient.
6.1.7 Lower the frame 1+ 3 of bed by pressing the DOWN button on the hand
control.
486
6.1.8 Make sure the lifter frame clears the patient when lowering over the patient.
6.1.9 Attach the hooks from the buckles to loops on the bottom of the lift sheet.
Republic of
Yemen 48Modern
48
Hospital
6.1.10 Press the buckles to give slack in the straps, then pull tight.
6.1.11 Make sure the lifter is unrestricted, raise patient, and weigh or proceed
transporting.
6.2 Bathing:
6.2.1 Place mesh-bathing sheet under the patient.
6.2.2 Place the lifter parallel to patients bedside with the bathinette folded inward
towards the
power box.
6.2.3 Move lifter next to the patient and unfold the top frame over and around
patient.
6.2.4 Raise lift and lower over patient by pressing the UP and DOWN button on the
hand
control.
6.2.5 Make sure that the frame clears the patient when lowering.
6.2.6 Attach hooks from buckles to grommets in bathing sheet with hooks pointing
down.
Press buckles for slack and pull tight.
6.2.7 Make sure lift is unrestricted, raise the patient.
6.2.8 Unfold bathinette under the patient and attach to perimeter of lifting frame.
Drain should
be at the foot end of the bed.
6.2.9 Connect the drain either to the waste container or to a floor drain such as
shower drain.
6.2.10 Attach diverter valve to the faucet and adjust the water temperature. Divert
water to
shower wand.
6.2.11 Wash hands, wear gloves.
6.2.12 Undress the patient and start bathing.
6.2.13 After bathing drain waste water from the system.
6.2.14 Disconnect the bathinette from the outer edge of the frame and slid it under
the patient
connecting it to the power box side of the frame.
6.2.15 Dry the patient and wipe under the bathing sheet to absorb excess moisture.
6.2.16 Lay a clean bath sheet onto the bed to keep bed linen from moisture when
lowering
patient onto bed. Lower lifter and place patient on the bed. Disconnect the
sheet and
remove lift.
6.2.17 Remove bathing sheet and bath sheet from the patient at the same time.
6.2.18 Provide clean gown for the patient and make him/her comfortable.
6.2.19 Aftercare of equipment:
6.2.19.1Bathinette
clean with non-abrasive cleaner or disinfectant. If machine7
SPECIAL
CONSIDERATIONS:
is7.1 When not in use, charge battery by plugging to the power cord into a wall
receptacle.washable,
Anderlift use normal hot cycle. Drip dry only. Do not put in dryer.
6.2.19.2Drain
hoses
disinfectant
is run through
hoses after each use.
will
not overcharge
andcan
be left charging
indefinitely.
7.2 Anderlift can be stored in collapsed position.
7.3 Lifter is not to be charged when in use by patient. Unit will not operate while
charging.
7.4 Moving lifter in collapsed position is not recommended.
7.5 Top buckles and hooks are to be used for bottom sheet; bottom buckles are to be
used for top
sheet.
487
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Breast Pump
CONTENTS: This General Ward policy and procedure deals with the guidelines in operating a
breast
pump.
1 DEFINITION:
1.1 The Medela Breast Pump- is a piston pump based upon a simple and robust design
that aids in
expression of milk. There are two types of pumps:
1.1.1 Medela Breast Pump Lactina
1.1.2 Medela Breast Pump Heavy Duty
2 PURPOSES:
2.1 To re-establish maternal milk supply.
2.2 To stimulate lactation.
2.3 To relieve engorgement.
2.4 To reduce pressure on sore or cracked nipples.
3 INDICATIONS:
3.1 Mothers who have:
3.1.1 Breast engorgement/Breast Infection/Latch on problem and sored nipples.
3.1.2 Flat or inverted nipple.
3.1.3 Premature or hospitalized baby.
3.1.4 Low milk supply.
3.1.5 Part time/full time job.
4.1 Breast pump with accessory kit
4.1.1 Piston with rubber seal
4.1.2 Cylinder with vacuum regulator
4.1.3 Cylinder holder
4.1.4 Valve breast shield
4.1.5 Milk bottle
4.1.6 Lid and disk
4.1.7 Tubing with connector
4.1.8 Insert for small breast
5 POLICIES:
5.1 Ensure that the machine is in proper working condition.
5.2 Bottle tubing must be sterilized before each use.
5.3 Periodic check up of the device by Biomedical Engineer must be done.
5.4 Pump must not be used in the presence of flammable anesthetics due to explosion
PROCEDURES:
6
hazards.
6.1 Follow the steps to assemble plastic accessory kit.
6.1.1 Pull the rubber seal over the base of the piston until it seats correctly.
6.1.2 Introduce the piston into the cylinder.
6.1.3 Screw the cylinder tightly in the cylinder holder.
6.1.4 Hold the assembly vertically and push it into the Lactina.
6.1.5 Twist the piston down to right. The guide piece on the cylinder holder must
engage in the
slit in the pump casing.
488
6.1.6
Republic of
Yemen 48Modern
48
Hospital
Attach the piston handle to the rubber clamp on the pump arm and ensure that
it can pivot
freely.
6.1.7 Snap the valve onto the breast shield to ensure that it locks into position
(select the proper
shield according to size of breast and nipple).
6.1.8 Screw the milk bottle on to the breast shield.
6.1.9 Insert the connector of the tubing into the breast shield.
6.1.10 Connect the other end of the tubing to the cylinder holder.
6.1.11 Set the vacuum regulator to minimum if required, suction strength can be set
at medium
or increased to maximum.
6.2 Plug in the breast pump to 110V.
6.3 Center the breast shield over the nipple. The breast shield should be pressed
against the breast to
form a seal.
6.4 Turn the breast pump on.
6.5 When the milk bottle is filled with desired quantity, switch off the breast pump and
disassemble
the accessory kit.
7 NURSING RESPONSIBILITIES:
7.1 The outside of the breast pump must be kept clean at all times, wipe it with a clean
cloth and
remove any milk residue with warm water/mild soap.
7.2 The disassembled plastic parts must be sterilized individually. The valve must
always be removed
from the breast shield.
8
7.3 Check the pump daily to make sure that there is no milk in the pump system.
7.4 When assembling sterilized parts, do not touch inside of parts.
8.1 Medela Heavy Duty Breast Pump is designed to operate optimally when the
regulator is at the
NORMAL. For treatment of very sored or cracked nipples, use the MINIMUM setting
only.
8.2 The collection cup/bottle should be held in an upright position to prevent milk being
sucked into
the overflow safety bottle/cylinder.
8.3 If the milk bottle has been overfilled and milk entered the connection tube, pumping
must be
stopped and the pump must be turned off. Disassemble the accessory kit.
8.4 Medela Heavy Duty Breast pump operates 48 cycles/run. Every cycle consist of 3
phases.
8.4.1 Vacuum Phase (suction phase)
8.4.2 Release Phase
8.4.3 Relaxation Phase
8.5 To stop pumping, pull breast shield between two suction phases gently from the
breast.
8.6 Before using the pump again, the tubing and overflow bottle must be washed.
489
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Defibrillator
defibrillator.
1 DEFINITION:
1.1 Defibrillator - an instrument by which normal rhythm is restored in ventricular or
atrial
fibrillation by the application of a high voltage electric current.
1.1.1 * Physio-Control Lifepak - consist of two modules:
1.1.1.1 ECG monitor module
1.1.1.2 Defibrillator module
1.1.2 * Code Master XL
1.1.3 * AED Lifepak 20 biphasic with pacing + pulse oximetry
2* Parts and Features refer to its respective operating manuals available in the
unit.
3 PURPOSES:
3.1 To terminate ventricular fibrillation or ventricular tachycardia without pulse.
3.2 To perform synchronized cardioversion. The defibillator delivers the countershock
within
milliseconds of the ECG R wave to prevent shock during absolute refractory period.
3.3 Pacing used to maintain cardiac rhythm when contractions initiated by natural
pacemaker are
inadequate.
4.1 Defibrillator Machines
4.1.1 Physio Control Lifepak
4.1.2 Code Master-XL
4.1.3 AED Lifepak 20
4.2 Power cord
4.3 ECG cable
4.4 Electrodes paddle set (Adult/Pedia) + disposable set
4.5 ECG paper
4.6 Electrode gel
4.7 External pacer
5 POLICIES:
5.1 Defibrillation should be performed by Cardiologist/ACLS provider.
5.2 Only the prescribed energy level should be delivered to the client.
5.3 Machine must be kept charge at all time.
5.4 All staff in the unit should be familiar regarding the operation and precautions in
using the
machine.
5.5 All accessories of defibrillator should be available at all times.
5.6 Preventive maintenance is a must.
5.7 Any malfunction in the machine should be reported immediately to the Biomedical
Engineer.
5.8 User test and test load for energy charging should be done every shift according to
machine. :
5.9 Ensure client cable is attached to monitor
490at all times.
5.10ECG paper roll must be checked and monitor run for 3-5 seconds on testing paper
must be at
least half full.
Republic of
Yemen 48Modern
48
Hospital
491
PROCEDURES:
6.1 Defibrillating client with Code Master - XL
6.2 USER TEST unplugged the machine.
6.3 On the defibrillator, turn the energy select control to 100 joules energy level and
Republic of
charge. When
machine
alarms
press button simultaneously.
Yemen
48Modern
48
6.4 Remove the paddles from their holder by grasping the handles and lifting them
Hospital
straight up.
6.5 Holding both paddles in one hand, apply conductive gel to the electrode surface of
each paddle.
6.6 Press CHARGE on either apex paddle or on the instrument front panel.
6.7 Wait for the charge indicators CHARGE light.
6.8 Call out CLEAR to alert personnel to stand away from the client and bed.
6.9 Place the sternum paddle near the upper sternum in the client right mid-clavicular
line, just below
the clavicle.
6.10Place the apex paddle, on the chest just below and to the left of the clients left
nipple in the
anterior axillary line.
6.11Final clear out and apply 10 to 12 kg of pressure to each paddles and deliver the
shock.
6.12Briefly adjust paddle pressure and placement to optimize client contact.
6.13Verify that no one is in contact with client, the monitoring cable, the bed rails or
another potential
current pathway.
6.14Call out CLEAR three times to alert personnel to stand away from the patient.
6.15Press and briefly hold both shock buttons, simultaneously to deliver energy to the
client.
6.15.1 Resetting the selected energy level.
6.15.1.1To increase or decrease the selected energy level after pressing the
charge button,
perform the following steps:
6.15.1.1.1 Move the Energy Select control to the new energy level and
discharge.
6.15.1.1.2 Wait for the Charge Done indicators and shock again.
6.16Non Invasive Pacing Optional Defibrillation with Code Master - XL +Using the Pacer
6.16.1 Apply pads as instructed on the package.
6.16.2 Attach monitoring electrodes as instructed in using leads to monitor.
6.16.3 Attach the client cable to the Code Master XL+s ECG Input connector.
6.16.4 Attach the client cable leads to the monitoring electrodes.
6.16.5 Attach the pads adaptor cable to the defibrillator output connector. Pull the
latch
connector toward the front of the defibrillator to lock the connector in place.
6.16.6 Attach the pads to the pads adaptor cable and turn the twists lock.
6.16.7 Turn the Energy Select control to the monitor on position.
6.16.8 Press Pacer On to turn the Pacer On. The Pacer is always in demand/fix mode
when it is
turned on.
6.16.9 Select the best lead for monitoring while pacing and adjust the rate.
6.16.10Select the Pacing mode when in demand mode, the Pacer will only deliver
Pacer Pulses
when the patients heart rate is lower than the selected pacer rate. When in a
synchronized mode, the pacer will deliver Pacer Pulses at the selected Pacer
Rate. When
in fix mode only machine will take over.
6.16.11Press to start pacing, the monitor will now display the message PACING as
well as the
selected mode, rate and output.
6.16.12Verify that the Pacer Pulses are well positioned in the diastole.
6.16.13Increase output until the beat is captured, selecting an alternate lead could
help you to
determine capture.
6.16.14To set the lowest possible output level to capture, decrease the current by
decrements of 5
492
milliampule by pressing output.
6.17Defibrillation during Pacing
6.17.1 Set the desired energy level with Energy Select Control.
6.17.2 Press charge, the defibrillator will automatically turn off the Pacer and start
charging.
Republic of
Yemen 48Modern
48
Hospital
6.17.4 Call out CLEAR three times to alert personnel to stand away from the client.
6.17.5 Press button of the machine and briefly hold both shocks buttons located on
the cable
connector. The shock will be delivered through the multifunction pads.
6.17.6 After shock is delivered, the pacer remains off. Resume pacing if it is required.
6.18AED Lifepak 20 see attached manual.
6.19Post Operation Responsibilities
6.19.1 Turn the power off or standby.
6.19.2 Clear the paddles, controls and cables.
6.19.3 After each use user test should be done.
6.19.4 Return the machine and plug the power cord into an AC Power outlet. Ensure
that the
battery charge and AC power lights are ON.
6.19.5 Check that sufficient ECG paper, electrode gel, defibrillator pads are available
for the
next use.
6.19.6 Check the machine energy shift and call the Bio-med if needed.
6.19.7 Maintain the cleanliness and readiness of the machine and unit for next use.
7
7.1 There are different types of machine available within the hospital, physical features
vary but the
principles in defibrillating the patient remains the same.
7.2 For synchronized cardioversion, machine should be programmed in synchronized
mode and the
prescribed energy will be released only with each R - wave of the cardiac cycle.
7.3 Do not allow the gel to accumulate on hands or on the paddle handler to avoid risk
of electrical
shock.
7.4 Do not spread gel between the paddle electrodes on the chest. The patient can be
burned if the gel
forms a path between the electrodes.
7.5 SpO2 monitoring is optional in Code Master XL machine. Turn the defibrillator on if
necessary by
turning the Energy Select control to MONITOR ON. Press the SpO 2 ON/OFF button to
display
the SpO2 reading in the upper right corner of the display. The pulse amplitude
indicator shows the
quality of the SpO2 signal. The pulse rate is delivered from the pulse oximeter.
493
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Dinamap Blood Pressure Monitor
Dinamap
blood pressure monitor.
1 DEFINITION:
1.1 Dinamap Blood Pressure Monitor - a unique pressurized reservoir enables for faster
blood
pressure monitoring. Single reading can be taken at the touch of a button (STAT
MODE) and
allows determination to be made at specific intervals.
2 PURPOSES:
2.1 To monitor non-invasive blood pressure accurately.
2.2 To obtain baseline vital signs of patients.
2.3 To obtain accurate readings in hypotensive situation with the use of double-hose
system.
3.1 BP cuff with different sizes
3.2 Power cord and hose
4 POLICIES:
4.1 Ensure that it is always in good working condition.
4.2 It should always be plugged on AC power.
4.3 Alarm should be on to detect abnormality in Blood Pressure.
4.4 Preventive maintenance is a must.
5 PROCEDURES:
5.1 Press switch to turn power on.
5.2 Connect BP cuff to patient.
5.3 Press START switch to initiate a determination in either auto or manual mode.
5.3.1 Auto Mode - makes determinations upon entry into auto state and at expiration
of time in
cycle minutes display or whenever start switch is pressed.
5.3.2 Manual Mode - makes a single determination only when start switch is pressed.
5.4 Press set switch to select cycle minutes time (1, 2, 3, 4, 5, 10, 15, 20, 30, 45, 60 and
90 minutes)
in auto mode.
5.5 Change preset alarm limits if desired.
5.6 Monitor blood pressure and patients condition.
5.7 If no longer needed, press and release latchy switch to turn power off.
6 NURSING RESPONSIBILITIES:
6.1 Ensure that the monitor is plug on AC power.
6.2 Select appropriate BP cuff size.
6.3 Check cuff and hose connections for any kinks and blockages.
6.4 Restrain patient movement while BP is monitored to get accurate measurement.
6.5 Arrange power cord and hose to avoid patients entanglement.
6.6 Avoid placing anything on top of the monitor.
6.7 Nurse must be aware that Dinamap BP monitor should not be used for the following
condition:
6.7.1 Patients experiencing convulsion or tremors.
6.7.2 Those connected to heart lung machines.
494
6.7.3 On an extremity with IV infusions, post-op site and with AV Fistula. Arrange BP
cuff
and hose and keep the monitor clean.
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Electrocardiography Machine
an
electrocardiography machine.
1 DEFINITION:
1.1 Electrocardiography Machine A device intended for recording the hearts electrical
activity
under the conditions of the ambulant practice and clinical routine.
1.1.1 Types
1.1.1.1 Bioset 3500, 3700
1.1.1.2 Cardiostat 3, 31
1.1.1.3 Esaote Biomedika
2 PURPOSE:
2.1 To record the electrical activity of the heart.
3.1 ECG machine with:
3.1.1 Leads
3.1.2 Recording paper
3.1.3 Conductive gel
3.1.4 Tissue
4 POLICIES:
4.1 Ensure that the machine is in good working condition.
4.2 Follow safety measures while using the machine.
4.3 Regular periodic preventive maintenance monitoring.
PROCEDURES:
5
5.1 Insertion of recording paper.
5.1.1 Press the cover opening button to release the cover.
5.1.2 Bring cover into upright position and put it aside.
5.1.3 Insert the paper block into the chamber, place it properly and pull some paper
out.
5.1.3.1 Insert the paper block in such a manner that the imprint side gets visible
if the paper
is pulled to the left. The black paper marks are above (behind).
5.1.4 Reinsert the cover.
5.1.5 Bring the recording paper into a symmetric position toward the cover.
5.1.6 Close the cover by slightly pressing its left verge.
5.2 Prepare the skin areas by applying conductive gel.
5.3 Place the electrodes to the prepared areas according machine manual instruction
5.4 Right arm (red)
5.4.1 Left arm (yellow)
5.4.2 Left leg (green)
5.4.3 Right leg (black)
5.4.4 4th intercostal space, right sternal border (w+r)
5.4.5 4th intercostal space, left sternal border (w+y)
5.4.6 Between left 4th and 5th intercostal space (w+g)
5.4.7 5th intercostal space, left midclavicular 495
line (w+br)
Republic of
Yemen 48Modern
48
Hospital
5.4.8 Left anterior axillary line, on altitude of c4 (w+bl)

