Lecture 1
X-Ray
CT Scan
MRI
核磁共振


唯一沒有輻射的檢查方法
Pace maker / 孕婦懷孕三個月不適用
PET Scan
正電子斷層掃描

將放射性追踪劑注入病人體內，並使用 PET 掃描儀器記錄病人的身體
影像。



由電腦建構出受檢部位的多方位圖像
放射性追踪劑通常會積聚在患病組織中，而非健康的組織內
PET 掃描器常與電腦斷層掃描（CT）一同使用，這便可將 CT 影像提
供的結構性訊息與 PET 的功能性訊息結合。
o 檢測和監控包括癌症、腦部神經障礙和心血管疾病等病症
o 確定癌症是否正在擴散至其他身體部位，以及擴散至何處
o PET 掃描可顯示大腦哪個部位導致癲癇發作，有助醫生制定癲癇症的
治療手術。
o 評估阿茲海默症和柏金遜症，產生的影像可精確地指出未正常運作的
大腦區域。
X-Ray
- General Radiology Exam Rrequest Form
*PT under 60 yrs + Contrast  Provide blood test within 1 year
- General X-ray VS Fluoroscopy

General X-ray
o LMP: within 28 days
o NO preparation
LMP
Aims
General X-ray
Fluoroscopy
Within 28 days
Within 10 days
Barium Swallow
VFSS
Examine upper gut
Examine Upper gut
Nil
Preparation
Aims
Adult Preparation
Barium meal
Barium follow through
Barium enema
Stomach / Duodenum
Small intestine
Colon / Rectum


Fasting / Light meal

Fasting / Light

Low residue diet
in the last dinner
meal in the last
Nil orally 8 hrs
dinner

Klean-prep
Nil orally 8 hrs

Fluid intake only

2 days prior
after Klean
Child Preparation
Nil orally 4 hrs
Nil orally 4 hrs
NO Klean needed
Ultrasound
- Ultrasound Request Form

Interventional Procedures (biopsy): Clotting profile within 2 weeks
o involve wound, therefore, need to check the blood clotting level

Cholecystectomy: No fasting required
o otherwise, fasting for at least 6 hours
o water + med is allowed

Urinary bladder: full bladder required
o Foley: clamped  collect urine as usual

Transabdominal: full bladder required

Transcrectal Prostate: Fleet enema

NO Preparation required: Doppler scan, Kidneys scan, Ureter scan
Computed Tomography Scan (CT Scan)
- CT Scan Request Form

Plain VS Contrast
o Contrast media: 碘  口服 或 注射  Kidneys 代謝  需提供三個月內的 Kidney 血液報
告

Elderly (60yr): Blood test result of creatinine

Female: LMP 10 days  Not pregnant  Sign consent form

Female: Out of 10 days  pregnancy test  positive  cxl or alternative or postpone

DM Patient on Metformin:
o Assess serum creatinine level within 1 year
o If eGFR>30ml/min/1.73m + no kidney injury

Continue taking Metformin
o If eGFR<30ml/min/1.73m


Stop taking Metformin (from the time administrating contrast medium)

Measure eGFR within 48 hours

Restart Metformin if kidney function no significant changes
Stop Metformin before CT Scan
o Contrast medium slows down the function of kidneys  Buildup of Metformin  Lactic
acidosis 乳酸中毒  Serious symptoms (e.g. difficulty breathing)

Coronary Angiogram
o 非入侵性無痛檢查
o 快速搵到粥樣斑塊位置
o Heart rate: <65/min  Beta blocker

Fasting: 3-4 hours

Renal function: check creatinine level

Allergy / Asthma: Prednisolone + IV hydrocortisone
o 8hrs and 4hrs before exam: IV hydrocortisone 200mg
o 9pm before the day of exam: Oral Prednisolone 40mg + 2 hours before the exam: Oral
Prednisolone 40mg
o Emergent pre-med: IV hydrocortisone 200mg STAT before the exam
Magnetic Resonance Imaging Scan (MRI)
- MRI Request Form

與金屬相沖  Take them off before examination

Cardiac pacemaker / ICD  Inform MRI dept in advance

Tattoos  color pigments  burn

Infusion pumps: long extension line

Cholangiogram (膽道胰管磁振造影術) : Fasting 6 hrs

Stress perfusion: Fasting 4 hrs

LMP: 28 days rule

Pregnant woman: >13 weeks safe
Intervention Radiology
1. Consent form
2. Blood clotting status
a. ATPP: how long it takes your blood to form a clot
3. Allergy history
4. Fasting management
5. Own med management
6. Bring your own film (for Doctor’s comparison)

