Nursing Procedure: How to Surgical Antiseptic

Surgical Antiseptic

Surgical Antiseptik Hand Washing

 

Also known as sterile technique, prevents contamination of an open wound, serves to isolate the operative area from the unsterile environment, and maintains a sterile field for surgery.
1. Remove all pieces of jewelry.
2. Wet hands using sterile water with water closest to your body temperature.
3. Wash hands using antimicrobial soap and/or povidone-iodine.
4. Clean subungual areas with a nail file.
5. Scrub each side of each finger, between the fingers, and the backs and fronts of the hands for at least 4 minutes.
6. Proceed to scrub the hands, keeping the hand higher than the arm at all times to prevent bacteria-laden soap and water from contaminating the hands.
7. Rinse hands and arms by passing them through the flowing water in one direction only, from fingertips to elbow.
8. Proceed to the operating room holding hands above elbows.
9. Dry hands and arms using sterile towel observing aseptic technique.

Nursing Procedure: How to Massage (Back & Chest Physiotherapy)

Definition
Another way of providing relaxation to patients is by initiating back care and giving them a massage. Learn on how you can be a pro-masseur and a nurse at the same time.

Purpose

1. To stimulate the circulation and give general relief.
2. To prevent bedsore / decubitus
3. To give comfort to the patient.

Equipment Needed

• Coconut oil
• Talcum powder
• Bath towel

Procedure

1. Help the patient to turn on his abdomen or on his side with his back toward the nurse and his body near the edge of the bed so that he is as near the operator as possible. If the supine position is used and the patient is a woman, pillow under the abdomen removes pressure from the breasts and favor relaxation.
2. Raise the gown.
3. Apply to back rubbing lotion or talcum powder to reduce friction. In rubbing the back use firm long strokes and kneading motions (see below). The amount of pressure to exert depends upon the patient’s condition. Begin from neck and shoulders then proceed over the entire back.
4. Massage with both hands working with a strong stroke. In upward then in downward motions. Give particular attention to pressure areas in rubbing (Alcohol 25%) to 50% is generally used for its refreshing effect, but rubbing lotion may be used.
5. Powder again the area at the completion of the rubbing process which should consume from 3-5 minutes.
6. Turn patient on his back and put on the gown.
7. Fix and make patient comfortable.

Movements Used

Effleurage Techniques

1. Effleurage (stroking) —is a long sweeping movement with palm of hand conforming to the contour of the surface treated, over small surface (on the neck) the thumb and fingers are used. Strokes should be slow, rhythmical and gentle with pressure constant and in the direction of venous stream.
2. Kneading—performed with the ulnar side palm resting on the surface and the fingers, and thumb grasping the skin and subcutaneous tissues which move with the hand of the operator.
3. Friction—is performed with the whole palmar surface of the hand or fingers and thumbs over limited areas. This movement is a circular form of kneading with pressure against the underlying part of tissue which cannot be grasped.

5 Moments For Hand Washing (Hand Hygiene)

Indicators of Hand Hygiene

Hand washing is the act of cleaning one’s hands with the use of any liquid with or without soap for the purpose of removing dirt or microorganisms. It is the most effective measure in reducing the risk of transmitting infectious diseases.

It cannot be said too often that hand washing is the most important and most basic technique in preventing and controlling infections. It is the single most effective infection control measure.
Hand washing is under the umbrella of hand hygiene. Hand hygiene is defined by the World Health Organization as a general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.

According to the World Health Organization (WHO), there are Five Moments for Hand Hygiene:

1. Before Patient Contact.
2. Before and Antiseptic Task.
3. After Body Fluid Exposure Risk.
4. After Patient Contact.
5. After Contact with Patient Surroundings.