5.4.9 Left central axillary line, on altitude of c 4 (w+v)
5.5 Switch the unit on and the dialogue box programme appears.
5.6 The clients data input box appears and the data can be entered before starting the
registration of
ECG.
5.7 After having entered the clients data, the menu is closed and the programme
returns
automatically to the previous function.
5.8 ECG can be recorded under manual or automatic mode.
5.9 Enabling PRINT UNIT SETUP will print all customized settings.
RESPONSIBILITIES:
6
6.1 Clean electrodes with running hot water after use.
6.2 Disinfect electrodes and cable by mean of a disinfectant soaked cloth.
6.3 Squeeze out the gel properly from the rubber bulb.
6.4 Do not dip plug connectors of cables into fluids.
6.5 Regularly clean the unit by means of a soft and non-fuzzy cloth, using a mild
soap solution.
496
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Infusion Pump
an infusion
pump.
1 DEFINITION:
1.1 Infusion Pump is a dual micro processor controlled electronic system with an
advanced lineal
peristaltic pump mechanism/precision pump chamber administration set to yield
volumetric
performance at an unparalleled level of safety and cost-effectiveness.
1.2 Types
1.2.1 Diatek Secura IV
1.2.2 Infusomat Secura
1.2.3 Infusomat fm
1.2.4 Volumed u VP 5005
2 PURPOSES:
2.1 For accurate and constant delivery of parenteral medications and IV fluids.
2.2 For long-term infusion of large volumes with high accuracy.
2.3 To ensure that the fluid is free from air by means of an air chamber.
3.1 Infusion pump
3.2 Infusomat set
3.3 Extension set
3.4 Cannula lock/3 way stopcock
3.5 IV fluids
3.6 IV pole
4 POLICIES:
4.1 Ensure that the machine is in good working condition.
4.2 Ensure that the machine is plugged to the respective voltage 110 volts or 220 volts
continuously.
4.3 The machine is equipped with a free-flow protection and flow sensor must be free of
PROCEDURES:
5
dirt or fluid
5.1 Check
theprevent
equipment
for proper
functioning
and the completeness of its accessories
spills to
malfunction
of the
unit.
before
using, preventive maintenance should be done by the Biomedical Engineer.
4.4 Routine
5.2 Connect the power cord of the machine to the electrical socket.
5.3 Prime the set, fill drop chamber 1/3 to full. Do not overfill.
5.4 Place flow sensor over collar of drip chamber.
5.5 Open pump door by pulling down and out on ring at base of door latch.
5.6 Install pump chamber.
5.6.1 Insert bottom connector into lower pump chamber mounting notch and position
PVC
tubing in air detector tubing slot.
5.6.2 Insert top connector into upper pump chamber mounting notch. Verify pump
chamber is
positioned vertically and direction of flow to patient is downward.
5.6.3 Close and latch door.
497
5.6.4 Verify pump chamber is firmly seated in flow stop clamp. If necessary, push
into
position.
Republic of
Yemen 48Modern
48
Hospital
5.6.5 Fully open control pump. Verify that no falling drops are observed in drop
chamber.
5.7 Press green power switch. Wait for completing of self-test.
5.8 Enter desired flow rate on key pad (1-400ml/hour).
5.9 If Volume Limit feature is desired, press the volume limit ON/OFF/CLEAR button
and enter
the desired volume limit (1-999/ml).
5.10Press START/STOP button to begin infusion. Yellow indicator will illuminate to
indicate pump
is running. Volume infused indicator will change to 0 and increase in 1ml
increments as fluids
is delivered.
5.11To change the rate, stop fluid delivery by pressing the START/STOP button. Enter
the desired
rate and push the START/STOP button to restart the infusion at the new rate.
5.12When IV fluid is consumed the alarm sounds. Turn off the machine by pressing the
power
RESPONSIBILITIES:
6
ON/OFF.
Disconnect
the
end
tubing
from
the
patient
and
the
whole
tubing
system
6.1 Keep the machine always clean and dry.
from
thethe machine is not in use, the machine should be plugged into line power at
6.2
When
chamber.
all times to
keep the internal battery fully charged.
6.3 Inform Biomedical Engineer for any malfunction of the machine.
6.4 Inspect unit to make sure all display areas are free from spillage, the diaphragms
covering the
pump mechanism, and air line sensors are undamaged, and that the pressure plate
7
on the back of
the pump door is undamaged.
7.1 To operate pump on battery power, simply remove power plug from wall socket or
disconnect the
power cord from instrument rear panel.
7.2 The flow rate cannot be changed when the machine is delivering fluid to the patient.
7.3 If not restarted within 2 minutes, the audible alarm will sound. It can be silenced for
additional
two minutes interval by pushing the alarm mute button.
7.4 Flow sensor connector should attached properly to the machine.
7.5 Nurses should be aware of the alarm codes displayed in the unit.
7.6 During cleaning and disinfection, the unit should be disconnected from the line
power.
7.6.1 Flow sensor should be cleaned with alcohol swab or rinse under warm water,
dry
thoroughly.
7.6.2 It should be cleaned with damp cloth or sponge wet in warm water with a mild
detergent
or alcohol if desired.
7.6.3 After cleaning the unit, it should be disinfected by using a spray surface
disinfectant. Dry
the case and front panel surfaces after completion.
498
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: IVAC Temperature Plus
an IVAC
Temperature Plus.
1 DEFINITION:
1.1 IVAC Temperature Plus - a digital thermometer capable of taking fast, accurate
temperatures,
with the use of a heat-sensing device known as thermistor to sense temperature.
2 PURPOSE:
2.1 To monitor body temperature in a fast and accurate manner.
3.1 This device is composed of the following:
3.1.1 Probe with ejection button
3.1.1.1 blue oral/axilla
3.1.1.2 red - rectal
3.1.2 Carrying strap
3.1.3 Probe cover box
3.1.4 IVAC machine home base
PROCEDURES:
45.1
POLICIES:
Calibration Self-check:
4.1
Ensure
proper
condition
using
it. beep. The instrument will be in
5.1.1
Select
and working
remove one
probe;before
note an
audible
4.2 Any malfunction in the device should immediately report to bio-medical engineer.
Predictive
Mode.
5
5.1.2 Verify that the display briefly shows 188.8oF and all messages. The self-check
takes
place during this time.
5.1.3 Verify that the test display is replaced by three dashes (- - -). The three dashes
do not
appear if only one probe is installed in the instrument. Instead the temperature
of the
probe is displayed after the self-test (80.0oF - 26.7oC will be displayed if the
probe is at
below this temperature).
5.1.4 In monitor mode the message MONITOR MODE will display and the PULSE
TIMER
button should be released.
5.1.5 Touch the probe tip to the back of your hand or other warm surface.
5.1.6 If an advancing temperature is displayed, the thermometer successfully passed
the
calibration check.
5.1.7 If the message FIX ME 4 appears, the thermometer is out of calibration and
requires
service.
5.2 Operational use:
5.2.1 Start-up
5.2.1.1 Install a box of 20 probe covers in the storage compartment at the rear of
the
instrument.
499
5.2.1.2 With your thumb and forefinger, grasp the base of a probe and withdraw it
from the
storage well. This action automatically turns on the instrument.
5.2.1.3 Verify that all display segments, except the pulse timer clock
momentarily light and
that the instrument beeps once (instrument will beep twice in the monitor
mode).
Republic
of
When this sequence
is complete, the instrument will display three dashes (- -) Yemen 48Modern
48
indicating the instrument is ready for use.
Hospital
5.2.1.4 Insert the probe completely and firmly into a probe cover to ensure a
secure fit. The
device is ready to use now.
5.2.2 Oral Temperature Measurement use the blue, oral probe.
5.2.2.1 Have the patient open his/her mouth. Holding the probe, slightly insert
probe tip to
the sublingual pocket where the richest blood supply is located.
5.2.2.2 Hold the probe during the entire temperature measurement process and
keep the
probe tip in contact with tissue at all times. Do not allow patient to
reposition the
probe.
5.2.2.3 While the patients temperature is being determined, the tissue contact
pinwheel will
appear in the top right corner of the display and the three dashes (- - -) will
be
replaced by an advancing temperature.
5.2.2.4 An audible tone indicates that the measurement is complete, and the
patients
temperature (in degrees and tenths of a degree) will appear on the display
will clear
as the probe is returned to the storage well.
5.2.2.5 Observe the displayed temperature and remove the probe from the
patients mouth.
Hold the probe as you would a syringe and press the probe ejection button
at the
base of the probe to eject the used probe cover into a waste container.
5.2.2.6 Return the probe to the probe storage well. This will automatically turn
off and reset
the thermometer for the next temperature.
5.2.3 Rectal Temperature Measurement:
5.2.3.1 Touch the tissue about a half-inch (1.3) above the sphincter muscle and
carefully
insert the probe. (The use of lubricant is optional).
5.2.3.2 To ensure continuous tissue contact and maximize patient comfort, hold
the probe in
position until the audible tone sounds indicating the patients temperature
has been
reached.
5.2.3.3 Note the temperature, withdraw the probe, press the probe ejection
button to eject
the used probe cover, and return the probe to the storage well.
5.2.4 Axillary Temperature Measurement:
5.2.4.1 Place probe in patients axilla, making sure the tip of the probe is in
contact with the
position to the axillary artery with the patients arm held close to their side.
The three
dashes (- - -) will be replaced with the probe tip temperature as the probe
warms up.
5.2.4.2 Leave probe in place for the same length of time as required for taking an
axillary
temperature (the instrument will not beep to indicate final temperature
reading).
5.2.4.3 Observe patients temperature, remove probe, eject probe cover, and
return probe to
storage well.
5.2.5 Monitor Mode Operation: In monitor mode, the Temp. Plus II thermometer as it
500
rises or
falls.
5.2.5.1 Push and hold the pulse timer button.
5.2.5.2 Select and remove one probe and attach a probe cover.
5.2.5.3 When the display test has completed, indicated by three dashes (- - -) in
Republic of
Yemen 48Modern
48
Hospital
seconds, moving sequentially around the clock, starting at 12 oclock. The