PT should withhold blood thinner before IR procedures
o Anticoagulant
o Aspirin
Summary:
X-ray / Flu:
60yrs
 Blood test within 1 year
U/S:
Interventional procedures
 Clotting profile
CT:
Harmful to Kidney
 Serum creatinine
Metformin + Malfun. kidney  Withhold metformin
 Measure eGFR within 48 hrs
 Restart if no significant changes
MRI:
More than 13 weeks pregnancy  Safe
IR:
Blood clotting (APTT)
Withhold blood thinner
22 Feb Fion’s Roleplay Revision
(1) Haematology 血液學 / Immunology 免疫學 Request Form
(2) Biochemistry Request Form
Haematology 血液學 / Immunology 免疫學 Request Form
ESR, Westergren (發炎 ESR 上升)
紅血球沉降率(Erythrocyte sedimentation rate, ESR)，簡稱血沉，為傳統的血液檢測，常包括在一般的
身體檢查中。風濕免疫病病人對 ESR 並不陌生，因為這是發炎指數之一，用以評估發炎程度。
ESR 量度血液樣本中紅血球沉降的速度。由於多種不同情況可導致 ESR 上升或下降，因此醫生不能
以 ESR 準確診斷任何一種疾病，但這特異性不高的測試讓我們知道身體有沒有發炎。醫生需要其他
檢查和臨床證據以作診斷。
如患者身體有發炎，紅血球沉降速度較其他人快，這是因為發炎過程導致血液中某蛋白增加，而這
蛋白令紅血球更易聚合，因而沉得較快。如果你 ESR 有所上升，便需要求醫以作進一步評估。
Blood: Haematology 血液學 / Immunology 免疫學 Request Form
For Dr. Chan Tai Man / Tsang Sze Wing
Urgent: If tick “O.T.”, please write down date and time of OT
Sampling Date: Today
Sampling Time: Written by 抽血員
Clinical Diagnosis / history: 儘量唔寫 “check-up”,因為 PT 要 claim insurance
Blood: Biochemistry Request Form
突然心絞痛先 check
X-Ray: General Radiology Examination Request Form
For PT who needs
Contrast
Put “tick” in
“General”
MRI 磁力共振: Magnetic Resonance Imaging Request Form




有冇幽閉恐懼症  解釋咩嚟
有冇心臟起搏器
有冇金屬植入物 （e.g. 通波仔 Intravascular Stent/ 假牙：固定 or removable?）
有冇藥物敏感