The following materials or equipment are needed to perform hand washing:

• Soap or detergent
• Warm running water
• Paper towels
• Alcohol
• Optional: Antiseptic cleaner, fingernail brush, plastic cuticle stick

5 Moment For Hand Hygiene

Principles and concepts surrounding hand hygiene:

• You must use running water in a sink that drains out instead of using a basin.
• You may use soap – antibacterial soap if necessary.
• You must rub your hands against each other for at least 30 seconds to facilitate removal of microorganisms.
• Long nails and jewelry trap germs. It is best to keep fingernails short. If you wear a ring, it is better not to remove the ring before hand washing so that it can be washed too.
• It is always better to use disposable paper towels than to use cloth towel when drying hands to ensure that you can only use those once.
• The faucet is always considered dirty and it is recommended to turn it off using a paper towel in the absence of the ideal sensor or foot pedal.
• Dispensers of soap should be used until completely empty. Once emptied, it should be washed before refilled.

Nursing Procedure: How to Antiseptic Hand Washing

Definition

Hand washing is the act of cleaning one’s hands with the use of any liquid with or without soap for the purpose of removing dirt or microorganisms. It is the most effective measure in reducing the risk of transmitting infectious diseases. It cannot be said too often that hand washing is the most important and most basic technique in preventing and controlling infections. It is the single most effective infection control measure.
Hand washing is under the umbrella of hand hygiene. Hand hygiene is defined by the World Health Organization as a general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.

Terms

To understand this study guide better, familiarize yourself with the terms used:

• Hand Hygiene. It is a general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis
• Hand Washing. It is defined as the washing of hands with plain (i.e., non-antimicrobial) soap and water.
• Antiseptic Hand wash. A term that applies to hand washing with an antimicrobial soap and water.
• Surgical Hand Antisepsis. Commonly called as a surgical hand scrub. This is to remove as many microorganisms from the hands as possible before the sterile procedure.

Goals

The purposes of hand hygiene are:

• Hand washing can prevent infection
• Avoid pathogenic microorganisms and to avoid transmitting them
 

 

Equipment

The following materials or equipment are needed to perform hand washing:

• Soap or detergent
• Warm running water
• Paper towels
• Optional: Antiseptic cleaner, fingernail brush, plastic cuticle stick

 

Nursing Action (Procedures)

Antiseptic Hand wash

Also known as clean technique, includes procedures used to reduce the number of organisms on hands.

1. Gather the necessary supplies. Stand in front of the sink.Wet the hands and wrist area. 
2. Keep hands lower than elbows to allow water to flow towards the fingertips. 
3. Cover all areas of hands with soap. 
4. With firm rubbing and circular motions, wash the palms and backs of the hands, each finger, the knuckles, wrists, and forearms. Continue this friction motion for 30 seconds.
5. Rinse thoroughly with water flowing towards the fingertips.
6. Pat hands dry, beginning with the fingers and moving upward towards forearms, with a paper towel and discard immediately.
7. In the absence of sensors or foot pedal, use another clean paper towel to turn off the faucet.

Nursing Procedure: How to Take a Radial (wirst) Pulse Rate

Definition: 

One of method to get heart rate using a radial palpation technique.

Equipment:

• Watch with second hand
• Stethoscope
• Alcohol swabs
• Non Steril Gloves

Goals:

1. To know the number of heart rate
2. To know rhythm

Nursing Action (Procedure):

HOW TO TAKE A RADIAL (WRIST) PULSE RATE

• Wash hands/hand hygiene. Rationale: Reduces transmission of microorganisms.

• Inform client of the site(s) where pulse will be measured. Rationale:Encourages participation and allays anxiety.

• Flex client’s elbow and place lower part of arm across chest. Maintains wrist in full extension and exposes artery for palpation. Rationale: Placing client’s hand over chest will facilitate later respiratory assessment without undue attention to the nurse’s action. (It is difficult for any person to maintain a normal breathing pattern when someone is observing and measuring).         

• Support client’s wrist by grasping outer aspect with thumb. Rationale:Stabilizes wrist and allows for pressure to be exerted.

• Place index and middle fingers on inner aspect of client’s wrist over the radial artery, and apply light but firm pressure until pulse is palpated. Fingertips are sensitive, facilitating palpation of pulsating pulse. The nurse may feel his or her own pulse if palpating with thumb. Rationale: Applying light pressure prevents occlusion of blood flow and pulsation.

• Identify pulse rhythm. Palpate pulse until rhythm is determined. Rationale:Describe as regular or irregular.