last
segment turns off at 60 seconds. The instrument will beep once at 15

seconds, beep
twice at 30 seconds, and beep three times and turn off at 60 seconds. Pulse
is
calculated in the same manner as using a stopwatch.
5.2.6.3 Pulse timer operation can be terminated at anytime by pressing the
pulse timer
SPECIALbutton.
CONSIDERATIONS:
6
The instrument will emit three short beeps to indicate termination,
6.1
Place
and
the the Temp. Plus II Thermometer in the home base before using it for the first
time or pulse
the timer display will turn off.
instrument will not operate. The instrument must also be returned to the home base
whenever the
batteries are placed.
6.2 If there is along delay from the first time the probe is remove from the probe
storage well until it
is inserted into the patients mouth, it is possible that the instrument will not display
a final
temperature. If this occurs, insert the probe into the probe storage well, remove it
again and start a
new measurement.
6.3 To recall the last temperature reading, press the PULSE TIMER button. DO NOT
withdraw the
probe from the storage well as this will cause memory to be erased.
6.4 After care of IVAC Temp. Plus.
6.4.1 Periodically clean the instrument surface by wiping it with a soft cloth
dampened with
mild detergent and warm water.
6.4.2 Do not use alcohol, ammonia or ammonium chloride based agents as they could
damage
the plastic exterior of the instrument.
501
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Multiparameter
(NELLCOR PURITAN BENNETT-4000)
Nellcor
Puritan Bennett-4000 multiparameter machine.
1 DEFINITION:
1.1 Multiparameter - a lightweight compact portable and accurate device designed to
monitor
essential vital signs, oxygen saturation and ECG. It is operated by power supply or
battery charge
and display parameters in eight languages.
2 PURPOSES:
2.1 To monitor the following:
2.1.1 ECG
2.1.2 Heart Rate
2.1.3 Non-invasive blood pressure (systolic, diastolic and mean arterial pressure)
2.1.4 Functional arterial oxygen saturation
2.1.5 Respiration rate
2.1.6 Temperature for adult and pediatric patients
3.1 During Magnetic Resonance Imaging (MRI).
3.2 Presence of flammable anesthetics (explosion hazard).
3.3 Do not use to monitor neonates.
3.4 Patients who are linked to heart lung machines.
4.1 Multiparameter ECG cable
4.2 NBP hose and cuff
4.3 SpO2 cable and sensor
4.4 Temperature probe
5 POLICIES:
5.1 Multiparameter and its accessories should be checked regularly to ensure proper
working
conditions.
5.2 Only the appropriate multiparameter cables and accessories should be used to avoid
false
monitoring.
5.3 NPB - 4000 should not be used in the presence of flammable anesthetics to avoid
PROCEDURES:
6
explosion
6.1 Plug the monitor connection to electrical power.
hazard.
6.2 Connect client cables to front panel connectors (BP cuff, sensor, electrodes, probes)
5.4 Always to be connected to AC power.
then attach to
client.
6.3 Press the on/standby switch to turn on the monitor. The monitor will go through a
self-test before
displaying the monitoring screen. The screen will display waveform, areas and
frames.
6.3.1 If no leads or accessories have been connected
to client, the screen will appear
502
blank of
data.
and
If the monitor detects valid signals, then a typical presentation with waveforms
tubular trend may appear.