有冇心臟病高血壓糖尿
有冇哮喘
有冇照過 MRI
幽閉恐懼症之解釋：
「似一個短 tunnel,唔黑既，有少少光。不過你就會訓係儀器中間，被儀器包圍住。如果過程唔舒服
都可以禁鐘，我地會停止個過程。」
如果 PT 有幽閉恐懼症，醫生會開啲令 PT 放鬆既藥。
History of Contrast Reaction
 上次邊到照？ HKSH  幾時邊日？ 搵得返過敏資料
Summary:
1. 最緊要填 Date and time, Doctor’s name, 自己名
2. 預左 PT 多問題問，所以要了解每個 Test 點做
3. 如果個 Test 趕住做，打去個 dept 問收到 form 未，講聲係 urgent
4. X-Ray 有 Portable
Lecture 1: Diagnostic Procedures
- Different procedures (need fasting?)
- What preparation do we need before transferring the patient?
- Some info in the notes is supplementary
Case 1: If a patient 肚痛，Doctor order U/S
- Ask for patient’s consent 「聽日book左U/S，轉頭會幫你book,轉頭同你講details」
- PH/ non-office hours做medical imaging  more expensive than weekdays  向patient報價
*Explain procedures about preparation/ procedures/ aftercare needs:
- dept sends 23/F 通知紙，tick格仔話比23/F知有咩preparation, e.g. Fasting till 8am tmr / can sip but can’t eat til
8 am tmr
- if urgently 即日做，未必有通知紙，fax紙去dept約booking, 有位會call 23/F
- 打contrast會有咩感覺
*幾耐會有個results
In-patient (more urgent): am做，當晚有報告 (tell patient: within 1 day)
out-patient: 2-3 days (tell patient: within 1 week)
x-ray片:好快有
_______________________________________________________________________________________
Barium Swallow: 吞顯影劑落肚
VFSS: Food / Beverage + 顯影劑落肚
[ No preparation needed]
Medical Imaging:
1. X-ray  General / Fluoroscopy螢光檢查
2. U/S
3. CT Scan
4. MRI
5. PET CT Scan 正電子發射掃描技術
X-ray – General Radiology Examination Request Form
*KUB = Kidney / Ureter / Bladder
*LMP = Last Menstrual Period
*Klean-prep: intestinal examination and colon cleansing before operation
- Barium > VFSS : hows how the muscles in the mouth and throat work during swallowing
References:
Barium Swallow
病毒培養
Medical Imaging
外科手術消毒
血糖
Diabetes Hong Kong
不同部位量血糖
肺結核肺炎
Lecture 2: Collection of Specimens
Why?
1. Spot any virus inside PT’s body  check their secretion
2. Compare the results to see any progress  check the effectiveness of treatment
Clinical
Alert:
Ensure the right patient  Verify ID & Specimen bottle (name + 「留痰」)
Sputum: - From lung, bronchi, and trachea
- Not from mouth and throat
Why collect sputum?
1. Check if the PT get TB lung  Acid-fast bacillus
2. C&S 1
Collect sputum for able-PT:
1. 3 Consecutive day
2. Early morning
3. Rinse mouth
4. Deep breath
5. Cough up: 4 – 10 ml
6. Time & Date on label
7. Mouth care
Collect sputum for unable-PT:
Sputum trap
Best sputum = Fresh + Cough up
Form: Bacteriology, Virology, Serology, Urine, Stool & Semen Request Form
1
Culture: find gems (bacteria & fungus) causing infection; Sensitivity: which antibiotics are the most / least effective
Lab Results: Dr. will remove / add certain antibiotics according to “R OR S”
R = Resistant (抗藥性 Drug is ineffective to that germs)
S = Sensitive
Blood:
Venipuncture
Common Blood Tests:
1. CBC
2. Serum Electrolytes (Potassium / Sodium)
3. Serum Osmolality (Any dehydration)
4. Drug Monitoring (抗排斥程度)
5. ABG (pH value of blood)  Apply pressure for 5-10 mins 抽完血後禁自己隻手
Swab:
Wound swab
Throat swab
1. Sitting Position
2. “ah” to minimize gag reflex
3. Take sample as quick as possible
Nasal swab & Nasopharyngeal swab
Lecture 3 Glucose Measurement
1. What is glucose?
a. Sugar in the bloodstream 血液中葡萄糖濃度
2. What is insulin?
a. Serve as a key to let glucose into the cells for storage and energy
3. What is diabetes?
a. Do not have enough insulin
b. Insulin resistance  high BSL
4. Glucose level is affected by medication
a. Medication: Steroid
i. Reduce pain and inflammation
ii. Prevent nausea during medical procedures
iii. Many types: Prednisolone
b. Steroid raise blood glucose levels by reducing the action of insulin (causing insulin
resistance) and making the liver release stored glucose into the bloodstream.
What factors affect blood sugar?
5. Who needs to be monitored?
Patient with:
a. Diabetes
b. Use of anti-hyperglycaemic medication
c. Use of parenteral or enteral nutrition with insulin therapy (bypass digestive system)
d. Fasting
6. Implementation of Glucose Measurement
Adult: Middle finger / Ring finger + Lateral side of fingertip
Infant: Lateral aspect of heel
Assessment:
1. Check NCP
2. Check patient’s medical record
3. Check history of bleeding disorder
4. Check medication for prolong bleeding
5. Check time of and type of last meal
6. Get PT’s label
Equipment:
1. Nova Stat Strip Glucose Meter
2. Nova Stat Strip Glu-test strips  within 6 months
3. Lancet
4. Sharp box
吊鹽水係將液體持續打入靜脈嘅方法，所
謂嘅鹽水成份唔只鹽水，通常都會有葡萄
Onsite:
1. Assess hand and skin conditions of fingertip  吊鹽水隻手唔驗血糖
2. Login
a. Operator
b. Accept “Glu”
c. Strip Code
d. Patient ID
i. 111 / 222 / 333
e. Insert strip
3. Massage hand and finger
糖、營養液甚至係藥，目的係令身體可以
快啲吸收，唔使等消化系統慢慢消化。
4. Disinfect fingertip
5. Air dry
6. Puncture
7. Wipe away 1st blood
8. Wait for 2nd blood
9. Apply to strip
10. Wait 6s for the results
a. Abnormal  report to N.N.
b. Normal  “Accept”
2-hour postprandial (PP)
Lecture 4 Postural Drainage
Postural Drainage
 Airway clearance technique: the use of gravity  clear secretions from different segments of lungs
 The affected parts of lung  higher point of body (10-15 mins)  secretions move
Who needs postural drainage?
 Post-operative status
o GA
o Painful incision
 Acute / Chronic lung diseases
o Bronchiectasis
o Cystic fibrosis
 Mechanically ventilated
不能夠自己咳出痰
Clinical Alert
1. Can the patient tolerate the change of position?
beforehand
2. Avoid after meal / full stomach
3. Schedule depends on the lung secretions (多痰多拍)
痰邊到來？
點解手術後咁多痰？
Assess patient’s ability / vital signs
Lecture 5 Nasogastric Tube Feeding