• Determine pulse volume. Quality of pulse strength is an indication of stroke volume. Rationale: Describe as normal, weak, strong, or bounding.

• Count pulse rate by using second hand on watch. For a regular rhythm, count number of beats for 30 seconds and multiply by 2. For an irregular rhythm, count number of beats for a full minute, noting number of irregular beats. Rationale: An irregular rhythm requires a full minute of assessment to identify the number of inefficient cardiac contractions that fail to transmit a pulsation, referred to as a ‘‘skipped’’ or irregular beat.

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Nursing Procedure: How to Take an Apical Pulse Rate

Definition:

One method to calculate heart rate (Pulse) using palpation techniques.

Equipment:

• Watch with second hand
• Stethoscope
• Alcohol swabs
• Non Steril Gloves

 
Goals:

1. To know the number of heart rate
2. To know rhythm

Nursing Action (Procedure):

How to take an apical pulse

• Wash hands/hand hygiene. Rationale: Reduces transmission of microorganisms.

• Raise client’s gown to expose sternum and left side of chest. Rationale:Allows access to client’s chest for proper placement of stethoscope.

• Cleanse earpiece and diaphragm of stethoscope with an alcohol swab.Rationale: Decreases transmission of microorganisms from one prescribing practitioner to another (earpiece) and from one client to another (diaphragm).

• Put stethoscope around neck. Rationale: Ensures stethoscope is nearby for frequent use.

• Locate apex of heart:

1. With client lying on left side, locate suprasternal notch. Rationale: Identification of landmarks facilitates correct placement of the stethoscope at the fifth intercostal space in order to hear PMI.
2. Palpate second intercostal space to left of sternum.
3. Place index finger in intercostal space, counting downward until fifth intercostal space is located. Rationale: Ensures correct placement of stethoscope.
4. Move index finger along fourth intercostal space left of the sternal border and to the fifth intercostal space left of the midclavicular line to palpate the point of maximal impulse (PMI)
5. Keep index finger of nondominant hand on the PMI.

• Inform client that his or her heart will be listened to. Instruct client to remain silent. Rationale:  Elicits client support. Stethoscope amplifies noise.

• With dominant hand, put earpiece of the stethoscope in ears and grasp diaphragm of the stethoscope in the palm of the hand for 5 to 10 seconds.Rationale:  Dominant hand facilitates psychomotor dexterity for placement of earpiece with one hand. Heat warms metal or plastic diaphragm and prevents startling client.

• Place diaphragm of stethoscope over the PMI and auscultate for sounds S1 and S2 to hear lub-dub sound. Rationale:  Movement of blood through the heart valves creates S1 and S2 sounds. Listen for a regular rhythm (heartbeats are evenly spaced) before counting.

• Note regularity of rhythm. Rationale:  Establishment of a rhythmic pattern determines length of time to count the heartbeats to ensure accurate measurement.

• Start to count while looking at second hand of watch. Count lub-dub sound as one beat:

1. For a regular rhythm, count rate for 30 seconds and multiply by 2.
2. For an irregular rhythm, count rate for a full minute, noting number of irregular beats.

Rationale:  Ensures sufficient time to count irregular beats.

• Share findings with client. Rationale:  Promotes client participation in care.

• Record by site the rate, rhythm, and, if applicable, number of irregular beats. Rationale:  Record rate and characteristics at bedside to ensure accurate documentation.

• Wash hands/hand hygiene. Rationale:  Reduces transmission of microorganisms.

Nursing tips when taking an apical pulse

• If taking an apical pulse, have the client breathe normally through the nose; breathing through the nose decreases breath sounds and makes the heart sounds easier to hear.

Source : www.nursingprocedure.blogspot.co.id

New Method / Formula to Giving Vascon (Noradrenaline)

NORADRENALIN

For example : Levoped, Levosol dan Vascon

SUPPLY

1 cc = 1 mg

INDICATION

Severe hypotension with peripheral resistance
lowering the total dose.

FUNCTION

Vasoconstrictor that increases blood pressure and
Inotropic strong (ß receptor stimulator).