6.4 Check the alarm limits, adjust if required rotate the knob in front panel to highlight
Republic of
the alarmlimits
icon, then
press the knob to view all alarm limits.
Yemen
48Modern
48
6.5 To change a limit, rotate knob until desired limit is highlighted then press. Rotate
Hospital
the knob until

desired value is obtained. After adjusting desirable limits, rotate knob to highlight
return then
press knob to exit the monitoring screen.
6.6 ECG monitoring:
6.3.2
6.6.1 Connect ECG cable to ECG input on front panel.
6.6.2 Connect ECG leads to ECG cable.
6.6.3 Prepare the electrode sites according to the electrode manufacturers
instructions (refer to
NPB - 4000 operating manual).
6.6.4 Attach the lead-wires to the electrodes, the electrodes to the client, as per
manual
instruction.
6.6.5 Then the machine will automatically derive heart rate from ECG whenever a
valid ECG
signal is present. If ECG is not present and SpO2 is being monitored, the heart
rate value
is derived from SpO2 signal.
6.6.6 If one or more ECG leads is not properly attached, the ECG Leads Off alarm
will
automatically shown in the monitor.
6.7 BP monitoring:
6.7.1 Attach the proper size of cuff to the client. Cuff width should span
approximately 2/3 of
the distance between clients elbow and shoulder.
6.7.2 Initiate BP measurement by pressing Start/Stop switch. Press and hold it for
2 seconds.
6.7.3 Blood pressure measurements can be made in three modes:
6.7.3.1 SINGLE: In which one measurement of each of the three blood pressure
(systolic/mean arterial pressure/diastolic) is displayed in the numeric frame.
6.7.3.1.1 Press the front-panel NPB switch. A single blood pressure
measurement will
be made.
6.7.3.1.2 The monitor numeric frame displays a clock icon and numeric valve
which
indicate the elapsed time in minutes since last taking a measurement.
6.7.3.1.3 The measurement remains in the numeric frame for 60 minutes. At
the end
of 60-minute interval, the measured value and the icon are removed
from
the display.
6.7.3.1.4 As soon as NPB measurement begins, any existing NPB values in the
numeric frame are removed. Variable value of the pressure is shown.
Systolic, diastolic and MAP values are presented when measurement is
completed.
6.7.3.2 Automatic NPB measurement:
6.7.3.2.1 Select the desired automatic measurement interval from the menu
accessed
via NPB numeric frame.
6.7.3.2.2 Upon selection, automatic mode is activated and the initial
measurement
will be made X minutes later.
6.7.3.2.3 Press the front panel NPB switch.
6.7.3.2.4 The NPB numeric frame will display the auto mode icon and the
number of
minutes selected for the interval between measurements.
6.7.3.3 To initiate stat mode of NPB operation:
503 and hold it for at least 2 seconds.
6.7.3.3.1 Press the front panel NPB switch
6.7.3.3.2 While stat mode is active (5 minutes), the stat icon appears in the
numeric
frame. The clock icon and minutes displays are removed.
6.7.3.3.3 Current cuff pressure is not shown during stat mode.
Republic of
Yemen 48Modern
6.7.3.3.5
48
Hospital
504
Republic of
Yemen 48Modern
Hospital
48
display.
6.8
SpO2 Monitoring :
At6.8.1
60 minutes
the sensor
stat measurements,
the
Connectafter
SpO2completion
cable then of
place
to a finger properly,
and that skin
displayed
NPB
integrity is
measurement
and the clock icon are removed.
acceptable.
6.8.2 Inspect the sensor site as directed to ensure skin integrity and correct position
and
adhesion of the sensor.
6.9 Respiration Monitoring:
6.9.1 This can be detected by using two of the three leads of the ECG electrodes and
cable.
6.9.2 Real time respiratory information is presented as a waveform on a graphic
frame,
respiration is presented in a numeric frame and in tubular trend date.
6.10Temperature Monitoring :
6.10.1 Measurement of client is accomplished by processing the signal from a probe
containing
resistance element whose impedance is temperature dependent.
6.10.2 Probes are furnished with a standard 10 feet lead, extension leads are
available.
6.10.3 The signal from the probe is conditioned by the monitor input gravity,
processed and the
measured values are shown in the numeric frame.
6.11Trend Data Storage :
6.11.1 Trend data in graphical or tubular format maybe presented on the screen.
6.11.2 Trend information in graphical format for a selected monitored parameter is
shown by
6.11.3 Clotting each of the 20 second averages as vertically positioned points on the
graph.
Displaying trend data :
6.11.3.1Rotate the knob to highlight the graphic frame in which the desired trend
is to
appear.
6.11.3.2Press knob. The level 1 menu for this frame appears frames 2 and 3.
6.11.3.3Remove the knob to highlight the trend description item in level 1 menu.
6.11.3.4Press knob. Control is returned to the level 1 menu.
6.11.3.5Rotate knob until return message is highlighted.
6.11.3.6Press knob. The display now contains a graphical trend (if selected) in the
previously highlighted graphic frame location.
6.12Printing:
6.12.1 Two types of real-time printed records maybe obtained by pressing the
appropriate button
on the printer in the right panel.
6.12.1.1Snapshot: A 20 second print recording real time graphical and numeric
information
beginning with the values 10 seconds before the print initiation and ending
10
seconds
after that event. Press the snapshot switch automatically all
AFTER CARE
RESPONSIBILITIES:
7
information
inNPB - 4000, charge all the time when not in use.
7.1 Keep the
themonitor
multiparameter
7.2 Keep the
clean anddisplay
tidy. window will be printed. Time is printed along the
bottom
7.2.1 Dampen a cloth with commercial, nonabrasive cleaner and wipe the top bottom
and front of the paper.
6.12.1.2Continuous:
A print of real time graphical and numeric information
surfaces lightly.
beginning
10 cables, sensors and cuffs, follow cleaning instructions in the directions for
7.2.2 For
seconds before initiating the action and continuing until stopped.
use
6.12.1.3Printing
in any
mode can be stopped
505 by pressing either of the two printer
shipped with those
components.
buttons
(snapshot switch, continuous switch).
6.13Press the on/standby switch to terminate monitoring.
Republic of
Yemen 48Modern
48
Hospital
7.3 Do not place the monitor in any position that might cause it to fall to patient, do not
lift the
monitor by the power supply cord or patients connections. Disconnections could
result in the
monitor dropping on patient.
7.4 Carefully route patient cabling to reduce possibility of patient entanglement or
strangulation.
8
8.5 If the accuracy of any measurement does not seem reasonable, first check the vital
signs by
alternate means and then check the NPB - 4000 monitor NPB - 4000 for proper
functioning.
8.6 The NPB - 4000 maybe used on a patient during defibrillation, but the readings
maybe inaccurate
for a short time.
8.7 Electromagnetic interference may cause disruption of performance. (e.g. cellular
phone, mobile
two-way radios, electrical appliances).
8.8 For pacemaker patients, the NPB - 4000 may continue to count pacemaker rate
during
occurrences of cardiac arrest or some arrhythmias.
506
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Pulse Oximeter