What are the usages of Nasogastric Tube?
o Short-term feedings of nutrient or medications
o Lavage stomach in case of drug poisoning
o Remove gastric content for lab analysis

Who needs Nasogastric Tube?
神經性厭食症(Anorexia Nervo- sa)是一種飲食失調的極端表現，原因 是患者過分迷戀自己的體重以及苛求 所吃的食
物。
這個疾病其實和 飲食本身無關，而是患者以一種非健康的方式來應對情緒問題，且陷入一 種妄自菲薄自我否定的精
神狀態。
併發症
因為心律 異常或體內鈉鉀鈣等維持體液平衡的 電解質紊亂所致。常見的併發症包 括:死亡、貧血，二尖瓣脫垂、心
律 不齊、心力衰竭等心臟問題，因骨質 流失而增加的骨質疏鬆風險。女性閉 經，男性睾酮激素水準下降。

Types of Feeding Tube
o Nasogastric tube
o Nasointestinal tube
o Nasojejunal tube
o Salem sump tube
(Not commonly used in HK)

Before Assessment
o 金 label
o Prescription

Diagnosis
o Progress Note

“to BSB” = Drainage bag

Fr.16

Aspirate Q4H
o Admission Form


Diagnosis

GI Assessment

History of Surgery

Chief complaint

Family history
Assessment
o Check history of nasal surgery
o Check any deviated septum
o Assess patency of nares
(Torch)
o Assess any deformities of nose
o Check intact gag reflex
(Tongue depressor)
o Auscultate for bowel sounds
(Stethoscope)
o Palpate patient’s abdomen for any distension, pain, rigidity 硬度

Equipment Features & Usages
o Syringe 50 ml
o pH indicator strips
o Adhesive tapes

Micropore

Duoderm Extra Thin
o Lopez Valve


Installation

Usage
Insertion Procedures
o Assessment
o Planning

Prepare equipment

Prepare patient
o Implementation

Evaluation
(Education)
(Education)

What are the uses of Nasogastric Tube?
1. Removal of gastric secretion
2. Introduction of nutrition into stomach
Why do we need to aspirate blood?
- Blood induces inflammation response.
What do we remove?
Intestinal gases, blood stain, gastric content.
What do we introduce?
Nutrition and medications.

Who needs Nasogastric Tube?
1. Dysphagia (Swallowing difficulty)
2. GA Patient (General anaesthesia)
3. Inadequate intake due to fatigue / depression / mental factors
4. Upper gastrointestinal bleeding
(?) (Stop food and drink intake. Aspirate the blood)
5. Poisoning / Drug overdose
(?)

Types of Nasogastric Tube
Stomach
Small intestine
Ryles Tube
Levin Tube
Harmful for rugae during aspiration
(會好易啜住胃壁)
Silicon
Features
Duration
Advantages
Disadvantages




Soft
Long
Thin
1 month



Flexible when inserting
More protective to stomach mucous
More comfortable to patient
PVC

Hard

7-10 days, not longer than 2 weeks

Not comfortable to patient

Equipment Features & Usages

Gloves & Googles

Underpad
Something to handheld:

Tray
Clean the nose:

Cotton-tipped applicator

0.9% Sodium chloride

Torch
Check gag reflex

Tongue depressor
Main:

Fr. 12-18 (HKSH: Fr.16)

Lopez Valve

Adhesive Tape – Micropore & Duoderm Extra Thin

Kidney dish

Syringe 50 ml

pH indicator strips

KY Jelly (Water-soluble)