DOSE

0,05 µg/kg/min

A FORMULA

DOSAGE REQUESTED X WEIGHT X 60           NUMBER OF DILUTIONS

EXAMPLE : Give the 0.01 mcg / kg weight / min with
Vascon dosage of 4 ml (4 mg) in 50 cc NaCl 0.9%
with patient weight 40 kg?

Method: Total Dilution = 4 mg = 0,08 mg

                                             50 cc

                                                      = 80 µg/cc

So : 0,01 µg x 40 kg x60 = 0,3 cc/jam

                  80 µg/cc

New Method / Formula to Corection of Hypernatremia

KOREKSI HIPERNATREMIA

• I : Fluid thats the body needs = kgBB x 0,6 = …… Liters

• II : Normal Natrium   x Fluid thats the body needs =… Liters

     Patient Natrium

•III :  Result I – Result II = ……….. Liters

Half given out in 10 hours

Can use Nacl 0.9%, Dex 5 % or RL Fluid

If use Dex 5 % check your patient blood sugar every 4 hours

You must check your patient electrolytes every 4 hours to

Example :

Patient weight 60 kg, Natrium 170

Answer :

 I. Fluid thats the body needs = 60 x 0,6 = 36 Liters

II. 140 x 36 Liter = 29,6 Liters

     170

III. 36 Liter – 29,6 Liter = 6,4 Liter
(Given half)

Nursing Procedure: How to Care Women's Catheters

PROCEDURE CARE WOMEN'S CATHETERS
STANDAR OPERATING PROCEDURE
DEFINITIONS	Perform the maintenance action in the area genetal women who catheterized
GOALS	Preventing infection Providing a sense of comfort
POLICY	Female patients were catheterized
EMPLOYEE	Nurse
EQUIPMENT	Bak instrument containing sterile swab Sterile gloves Disinfectant Warm water, washcloths, towels Perlak and pengalas Crooked
PROCEDURE IMPLEMENTATION	Phase Pra Interaction Checking the therapy program Washing hands Setting up the instrument Phase Orientation Greets the patient and the patient's name sapa Describe the purpose and implementation procedures Asking for consent / patient readiness Work Phase Sampiran installing / maintaining privacy Preparing patients with dorcal recumbent position and fired under the patient's clothing Installing perlak , pengalas Wearing gloves Clean the genitalia with warm water Ensure the position of the catheter is properly installed ( pull carefully , catheters are retained ) Provide disinfectant with a swab on the end of the catheter Removing pengalas and gloves Tidying patients Phase Termination Evaluating new measures do Saying goodbye to the client Clean up and return the device Washing hands Noting the activities in the nursing record sheet

Nursing Procedure: How to Give Eat Patient Via NGT

FEED PATIENTS VIA NGT STANDAR OPERATING PROCEDURE DEFINITIONS Incorporating liquid food / drug via naso gastric tube GOALS Maintaining nutritional status Administration of drugs POLICY Patients who can not eat by mouth EMPLOYEE Nurse EQUIPMENT Boiled water Liquid food / medicine Funnel 5/10 cc syringe Tissue Perlak / pengalas Crooked Gloves PROCEDURE IMPLEMENTATION Phase Pra Interaction To verify the data previously when there Washing hands Placing the device near the patient correctly Phase Orientation Greet and say hello to the patient's name Describe the purpose and procedures of action on the family / patient Asking for consent and readiness of clients Work Phase Maintaining privacy Adjust the position of the patient in semi-Fowler position /          Fowler (if no contraindications) Wearing gloves Installing pengalas on your chest Determine the position of NGT by aspiration of gastric contents installing funnel Entering boiled water, open the clamp, elevate 30 cm, before the expiry of the clamp back Incorporating liquid food, open clamps, elevating 30 cm, clamps back before it runs out Entering boiled water, open the clamp, elevate 30 cm, before the water runs out the clamps back Closing the end of NGT with syringe / clamps Clean the leftovers in patients tidying patients Phase Termination  To evaluate actions  Saying goodbye to the client Tidy tools  Washing hands  Noting the activities in the nursing record sheet