Nellcor
pulse oximeter.
1 DEFINITION:
1.1 Pulse Oximeter - a non-invasive device that works by applying a sensor to a pulsating
arteriolar
vascular bed such as a finger or toe. The sensor contains a dual light source and a
photodetector.
2 PURPOSES:
2.1 To check arterial blood oxygen saturation.
2.2 To monitor pulse rate.
2.3 It can help in early detection of potentially serious problem.
2.4 It provides continuous, real time information about oxygenation.
3 INDICATIONS:
3.1 For patients who may be at risk for developing hypoxemia.
3.2 Intended for use in adult, pediatric and neonatal patients in all hospital areas,
hospital type
facilities and in the home environment.
4.1 Pulse oximeter
4.2 Sensor probe
5 POLICIES:
5.1 Ensure that the device is in good working condition.
5.2 Ensure that the device is plugged to the correct voltage continuously.
5.3 Routine preventive maintenance should be done by Biomedical Engineer.
5.4 Check sensor site and circulation distal to the probe every 4 hours and change the
probe site as
appropriate.
6 PROCEDURES:
6.1 Check the equipment for proper functioning and completeness of its accessories
before using.
6.2 Connect the power cord of the machine to the electrical socket.
6.3 Apply the finger probe to the patient with cable running along the upper aspect of
the finger.
6.4 Apply tape over the cable to prevent the sensor from becoming dislodged.
6.5 Turn on the machine.
6.6 The screen will show digital display of pulse rate and oxygen saturation.
6.7 Adjust the alarm limits of the pulse rate and oxygen saturation.
RESPONSIBILITIES:
7
For any
alarm sound
justopaque
press the
alarm in
key
button.
7.16.8
Cover
the sensor
site with
material
the
presence of bright light source
6.9
such
asCheck
directsensor site and circulation distal to the sensor, and move the sensor to
another
site surgical
at least lamps, infrared warming lamps and phototherapy lights to minimize
sunlight,
the every 4 hours.
6.10After
use,
gently remove
the finger which
probe can
fromcreate
the patient
and turn
off the machine.
potential for
ambient
light interference
unreliable
readings.
7.2 Sensors should not be used during MRI scanning because the sensors could affect
the MRI image
507
or the MRI could affect the accuracy of the oximetry measurements.
Republic of
Yemen 48Modern
48
Hospital
7.3 Avoid applying additional tape to the probe to minimize the risk of impaired
perfusion and tissue
injury.
7.4 Clean the sensor by wiping 70% alcohol.
7.5 Sensors should be placed on the extremities positioned at heart level.
7.6 Do not use a damage sensor with exposed optical components.
508
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Septic Fluid Aspirator Medap P7040
Septic
Fluid Aspirator Medap P7040.
1 DEFINITION:
1.1 The Septic Fluid Aspirator P7040 - a high-performance, low-noise aspirator device for
continuous operation and is suitable for low flow rates and high vacuum.
2 PURPOSE:
2.1 To aspirate body fluids (septic fluids, blood and serous fluids) and particles contained
therein
from natural and artificial orifices.
3 CONTRAINDICATION:
3.1 The septic fluid aspirator is neither suitable for use in surgery nor as a drainage
aspirator. The
particles contained in the gas phase might lead to an early clogging of the humidity
filter.
4.1 Medap Septic Fluid Aspirator
4.1.1 Silicone tube
4.1.2 Basic aspirator
4.1.3 Regulating screw
4.1.4 Rocker switch
4.1.5 Vacuometer
4.1.6 Suction nipple (optional)
4.1.7 Septic fluid jar cap
4.1.8 Float holder
4.1.9 Float
4.1.10 Gasket
4.1.11 Septic fluid jar
4.1.12 Suction unit
4.1.13 Bacterial filter cap
4.1.14 Filter paper (bacterial paper)
5 POLICIES:
5.1 Only qualified personnel are permitted to use this device in accordance with the
operating
instructions.
5.2 Ensure proper working condition of machine prior to operation.
5.3 The following part of the machine must be sent to CSSD daily for sterilization:
5.3.1 Septic fluid jar cap
5.3.2 Float holder
5.3.3 Float
5.3.4 Gasket
5.3.5 Septic fluid jar
5.4 Infection Control Policy must be followed when using the device.
5.5 Bacterial filter paper must be changed daily when in used.
509
Republic of
PROCEDURES:
Yemen
48Modern
48
6.1 Check
if the supply
voltage corresponds to the information on the type of label.
Hospital
510
Republic of
Yemen 48Modern
48
Hospital
6.2 Place the aspirator in a safe position.

6.3 Check whether the float is correctly positioned in the overflow prevention device. If
not
positioned properly, the device might be damaged.
6.4 Place the septic fluid jar cap unto the septic fluid jar.
6.5 Use both balls of your thumb to press down the carrying handle and have the hooks
lock into the
groves of the septic fluid jar.
6.6 Insert the suction unit into the holder with the patients side connection (light
chrome) directing to
the front and connect tubing to the suction element.
6.7 Connect suction unit with the shorter tube via the humidity filter to the aspirator.
Pay attention to
direction of flow. The side of text must point in the direction of the suction unit.
6.8 Screw off the bacterial filter cap and remove the used bacterial filter (not necessary
in the care of
new devices).
6.9 Insert new bacterial filter into the cap in such a way that the side with the fine
structure faces the
aspirator.
6.10Re-fix the bacterial filter cap and connect the aspirator.
6.11Carry out a functional check:
6.11.1 Switch on the device.
6.11.2 Bend over the tube leading to the patient or hold it closed.
6.11.3 Adjust vacuum with the regulating screw and check it. If no or hardly any
vacuum is built
up.
6.12Attach new suction catheter to suction nipple.
7
7.1 Always pull the plug prior to each cleaning.
7.2 Do not clean the surfaces of the housing with solvents that contain hydrocarbon
(e.g. benzene).
7.3 Carefully rinse the parts, which were disinfected in solution, with water and dry all
parts
thoroughly.
7.4 Do not switch on the aspirator when vacuum is present since the device might
overheat.
7.5 Check aspirator for visible damage prior to use, e.g. ruptures or cracks in tubes or
septic fluid
container.
511
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Syringe Pumps
syringe
pump.
1 DEFINITION:
1.1 Syringe Pumps - a continuous infusion device designed for precisely controlled
infusion of
liquids at a constant and exact delivery rate for long duration by means of a disposable
syringe.
1.1.1 Soveta
1.1.2 Secura
1.1.3 Fresenius
2 PURPOSE:
2.1 To deliver regulated small amount of infusion e.g. Heparin infusion. Dormicum,
Tracrium, Insulin
etc.
3.1 Perfusor with cable
3.2 Perfusor syringe
3.3 Perfusor set
4 POLICIES:
4.1 Never start operating the machine when it is defective.
4.2 Check working condition before starting.
4.3 The infusion system should be filled in such a way as to avoid formation of bubbles.
PROCEDURES:
4.4Connect
In ordermains
to avoid
battery
discharge,
theand
pump
should
not be disconnected from the
5.1
cable
to pump
connector
mains
socket.
source
power
5.2 Switch the pump on with ON and OFF key. The green lamp mains will light. The 5
for period longer than 90 days to prevent permanent damage.
following
4.5
Correct will
voltage
should always be used.
messages
be displayed.
4.6
Repairs
should
be
performed
byisauthorized
persons.
5.2.1 NO MAINS!! Warning
that only
pump
not connected
to the mains, connect it to the
mains
then press YES accepting this fact.

5.2.2 CONTINUE? This message is displayed if previous infusion has not been ended.
YES
means infusion will be continued, NO new infusion will be started.
5.2.3 PROGRAMMING refers to the type of syringe used. NO means other syringe
types are
displayed until you are using the desired one. YES is the one displayed is
accepted then
following messages is seen.
5.2.3.1 Volume - By pressing NO previous valve is cleared and the new one can be
entered
with numerical keys. YES accepts the number visible on the display. Select
limited
volume that the syringe can hold.
5.2.3.2 Rate - Select Syringe Volume (not infusion volume) the following maximum
infusion rate are available
512
99mls/hr for 50/60ml syringes
75ml/hr for 35ml syringes
Republic
press

If the programmed rate exceeds the above values, the pump displays
information about this fact. Enter the proper value of infusion rate and
of
YES.
Yemen 48Modern
48
It is possible to program infusion time instead. Switching from RATE to

Hospital
TIME (and vice versa) is obtained by pressing NO twice.
5.2.1.1 Time - maximum tine is 99 hours, 59 minutes and 59 seconds. By pressing
NO the
actual value can be cleared, by YES accepted. After NO, all zeroes appear on
the
display. Enter numbers from left to right. The programmed digit can be
cleared with
NO. A blinking zero shows where the actually programmed digit should be
entered.
All six digits must be entered, example:
One hour is programmed as 01:00:00
30 minutes is programmed as 00:30:00
After RATE and TIME is programmed (accepted by YES) and in case if
three occlusion limits were installed by programmer the following
messages
appears:
Occl. XXX (means any occlusion limit: LOW, MID, HIGH)
5.2.1.1 Bolus - If bolus facility is not used, YES key should be pressed, or volume
0 ml
should be programmed. Otherwise, bolus volume should be entered and
accepted by
YES. Bolus volume cannot be higher than the total programmed infusion
volume.
After bolus is programmed the following messages appears on the display:
INSERT
SYRINGE!
5.3 Filled syringe should be inserted, when the following message is visible: INSERT
SYRINGE!
5.4 Draw up a syringe; connect infusion line and fill, avoiding the formation of bubbles.
5.4.1 By pressing >, the arm of the syringe can be moved to the right. If this key is
pressed.
For a time longer than 2 seconds, the movement of the arm is automatic.
5.4.2 It can be stopped with RUN/STOP or < BOLUS.
5.5 Insert the syringe plunger into the groove in the arm.
5.6 Press < BOLUS and hold it until the syringe can be easily inserted into the slit in the
syringe
mould.
5.7 Lift and turn the syringe clamp, so it holds the syringe firmly in the mould. Make
sure the syringe
is straight and its plunger is not bent. After the syringe is inserted < BOLUS can be
used for
adjustment of volume and priming.
5.8 When the syringe is in place, press YES. When READY to run. Appears on the screen,
press YES
to start the infusion. RUN lamp flashes, the arm of the pump moves to the left with
programmed
speed and the following appears on the display:
run xx:xx.xx
5.9 To change the rate when the infusion is in progress, observe the following
programming:
5.9.1 Press PROG key, introduce new infusion rate and press YES. From that moment,
the
pump works with a new rate.
5.9.2 If VIEW mode is on, press PROG then YES until RATE: xx.x ml/hr is visible. Press
NO then introduce new infusion rate and press YES again.
5.10After the programmed volume is administered, the pump stops and the audible
alarm sound. END
of infusion is displayed. If the pump513
in not switched off at the end of the infusion,
then KVO
(keep vein open) function is executed. It is described by the following message KVO
xx ml/hr
alternately with END of infusion.
Republic of
NURSING RESPONSIBILITIES:
48Modern
48
6.1 The Yemen
programmed
rate and volume values are accurate only, when the appropriate
syringe is
used,
Hospital
exactly the one that was programmed.
514
Republic of
Yemen 48Modern
48
Hospital
6.2 For cleaning and disinfection, the device must be switched off and disconnected
from the mains.
The unit is wiped with a disinfectant - soaked cloth or alcohol - based disinfectant can
be used
also. After disinfection, at least one minute should elapse before the pump is
switched on again.
6.3 Keep the rate 0 after the use.
6.4 Keep the machine clean and dry always.
6.5 The syringe should be labeled with the preparation of the infusion, date and time it
was started and
the signature of the nurse who prepared the infusion.
7
7.1 Perfusor secura has a precise setting of delivery rate combined with the selected
syringes either 25
or 50ml. It has pre-alarm intermittently for 3 minutes prior to the end of infusion.
7.2 Alarms will occur of there is low supply of battery or no mains and due to stoppage
of plunger
movement related to occlusion or end of infusion.
7.3 To operate the perfusor secura.
7.3.1 Place the syringe holder in the outboard position. Activate the black push
button and the
back motion lockout will be released.
7.3.2 Slide the syringe holder to the outboard position.
7.3.3 Deaerate the lines by turning the adjustment knob in a clockwise direction, the
lines will
be deaerated and at the same time the play in the drive system will be
eliminated. After
operation starts, neither the push button nor the rotary knob may be activated.
7.3.4 Program the rate.
7.3.5 To turn on the equipment, press the switch (green lamp lights). When the
equipment is
turned on, there will be a red fault lamp for a short time and the acoustical
alarm will
sound.
515
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: Ultrasonic Nebulizer
an ultrasonic
nebulizer.
1 DEFINITION:
1.1 Ultrasonic Nebulizer - a device used in short therapeutic sessions to deliver moisture
or
medication by producing 100% humidity in a fine aerosol mist of fluid droplets that
ideally and
slowly settle deep into the lungs.
2 PURPOSE:
2.1 To mobilize the thick secretions and facilitate a productive cough.
3.1 Corrugated tube
3.2 Mouth piece
3.3 Nebulizer mask (Adult and Pedia)
3.4 Solution cup
3.5 Brush
3.6 Bacterial filter
3.7 Dust filter
3.8 Silicon rubber ring
3.9 Sterile distilled water
4 POLICIES:
4.1 Ensure that the device is in good working condition.
4.3 Preventive maintenance of the unit should be done regularly by the Bio-Medical
PROCEDURES:
Engineer.
5
5.1
Preparation
of the device:
4.4
Obtain physicians
order. Identify the correct client.
5.1.1 Fix silicone rubber ring on the cylindrical tube on the bottom of nebulizing
room, and the
solution cup on silicone rubber ring.
5.1.2 Pour water into waterpool up to water level.
5.1.3 Set bacterial filter into place.
5.1.4 Fix checked valve, do not fix it upside down.
5.1.5 Fix corrugated tube on nebulizer outlet, and fix mouthpiece and/or nebulizer
mask on the
other end of corrugated tube.
5.1.6 Completely liquefied solution only should be poured properly into solution cup.
(capacity
of the cup : - 30ml)
5.2 Handling of the device:
5.2.1 Set time of nebulizing time
5.2.1.1 When the timer is set within 15 minutes, turn it over to a given time
clockwise once,
and then turn it counter clockwise again and fix the nebulizing time. For
continuous
516
use, turn time counter clockwise and fix at CONTIN. (when time indicates O,
the
unit will not nebulize).
Republic of
Yemen 48Modern
48
Hospital
Switch power on. Power lamp lights. Make sure water depletion lamp does not
light. If
the lamp lights, add more water to waterpool.