Non-woven gauze

Stethoscope

Dentures container (HKD 30 each)
Something basic
Something routine:
90% Disinfection
Sterilize
Clinical alerts:
1. Contact precaution / Isolation PT: PPE
2. 唔建議 90 度，因為 PT 會向前傾
a. 餵奶過程最緊要比頸椎有適當支撐
3. 用 end of tube 嚟量度條 tube 要幾長
a. Nose tip – Earlobe – Xiphoid Process
b. 成個過程盡量保持乾淨，even 呢個並非無菌程序
4. 比 PT 一個清晰指引
a. 頭 dump 低
b. 吞口水
5. 插 tube 過程檢查有冇 Coiling,最後叫 PT 打開口檢查
Validate Right Gastric Placement
1. Aspirate pH of gastric content by 50ml syringe
a. 睇色質量 (colour, consistency, odour)
2. Check X-ray
a. X-ray dept
b. Portable X-ray
3. Whoosh Test
a. Inject 10-20ml air & Listen for a whooshing sounds
度好位就固定位置
Locate the tube in the center of the nostril
 maximize air inflow
 prevent irritation to the edge of nostril
固定好位置就駁 Connector
After feeding, OFF to patient.
- 短啲縛 rubber adopter, 縛 nutritional source / BSB / Spigot
- 長啲縛 feeding tube (姐係 patient)
- 中間比藥
Documentation:
Summary:
Assessment  度管  放管  痴管  抽汁  駁 connector  餵奶  BSB  Document
Decompress lung
Nostrils deformity
Lecture 14 Start Feeding
Main idea:
a. 已經插左 Feeding Tube，要比營養奶 Patient 的過程
b. Feeding and Care – They are in pair
a. Suctioning (if needed)
Remain position:
30 mins
Feeding:
45 mins – 1 hr
b. Oral care
c. Napkin change
Assessment:
1. Explain procedures in simple words
2. Raise bed to appropriate height
3. Semi / High fowler’s position
a. 60-70 degree
4. Check any coiling in nostrils and mouth
5. Check bowel sounds by stethoscope  expose the only part, not the whole body
6. Palpate stomach
Planning:
1. Feeding by Syringe
2. Feeding by Feeding Set
Syringe
Food thermometer
Feeding Set

Warm the content to 35 – 37 degree

Microwave: 10-20s

Place the food thermometer on a piece of tissue paper to avoid
contamination

奶要浸到個細 loon
Label
No
Yes
Feeding Cup
Yes
No





PT’s surname
Bed number
Food / Formula type
Amount
D&T of opening on FD Set
How to determine the use of tube?
Short term
Long term

Nasogastric tube (NG)

Orogastric tube (NO)

Gastrotomy tube (PEG)

Jejunostomy tube (J Tube)
Types of Feeding
 Bolus Feeding
o Syringe
o Bag

Continuous infusion (pump)
o 24 hours
o “cycled feedings”
o Rate 升 actual feeding time 跌
1. Store used formula in a covered container inside refrigerator
2. Warm the refrigeratored formula
3. Discard used formula after 24 hours
4. Flush the tube to avoid tube clotting
a. Lukewarm water
b. Before / After feeding
Bolus Feeding
Right before / After feeding
Continuous Feeding
Flush 4-6 times per day
Long term feeding
or
nose / mouth are contraindicated
5. Clamp tube before you disconnect the tube
6. Unclamp tube before any insertion
7. Check residuals = Ensure stomach is emptying properly
a. Gastric residual volume 胃餘容積
i. 使用鼻胃管灌食之病人，灌時前可以空針反抽檢查胃餘容積，以評估病人消化
情形
ii. 胃餘容積在營養治療上的重要性:管灌食病人連續 2 次灌食前反抽，胃殘留量
>200ml 時，則暫停灌食一餐至病患的胃排空改善，以防食物反吸入造成吸入性
肺炎，仍未改善則考慮改變灌食方法或插管位置，若是 使用 bolus feeding，可
改為 continuous feeding，若是因為血糖控制不佳造成胃輕癱或創傷導致腸絞塞，
而使 胃排空變緩，可將插管路徑由鼻胃管改為鼻十二指腸或鼻空腸灌食。
胃輕癱: 胃排蠕動 / 空速度極慢, 食物從胃部排空到十二指腸所花的時間比平常更長。
Percutaneous Endoscopic Gastrostomy (PEG)