5.2.3 Turn controller clockwise (toward MAX), nebulizing volume is increasing. Low
water
temperature may cause the decrease of nebulizing volume.
5.2.4 Have the patient hold mouthpiece between his teeth, or cover his nose and
mouth with
nebulizer mask.
5.2.5 After finishing the therapy, switch power off.
5.3 After therapy:
5.3.1 Clean up nebulizing room, nebulizer lid, solution cup and corrugated tube, and
brush the
surface of oscillator.
5.3.2 Wash dust filter in water at least once a week.
5.3.3 Put the accessories and power cord in order for the next use.
5.3.4
Avoid RESPONSIBILITIES:
a high temperature, high humidity and direct sunshine in storing the 6
NURSING
device.
6.1 Avoid the place where it is splashed with water.
5.3.5
sterilize nebulizer
room,
nebulizer
6.2 Do
Usenot
a completely
liquefied
solution.
6.3 Be careful not to exceed the nebulizing time and solution volume necessary to
the treatment.
6.4 Instruct the patient not to open the unit.
6.5 Replace the bacterial filter with a new one with every patient to prevent
infection.
517
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL

Title: Suction MachineDue for Review:Page 1 of 2
DEFINITION:
1.1 Suction Machine -is a performance, low noise aspiration device for continues
CONTENTS:
operation
and This
is General Ward policy and procedure deals with the operation of suction
machine.
suitable for high flow rates and high vacuum.
1
PURPOSE:
2.1 To aspirate body fluids (septic fluids, blood and serious fluids) and particles
contained therein
2
from natural and artificial orifices and is intended for application in the patient during
surgery and
septic fluid aspiration.
3
3.1 Basic Aspirator
3.2 Holder cap with Septic fluid jar
3.3 Cap
3.4 Cap of overflow prevention device
3.5 Catheter cage
3.6 Powder cable
3.7 Bacterial filter cap
3.8 Overflow bottle
3.9 Septic fluid container
3.10Silicon tube
3.11Bacterial filter paper
3.12Cap plug
3.13Connecting tube/ hydrophobic filter
PROCEDURES:
4
4.1 Check aspirator for visible damaged prior to use. Make sure that:
4.1.1 The supply cable is not defective
4.1.2 The fetus are in proper condition
4.1.3 The overflow prevention device is not damaged and the float is inserted.
4.1.4 The tube and septic fluid contains are without any rupture or cracks.
4.1.5 The septic fluid jar cap is correctly positioned and tightly closed.
4.1.6 The cap plugs are free from contamination or residues.
4.2 Position the device in a safe position and arrest the caster brakes.
4.3 Use the On-Switch on the device; the power indicator is lit in green.
4.4 Bent over the suction tube or hold the tube nipple closed and adjusts the vacuum
with the
regulating knob.
4.5 To increased the vacuum turn regulating knob to the right.
4.6 Reduction vacuum turn the regulating knob to the left.
4.7 Aspirate septic fluid, if frothing occurs during aspiration use standard froth
prevented since
otherwise the overflow prevention device might not close on the case of excess
aspiration.
4.8 When the septic fluid container is filled about 2/3 attached the cap plug onto the
empty suction
unit.
4.9 The humidity filter should be replaced which518
visible contamination are present and
or the
displacement decreased.
4.10Re-prepare aspirator after use.
Republic of
Yemen 48Modern
48
Hospital
NURSING RESPONSIBILITIES:
5
5.1 Do after care of equipment.
5.2 Pull the power plug prior to each cleaning.
5.3 Clean parts carefully and thoroughly with disinfecting solution with water. Dry all
parts very well.
Make sure that no fluids penetrate the aspirator.
6.1 Do not switch on the aspirator when the vacuum present since the device
might over heat.
519
Republic of
Yemen 48Modern
48
Hospital
48 MODERN HOSPITAL
Title: OPTIUM XCEED GLUCOMETERDue for Review:Page 1 of 4
CONTENTS: This General Ward policy and procedure describes the glucotest laboratory and
nursing
responsibilities using the Optium Xceed Glucometer.
1 DEFINITION:
1.1 Optium Xceed (Abbott) is a device intended for POCT in the management of patients
with
diabetes.
2 PURPOSES:
2.1 To monitor blood glucose level in diabetic patients.
2.2 To measure -ketones (-hydroxybutyrate) the most important ketone bodies
circulating in the
blood.
2.3 To obtain quick results of glucose and -ketones in blood.
2.4 To specify the suitable and effective treatment.
The machine must not be used to make diagnosis or treat patients whose glucose may
be critical.
3.1 Glucometer device (Optium Xceed Abbott)
3.2 Glucose strips and/or ketone strips
3.3 QC Material
3.4 Penlet sampler
3.5 Sterile lancet
4 PROCEDURES:
3.6 Small sharp disposable container
4.1 Specimen - Fresh blood drop is obtained using a lancing devise. The sampling site is
usually the
3.8 Alcohol swabs
finger tip. Other alternative sites may be used are the forearm upper arm or the base of
3.9 Small band-aid
the thumb.
3.10 Sterile gauze (2x2)
4.2 Calibration
4.2.1 The meter is calibrated:
4.2.1.1 When using it for the first time
4.2.1.2 Each time a new lot number of blood glucose or ketone test strips is opened.
4.2.2 Remove the glucose or -Ketone calibrator package from the new box of test
strips.
4.2.3 Open the calibrator package. Find the three raised bumps on the calibrator
package. Peel the
clear cover away from the three raised bumps.
4.2.4 Hold the calibrator with the LOT number (Glucose) or calibration CODE (-Ketone)
facing up.
4.2.5 Insert the calibrator into the strip port. Push it in until it stops. The Display Check
shows on the
display window as follows: first the time, month and day. Next the LOT number
(Glucose) or
calibration CODE (-Ketone) shows on the display window.
4.2.6 Check that the LOT number or calibration CODE on all these items matches:
4.2.6.1 Display window
520
4.2.6.2 Test strip calibrator
4.2.6.3 Test strip instructions for use
4.2.6.4 Test strip foil packet
Republic of
Yemen 48Modern
Hospital
48
4.2.7 Remove the calibrator from the meter and store it in the meters carrying case.
4.3 Blood Glucose Testing Procedure
4.3.1 Remove the glucose test strip from its packet and insert the three black lines at its
end into the strip
port.
4.3.2 Push it until it stops, the meter turns on automatically. The following items shows on
the display
screen one after another.
4.3.2.1 Time, month and day
4.3.2.2 LOT number for the box of glucose strips in use.
4.3.2.3 Apply blood message
4.3.3 Obtain a drop of blood from the finger tip of the patient using the lancing device.
4.3.4 Touch the blood drop to the white area at the end of the test strip. Continue touching
till the meter
begins the test and a countdown starts.
4.3.5 At the end of the countdown, the blood glucose result appears on the display window
and is stored
in the meters memory. Also write down the result in the patients result logbook.
4.4
Blood
-Ketone
Testing
Procedure
4.3.6
Removing
the
test strip
shuts off the meter.
4.4.1
It
is
indicated
for
monitoring
patients with diabetes specially if:
4.3.7 Discard the test strip properly.
4.4.1.1 Blood glucose is higher than 300 mg/dL
4.4.1.2 Unusual blood glucose levels are obtained.
4.4.2 Remove the glucose test strip from its packet.
4.4.3 Insert the three black lines at its end into the strip port and push it until it stops,
the meter turns
on automatically. The following items show on the display screen one after another.
4.4.3.1 Time, month and day
4.4.3.2 CODE number for the box of -ketone strips in use.
4.4.3.3 Apply blood message
4.4.4 Use the lancing device to obtain a blood drop from the finger tip of the patient
using the lancing
device. (Important: Use only fingertip blood samples for blood -Ketone monitoring.)
4.4.5 Touch the blood drop to the purple area on the top of the test strip. The blood is
drawn into the
test strip.
4.4.6 Continue to touch the blood drop to the purple area on the top of the test strip
until the meter
begins. The display window shows the countdown starts.
4.4.7 At the end of the countdown, the blood -Ketone result appears on the display
window with the
4.5 Quality Control ( QC )
word KETONE. The result is stored in the meters memory as blood -Ketone result.
4.5.1 QC is performed when patient testing is anticipated frequently on a daily basis
You should
for units
also write down the result in the patients result logbook.
providing that daily testing. It is done by the clinical staff at the POCT site and is
4.4.8 Removing the test strip shuts off the meter. Discard the test strip properly.
recorded in the
QC logbook. (This includes information about test result, control level, control lot, test
strip
information, operator ID, test time and date and comments). QC results are reviewed
regularly by
the laboratory.
4.5.2 QC Procedure
Three level control solutions can be used for glucose or -ketone testing.
An opened control solution is valid for use up to 90 days.
4.5.2.1 Remove the glucose or -ketone test strip from its packet.
4.5.2.2 nsert the three black lines at its end into the strip port.
4.5.2.3 Push it until it stops, the meter turns521
on automatically. The following items
show on the
display screen one after another.
4.5.2.3.1 Time, month and day
Republic of
Yemen 48Modern
Hospital
48
4.5.2.3.2 LOT number for the box of glucose strips and CODE number for the box of
-ketone
strips in use.
4.5.2.3.3 Apply blood message
4.5.2.4 Mark the test as a control test.
4.5.2.5 Turn the control solution bottle upside down three to four times to mix the
solutionthen
apply a drop of control solution to the test strip.
4.5.2.6 Continue to touch the control solution to the test strip until the meter begins
the test.
4.5.2.7 At the end of the countdown, the control result shows on the display window.
The result is
stored in the meters memory as a control result. In the QC logbook, record the
result as a control
result.
4.5.2.8 Removing the test strip shuts off the meter. Discard the test strip properly.
4.5.2.9 Compare the control result to the Expected Results for Use with MediSense
Control
Solutions range printed on the controls.
4.5.2.10 If Controls results are within the range, the meter and test strips are
4.6 Maintenance
working
correctly.(IfProcedure for daily cleaning )
4.6.1
Store
the meter
its carrying
case.repeat testing with a new strip. If result is
the control results
fall in
outside
the range,
4.6.2
Daily
cleaning
of
the
meter
is
done
with a soft cloth and 10% Na hypochlorite or
still not within
70%
alcohol.
the range, contact the laboratory.
4.6.3 Do not try to clean the strip port.
4.6.4 Replacing the battery - When the meter displays the message denoting low
battery on its screen,
replacement should be done.
4.6.4.1 Gently push the battery cover in and up with your thumb. Lift the battery
cover out of the
meter.
4.6.4.2 Pull on the plastic tab sticking out of the meter to remove the old battery.
4.6.4.3 Insert a new CR2032 Lithium (coin cell) battery with the plus sign (+) facing
up.Special Considerations
4.7
4.6.4.4
Place
the notches
onstrip
the battery
into
appropriate molded areas, and
4.7.1
DO NOT
"press"
the test
against cover
the test
site.
then
pushit
in
and
4.7.2 DO NOT scrape the blood.
down
till ause
click
is flat
heard.
4.7.3
DO NOT
the
side of the test strip.
4.7.4 DO NOT use test strips that have passed the expiration date on the package since
they may
cause false results.
4.7.5 Test strips automatically absorb the sample into the strip.
4.7.6 Confirmation beep helps eliminate wasted test strip and short sampling.
4.7.7 The device gives results within 5 seconds (Glucose) and 10 seconds (Ketone) and
has a
memory capacity of 450 memory readings.
4.7.8 For clients on hemodialysis, test is done before and after dialysis through the
arterial port ofthe
extracorporeal circuit.
4.7.9 Referrence Ranges
4.7.9.1 Blood glucose : 70 120 mg/dL
4.7.9.2 Blood -ketones : Less than 0.6 mmol/L
4.7.10 Critical Ranges
4.7.10.1 Blood glucose : Less than 40 mg/dL
More than 500 mg/dL (Adult)
More than 300 mg/dL (Newborns)
522
4.7.10.2 Blood -ketones : > 1.5 mmol/L
Republic of
Yemen 48Modern
48
Hospital
4.7.11 Measurable Ranges

4.7.11.1 Blood glucose : 20 - 500 mg/dL
< 20 mg/dL, the result appears LO
> 500 mg/dL, the result appears as HI
4.7.11.2 Blood -ketones: 0 - 6 mmol/L
> 6 mmol/L, the results appears as HI
523
Republic of
Yemen 48Modern
OTHER
DEPARTMENTS
Hospital
POLICIES AND PROCEDURES

AFFECTING NURSING PRACTICE
524
48
Republic of
Policy No.
RS002 Yemen
48
48Modern
Hospital
48 MODERN HOSPITAL
Manual: RESPIRATORY THERAPY

Published DateYear Version
Date Implemented
Title: Arterial Blood Gas
Page 1 of 8
CONTENTS: This OM describes the policies, procedures & responsibilities of Respiratory Care
Unit personnel with regards to arterial blood gas sampling in SGH.
1 DEFINITION of TERMS:
1.1 Arterial punctures involve drawing blood from a peripheral artery (radial, brachial, femoral,
dorsalis pedis) through a single percutaneous needle puncture. Results obtained from
sampling arterial blood gas are the cornerstone in the diagnosis and management of
oxygenation and acid-base disturbances.
2 PURPOSES:
2.1 To provide guidelines to assure that all blood gas punctures and samples are performed
properly with patient safety as the foremost consideration.
2.2 To ensure that arterial blood samples are properly handled from the time that they are
obtained until the time that they arrive at the location where the analysis are performed.
2.3 To establish guidelines for notifying the physicians of blood gas values outside the normal
limits/range (panic values).
2.4 To provide guidelines for a safe and effective technique for assessing collateral circulation
in the hand prior to arterial puncture (Allens Test).
3 INDICATIONS:
3.1 The need to evaluate the adequacy of ventilation (PaCO2), acid-base status (pH), and
oxygenation status (PaO2).
3.2 The need to determine the patients response to therapeutic intervention. (e.g. O2
Therapy).
3.3 The need to monitor severity and progression of a documented disease process.
4 CONTRAINDICATIONS
4.1 Negative results on Allens test are indicative of inadequate blood supply to the hand and
suggest the need to select another extremity or the site for puncture.
4.2 Arterial puncture should not be performed through a lesion or through or distal to a
surgical shunt.
5 HAZARDS and POSSIBLE COMPLICATIONS:
525
Republic of
Yemen 48Modern
48
Hospital
5.1 Arteriospasm
5.2
5.3
5.4
5.5
5.6
Air or clotted blood emboli

Arterial occlusion
Hemorrhage
Pain
Patient or sampler contamination
6 POLICIES and GUIDELINES:
6.1 Arterial blood gas punctures shall be performed only if:

6.1.1 A written physicians order is available in the patients file.
6.1.2 Direct verbal instructions or via telephone by the physician to the Respiratory
Therapist.
6.2 Twenty five (25G) x 5/8 needles shall be used on all radial, brachial and dorsalis pedis
arterial punctures. Never use needles larger that 23G for any site.
6.3 A maximum of two (2) puncture attempts per patient per site shall be made by any one
therapist.
6.4 A maximum of four (4) puncture attempts per patient for two sites shall be made by any
two therapists.
6.5 Authorized puncture sites include (in order of preference):
6.5.1 For adults and children over 12 years:
6.5.1.1 First (1st) choice: Radial Artery
Rationale/Key points
6.5.1.1.1 Collateral circulation by ulnar artery can be tested and documented
6.5.1.1.2 The artery is superficial with no nerve immediately parallel to it.
6.5.1.1.3 Ease of determination/detection of bleeding/ occult bleeding.

6.5.1.1.4 Bevel of needle should be up and artery penetration is at
approximately 30 to 45 angle.
6.5.1.2 Second (2nd) choice: Brachial Artery
6.5.1.1.1 If neither the right nor the left radial artery may be punctured, then
puncture the brachial artery.
526
Republic of
Yemen 48Modern
48
Hospital
6.5.1.1.3 No test for collateral circulation can be performed.
6.5.1.1.4 Care must be taken not to obtain venous blood, puncture the nerve or
puncture the bicipital aponeurosis.
6.5.1.2 Third (3rd) choice: Dorsalis Pedis Artery
Rationale.Key points
6.5.1.1.1 If unable to obtain sample from brachial arteries (due to bandages,
casts, burns, etc.) then puncture the dorsalis pedis artery.
6.5.1.1.2 Dorsalis pedis artery is very peripheral. Care must be taken not to
insert the needle too deep.
6.5.1.1.4 No test for collateral circulation can be performed.
6.5.1.1.5 The foot is perfused with blood from both the dorsalis pedis as well as
the posterior tibial arteries with good circulation through the plantar
arches in the foot.
6.5.1.2 Fourth (4th) choice: Femoral Artery (Emergency/Code situations only)
6.5.1.2.1 A physicians written or verbal order specifically indicating femoral
artery puncture is required.
6.5.1.2.2 Only RTs experienced with femoral puncture is allowed to perform
femoral puncture.
6.5.1.2.3 Procedure is reserved only for emergency/code situations or extreme
hypotension.
6.5.1.2.4 A longer needle (1-1 ) may be required, but needle must not be
larger than 23G
6.5.1.2.5 Angle of entry is 90.
6.5.1.2.6 Assessment of hemostasis is mandatory, as bleeding into the fascial
planes may persist unnoticed.
6.5.1.3Infants and children under 12 years:
First (1st) choice: Radial Artery
Second (2nd) choice: Dorsalis Pedis Artery
Third (3rd) choice: Brachial Artery
527
6.5.1.3.1
6.5.1.3.2
6.5.1.3.3
Republic of
Yemen 48Modern
48
Hospital
Fourth (4th) choice: Femoral Artery