Check for any changes in the skin or tubing
Insertion
Tube & Fr
Assessment

Suctioning

Napkin Change

Oral Care
Feeding

餵前 check marking, nose,
Removal

透啖氣唔好呼
氣
mouth

打 20ml 氣
Ryle’s Tube
Ryle’s Tube
Ryle’s Tube
Fr.16
Fr.16
Fr.16
Allergy
Marking location
- Check mouth
Nose
- Bleeding
Bowel
- Surgery history
- Bowel sound [expose the only
- Deformity
part]
- Potency
- Palpate stomach to see if any
distention
Mouth
- Bleeding
- Surgery history
- Sputum
- 睇吞唔吞到一啖口水
- Gag reflex
Bowel
- Bowel sound (5-30/min)
in 4 quadrant
- Palpation
- Observe
Elimination Need
Collect
- Ryle’s Tube Fr.16
Equipment
- KY Jelly
（有系統地分
- Lopez Valve + Spigot
開用品）
- Kidney Dish +
Underpad
- 50ml Syringe
- pH indicator strips
- Micropore
- Gallipot (if needed)
Layout
- Prop up patient 60-80
Equipment
- Place an underpad +
Kidney Dish
- 撕開包裝
- Lopez valve 安裝好
*舊膠插短邊，插實會
“啪”一聲
*經常 OFF TO PATIENT
- 拎一條 pH strip
*留意顏色方向
*擺 Galliport 之上備用
- Put KY Jelly on a gauze
- 長 Duoderm Extra Thin
一分為二 + 剪圓角
Implementation
- Nose tip – Ear lobe –
Xphoid process  Marking
- 入到 5-10cm, PT 低
頭，叫 PT 吞啖口水
（當有阻力時吞啖口
水）
- 初步固定
- 抽 gastric juice 30ml for
pH
-抽 gastric juice until
resistant
*留意自己抽左幾多支
Syringe
- Connect Lopez Valve to BSB
& OFF
- 最後固定 （除舊迎
新）
*唔好 cover 到 marking
*痴臉 （有 buffer 緩衝）
- Check if the tube coiled
in the mouth
- Aftercare + 坐一陣先訓
低
存 Bedside
- Syringe
- pH indicator strip
- Normal Saline
- Spigot (in case 突然 off
BSB)
Notes:
- Whoosh Test (if needed): 2030ml air
- Pantry 用 filter water 洗野。
- 如果太多胃液係 kidney
dish，可以係洗手間倒晒 d 胃
液先
如果抽唔到胃液，有兩個方法：
1。轉 PT 去 Left side，因為有時條管啜住胃壁
2。搵 Named Nurse 做 Whoosh Test
Lecture 21 Feeding Procedure by Ka Po
1. Feeding Pump Features
2. Preparation of Formula
a. Verify formula
[Patient’s safety]
b. Warm the milk
[Patient’s safety]
3. Assessment – Report
Types of Formula
Feeding Pump Features
Equipment for Assessment

Label

Nursing Care Plan

有冇食物藥物敏感？

Marking is in position

The intactness of Duoderm Extra Thin
o Nose
o Face
**5cm 1 格，睇返 nursing care plan marking 位置係邊

Torch
o Check mouth (In-situ)

Stethoscope
o Bowel Sound

Warm Blanket
o Cover the neck and upper chest when checking bowel sound

如果 PT 有氣管造口，問下 PT 依家有冇痰、洗唔洗幫你吸左先
- Explain Procedure:
1. 一陣會幫你坐高個人起碼 45 度 或以上，等 D 營養奶易 D 落到胃
2. 輸入營養奶前會打 30ml 水幫你沖一沖條管先
3. 輸入營養奶後同樣都會打返 30ml 水沖條管
4. 維持係同一個位置起碼 30 分鐘，比時間胃消化營養奶
- Prop up PT at least 45 degree
1. 坐高左個人有冇覺得唔舒服
Equipment for Implementation
Feeding pump
Formula
Jar
Thermometer
Feeding bag
Syringe
Warm water for flushing
Underpad
2 labels for feeding bag
65
Lopez Valve
Feeding tube
**Ensure there is no sudden event, e.g. physio**
Assessment:
千其唔好 overheated!
- Prop up PT already
- Address elimination needs / Suctioning needs
Collect equipment for implementation:

對奶
o Nursing Care Plan + NN
o PT’s name
o Brand name 逐個字讀出來
o 250ml
o Expiry Date
o 係咪可以餵晒？
That’s why you need to check with Nursing Care Plan!
o 係咪夠鐘餵？

調酒師  Disinfect 奶面  開奶 in the jar

叮奶 in the jar:10 秒  攪拌  10 秒  攪拌

量溫度 (35-37C)
o 六角對六角
o cover 個 loon loon
o 攪拌用匙攪，不是溫度儀

拎新奶袋，檢查一次係咪冇穿冇爛 => Intact

例奶入新奶袋

貼兩張 label,要 CI / NN 簽名
o 奶袋使用日期及時間
o 奶的種類、開奶人、CI / NN 名

*Prime Tube til the end of tube

Feeding set 插好 feeding pump:
o 平面 sip 中間，唔好硬塞
o 跟返坑位放返好條管
o Check 電源
Implementation:

Place a warm blanket on the PT

插電制

Check tube is in the right position = Aspirate gastric content
o Check pH Indicator baseline (same direction)
o Lopez Valve connect to patient & Syringe
o OFF to medical port
o Aspirate 5ml gastric juice

色

質

量
o OFF TO PATIENT  用完一次就要！
加塊 Gauze，以防漏水
打水唔 OFF TO PATIENT
用完即 OFF TO PATIENT
By Gravity 慢慢落，唔洗拎太高，否則會衝力
太快
D 水去到 Tube 位置立即 OFF，**以免空氣入
左 Patient
Clinical Alert:
1. 餵藥一定要 Three Rights Five Checks
a. 就算係姑娘叫你餵，都要 Double confirm with N.N., 例如問係咪 2304-5 一粒淺粉紅色
藥丸
b. 有咩事都會賴餵個個到
2. Alert 幾時要 eternal feeding，RN 比醫生更常接觸病人  Clinical Judgement
3. Alert 大小二便色質量，唔好填完係 I/O 就算
a. 如果連續好幾日都係 yellowish watery small amount,就要去 find out 點解會咁
做 RN 唔係做 ward aide, RN 係要見到有野唔對路就要去搵出背後原因，唔係治標係要治
本。
4. Feeding 前要睇 I/O chart，留意 output amount / colour / consistency, 會比到 hints 你點去做
assessment.
a. 例如 PT yellowish watery small amount，3-4 times/day for 4 days, 咁就要問 PT 大便時有冇
困難，有冇肚痛 / 肚漲 / 胃痛
b. 例如 PT 拉黑水液，得一粒屎，連續幾日，就要問問 PT 有有冇飲夠水，食菜同生果，
有冇排便困難，有冇肚痛 / 肚漲 / 胃痛
做 RN 唔係做 ward aide, RN 係要見到有野唔對路就要去搵出背後原因，唔係得個「做」
字。
5. 即使同事交更比你管你，都要 check 下條管 marking 係咪岩位
6. Nursing student 要同 staff double confirm
a. food type
b. formula brand
以防調亂兩個 PT 既奶
c. amount
**Why we need to prime the tube?

To prevent micro-bubbles
Micro-bubbles  Lodge in heart and pulmonary vascular bed
如果以靜脈注射打「空氣針」，則有可能致死。有研究指，若多於 3 立方厘米（cc）空氣進入血
液，會影響血液引流，或令血液未能及時供應至身體各部位，出現氣泡栓塞
Lecture 6 Nasopharyngeal Suctioning (Year 4 / Staff 左要做)
High-risk procedures  not handled by student nurse
Purpose: remove the secretions through suction outlet
Assessment
1. Check NPC / Doctor’s notes （讀一篇文出嚟）
Doctor’s prescription: Type / Fr.
a. Nasopharyngeal Suctioning
Admission Form: AAA / Surgery history
b. Oropharyngeal Suctioning
DOC: Vital signs – RR & SPO2
I/O: 幾點食過野
2. Verify ID
3. Check NPC / Doctor’s notes （讀一篇文出嚟）
a. Nasopharyngeal Suctioning
b. Oropharyngeal Suctioning
4. Assess PT
a. Lung sounds – bubbling
Stethoscope & recheck after procedures
b. RR & Spo2
Oximeter
c. Cyanosis (blue skin or lips)
d. Abiliy to cough
e. Prop up at least 45 2OR Rt lateral facing me
(睇排板)
f. Toilet needs
g. NO eating / drinking
h. PCA if necessary
(睇排板)
i. Call bell + Siderail
5. Get ready for equipment (Installation & Unpack tube) & PT
a. Place an underpad on the check of PT
b. Lubricate by 0.9& NS
6. Test suction force by pressing the thumb port
7. Encourage PT to take a deep breath before suctioning
8. Implementation
a. NEVER press during insertion until you hear the “shhhh…” sound (reach 到舊痰)
Adult
Naso
Oro
Depth
12-15 cm
10-15 cm
Pressure
100 mmHg
100 mmHg
(80-120 mmHg)
(100-150 mmHg)
10s per suct （轉轉禁禁 taentaen）
Suction duration
30s – 1min PT rest
Rinse tube
5mins in total
Clinical alert

Keep eyes on oximeter to monitor Spo2

Naso: Lt nos.  Rt nos.