6.5.1.3.4
6.5.1.3.4.1Femoral punctures are never performed under any

circumstances, on any children under the age of eight (8) years to
prevent possibility of lacerating the childs urinary bladder.
6.5.1.3.4.2A physicians written or verbal order specifically indicating
femoral artery puncture is required.
6.5.1.3.4.3Only RTs experienced with femoral puncture are allowed to
perform femoral puncture.
6.5.1.3.4.4Procedure is reserved only for emergency/ code situations or
extreme hypotension.
6.5.1.3.4.5A longer needle (1-1 ) may be required, but needle must not
be larger than 23G
6.5.1.3.4.6Angle of entry is 90.
6.5.1.3.4.7Assessment of hemostasis is mandatory, as bleeding into the
fascial planes may persist unnoticed.
7 RESPONSIBILITIES:
7.1 Attending physician shall initiate written or verbal orders (documented in patients file)
regarding all arterial blood gas sampling. The physicians order shall include the following:
Oxygen Flow
Oxygen device
Ventilator setting
FIO2
7.1.1
7.1.2
7.1.3
7.1.4
7.2 Priority of sample collection:

7.2.1 STAT collection
7.2.2 Routine ( indicate frequency)
7.2.3 Specific time of collection
7.3 The nurse on duty shall write the request on the official physiotherapy requisition form
and inform the RT on duty of the said request.
7.4 All RTs shall be familiar/knowledgeable with:
7.4.1 Criteria for Site and Technique of Arterial Punctures
7.4.2 Infection Control, Application of Standard Precautions & Universal Blood &
Secretion Precaution
7.4.3 Contraindications & Complications
528
Republic of
Yemen 48Modern
48
Hospital
7.4.4 Proper reporting of ABG (panic values) results
7.4.1 All RTs shall perform procedure in accordance with the procedure established in
this policy and procedure manual.
8 EQUIPMENTS:
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
Sterile 3cc or 5cc syringe, pre-heparinized

23G or 25G needle, short level, clear hub with lure lock.
Needle stopper
Syringe tip cap
70% alcohol prep pad or other suitable antiseptic solution
2 x 2 gauze pad
Adhesive bandage
Ice chips/ cup filled with ice water / ice pack
Gloves (clean)
9 PROCEDURE:
9.1 Allens Test

9.1.1 The Allens test shall always be performed prior to radial punctures. This test shall
be a standard mandatory procedure. No Exceptions.
9.1.2 Have the patient clench his hand into a tight fist.
9.1.3 Occlude the radial and ulnar arteries.
9.1.4 Let the patient open his hand (but not to fully extend).
9.1.5 Release the pressure from the ulnar artery.
9.1.6 If ulnar circulation is adequate, the hand should become normal in color after a
few seconds.
9.1.7 Do not puncture radial artery if circulation is not back in fifteen (15) seconds.
9.1.8 If Allens Test is negative:
9.1.8.1Check the other hand.
9.1.8.2Document and communicate to the physician and other RT staff the patients
name, pin# and results of the test.
9.1.8.3If the right and left radial arteries have both negative results for Allens Test
perform brachial or dorsalis pedis puncture.
9.1.9 Arterial Puncture
9.1.9.1Write the date, time & badge# on the request form upon receiving the form.
529
Republic of
Yemen 48Modern
48
Hospital
9.1.9.2Fill up the laboratory request form with all the necessary information.
9.1.9.3Check/ verify for a complete physicians order in the patients file.
9.1.10 Review the patients medical file for:

9.1.10.1History of patients clinical condition.
9.1.10.2Respiratory therapy orders ( oxygen & ventilator set-ups)
9.1.10.3Anticoagulant or thrombolytic therapy
9.1.10.4Special precautions
9.1.11 Wash hands.
9.1.12 Identify patient by checking ID bracelet then explain the procedure, equipment &
therapeutic objectives to the patient.
9.1.13 Check for proper oxygen therapy set-up, FIO2, oxygen concentration and oxygen
device and ventilatory set-up.
9.1.14 Apply clean gloves.
9.1.15 Assemble equipment including ice-water solution. Visually inspect needle tip for
patency and imperfections.
9.1.16 Label slush ice water container with patients name & PIN. If ice slush is not
available, label the syringe with patients name & PIN.
9.1.17 Palpate radial artery to assess the strength of pulse.
9.1.18 Perform Allens Test.
9.1.19 Disinfect the patients skin with alcohol pad, wiping it in a circular motion from the
center outward.
9.1.20 Using index and middle fingers of your non-dominant hand, carefully palpate
artery again. Palpate as long as necessary to make sure there is good pulse and
artery is stable.
9.1.21 Hold syringe with dominant hand with needle bevel up. Quickly puncture site with
corresponding angles for different sites (radial 30-45, brachial 45-90, femoral
90).
9.1.22 Arterial entry is indicated by a flush or pulsating blood in the clear hub of the
needle.
9.1.23 Allow the syringe to fill automatically until at least 1-2ml for adults and children
over 12 years old, 0.5 ml for neonates and children under 12.
9.1.24 Discontinue puncture after obtaining sample and apply digital pressure to site for
at least 5 minutes or until hemostasis is achieved.
9.1.25 Check sample for air bubbles and expel immediately if any air is present. Never
pull plunger of syringe down as this can cause aspiration of ambient air that may
530
Republic of
Yemen 48Modern
48
Hospital
affect result of analysis.
9.1.26 Insert the needle into needle stopper making sure that the needle does not
protrude through the rubber.
9.1.27 Remove needle and apply luer tip cap on syringe. Agitate syringe to mix sample.
9.1.28 Fully immerse entire syringe with the capped end downwards in slush ice water or
keep between ice packs if no ice slush is available.
9.1.29 Check puncture site. If no evidence of bleeding is present apply adhesive
bandage.
9.1.30 Place sample in biohazard bag and send sample to laboratory.
9.1.31 Remove gloves & wash hands.
9.1.32 Dispose all waste following infection control policies.
9.1.33 Proper documentation of the procedure should be done in the Respiratory
Therapy Treatment Sheet and in the Ventilator Check List if the patient is
mechanically ventilated and should include the following.
9.1.33.1Date & time ABG sample was drawn.
9.1.33.2Puncture site
9.1.33.3Result of Allens test
9.1.33.4Oxygen device, flow, FIO2 or ventilator settings
9.1.33.5Hemostasis status
9.1.33.6Name & ID # of therapist
10 PROCEDURE FOR TREATMENT SHEET:

10.1Emboss the patients PIN card for identification on the Respiratory Therapy Treatment
Form.
10.2Fill-up the required data i.e. date, time, room number.
10.3Re-check patients file for doctors order for the specific respiratory treatment required
including medication, dose and frequency of treatment
10.4Identify the patient and assess baseline vital signs including breath sounds and
document the gathered data in the treatment form.
10.5Perform the treatment required then perform post treatment assessment including
patients tolerance to the procedure/treatment given and document in the treatment form.
10.6The Initials & ID # of the staff who performed the assessment and the treatment should
be placed in the space provided for in the Assessment Form.
10.7Attach the form in the patients clinical file.
531
Republic of
Yemen 48Modern
48
Hospital
532

General Nursing Departmental Manual

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

General Nursing Departmental Manual

Uploaded by

Copyright:

Available Formats

Republic of

Title: Instillation of Ear

GENERAL NURSING INTERNAL POLICIES AND PROCEDURES

NURSING MISSION-VISION STATEMENT

NURSING SHARED MISSION

The The Nursing services are committed to

NURSING SHARED VISION

NURSING DEPARTMENT GOALS AND

1.1 To utilize the nursing

who entrusted their lives to our care.

2.2 To make use of appropriate hospital facilities in meeting

NURSING DEPARTMENT'S SCOPE OF

2.9 Take responsibility for own personal and professional

3.4 There is an Assistant Nursing Director, in collaboration with the nursing

4 STRATEGIC PLAN FOR PROVIDING NURSING CARE:

5.2 Decision-making nurses identify obstacles in the promotion, restoration,

6.2.1 Nursing care plan

4.9 Inform admitting/treating physician or his/her resident.

3.5.No discharge should be done without Notification of Payment (Attached Form 4

5.1.1.1 Carryout doctors order for medically

5.2.1.3 provide related education, as appropriate to the situation.

3.4.5 Psychiatric conditions.

1 = Visual or hearing deficit

4.3.1 Obtain a written acceptance from the receiving hospital.

4.3.3 Ask client or relative to settle account in Admission/Discharge Office

charges are updated by Units Ward Secretary.

Manual: General Nursing Departmental Manual

Manual: General Nursing Departmental Manual

6.4.5.1 Assist the Code Blue Team

Receiving nurse confirms that the order is taken correctly by repeating,

Manual: General Wards Policies and Procedures

3.1.4.6 Receiving Hemotherapeutic and radio-active material including radiation

Consent should be included in the admission file of patient to be endorsed to the

Manual: General Nursing Departmental Manual

Manual: General Nursing Departmental Manual

Document patients reactions and responses to the 4.2.8

3.6 Right to participate in his treatment plan to:

4.4.2.5 Mealtime/quality/special diets

Manual: General Nursing Departmental Manual

Manual: General Nursing Departmental Manual

4.1.2.12Sharps and blunt objects are not allowed especially to Psychiatrist

4.1.2.15Order patients diet as recommended by the doctor.

Fire Safety, how to use fire fighting equipment and to evacuate

Manual: General Nursing Departmental Manual

Complete Blood Count

- Total Iron Binding Capacity

3.7.1 Medication given to the wrong patient.

5.13.3 Right Dose

4.1.2 When Returning Belongings to the Patient:

Title: WAIVED and POINT of CARE TESTINGDue for Review:Page 1 of 4

4.1 Point-of-Care Testing Committee

invited as necessary to participate, on regular basis. POCT Committee assigned, Lab

Manual: Nursing Administration Policies and

5.9 Use only the Official Competency Assessment

Manual: General Nursing Departmental Manual

Manual: General Nursing Departmental Manual

4.5 Concerned nurse fills-up an incident report.

Manual: General Nursing Departmental Manual

Applies to: General Ward and Specialty Units

Manual: General Nursing Departmental Manual

3.1.2.4 Physical condition

4.3.1 Assists the staff in the development of patient care plan.

name and ID number.