Oro: Insert catheter along the side to prevent gagging

After 10s, stay thumb away from control valve to prevent
hypoxemia
9. Assess need of refill
a. 0.9% Sodium Chloride
b. Gloves
c. Medi-vac
10. Report
a. Type & Fr. of suction tube
b. Sputum 色質量
c. Reassessment 情況 (Spo2 / RR)
I completed naso and oro suction with Fr. 12.
2
depend on the body conditions of PT.
Alert:
1) High pressure cause excessive trauma to muscosa
2) Suctioning removes air from patient’s airway and may cause hypoxemia
3) Pre-oxygenation prn
4) Lubricate the tip of catheter with 0.9% to reduce friction and eases insertion
5) Never apply suction during insertion (唔好禁 suction control valve / thumb port) to reduce trauma
6) Oro: Insert catheter along the side to prevent gagging
Lab Test:
1. Light / Warmth / Privacy
2. Perform Hand Hygiene
3. Verify ID
4. Explain procedures
Anaesthetic 麻醉藥 (anna/sthe/tic)
Intravenous cannulation 靜脈注射
Venous 靜脈
microorganisms = germs
Antisepsis = to destroy germs
Asepsis = the absence of bacteria, viruses, and microorganisms
Aseptic technique = a set of practices and procedures for ensuring asepsis and preventing the transfer of potentially
pathogenic microorganisms to a susceptible site on the body
Principles of Aseptic Techniques:
1. Large area of environment
2. Operators’ hands, patient’s affected area
3. Equipment
4. One swab once
5. Dispose the equipment which is out of the sterilized field
6. Needs of human resources rises
When do we need aseptic techniques?
1. Surgery (Before / During / After)
2. Wound care
3. Urethral catheterization
4. 皮膚以下要 expose to air / Invasive procedures
Ch 31 Asepsis and Infection Prevention
Introduction of microorganisms

Harmless and even beneficial microorganisms

Normal resident flora
o
E.coli  Large intestine
o
cause infection of urinary tract

Virulence: 可以有幾毒

Severity: 隻毒可以有幾嚴重

Communicability: 傳播力有幾強

Pathogenicity: 隻毒可以幾有能力令人發病
Heart diseases, stroke = non-communicable diseases
Infection

Growth of microorganisms  somewhere they are not usually found

Immune system 唔夠病毒打
Acute
突然間有病，維持好短時間
e.g. Kidney
Chronic
一直有病，維持長時間
e.g. Hep B liver cancer
Infections agent

係 somewhere unusual 搵到個隻 microorganisms ＝Infection agent
Subclinical

no S&S can be recognized
Example: Cytomegalovirus CMV 巨 細 胞 病 毒
部分被感染者，並不會出現任何症狀或徵候。 然而，對於未出生的胎兒或免疫力有缺陷者，巨細胞病毒卻具
有致病力。巨細胞病毒一旦進入人體內，則會終生存在。
若胎兒 感染巨細胞病毒，則可能產生各式各樣的殘疾。
「巨細胞病毒」(Cytomegalovirus) 屬「疱疹病毒」(human herpes virus) 一種，又稱「人類皰疹毒第五型」
(Human herpesvirus-5, HHV-5), 全港超過九成人曾受感染，大多沒有任何病徵，但個別情況可以致病。
巨細胞病毒主要經唾液傳播，香港環境擠迫，幼兒早受感染。
HK Red Cross:一部分的捐血樣本，會進行巨細胞病毒抗體（CMV）檢測，抗-CMV 呈陰性的血液，可供應有
特別臨床輸血治療需要的病人使用。
Disease

Detectable alteration in tissue
Pathogen


Nucleic acid
Enter living cells to reproduce
If no asepsis used, then you will have sepsis
Asepsis
Techniques
Medical
 Standard (reduce)
Surgical
 Sterile (eliminate)
Aim

Limit the number of
microorganisms

Free from
microorganisms
How to achieve the aim?

Confined microorganisms
to specific area

Practices of destroying
microorganisms
3M Steri-Drape Surgical Drape Packs
Berry & Kohn's Operating Room Technique
Mayo Stand
Analgesics
Differences among 3 cleansing solutions

以清潔傷口來說，透明嘅生理鹽水為最合適，0.9％NaCl 與人體體液濃度相近，清洗傷口不會刺激傷
口造成痛楚� � ，不會對皮膚造成過敏，但無殺菌功效，因此適合用作清潔傷口，但對發炎傷口並無
消炎作用� � 。

粉紅色(如 PROSEPT / UNISEPT)：成份是 chlorhexidine gluconate 0.05%(主要用作消毒)

黃色(如 TISEPT)：成份是 chlorhexidine gluconate 0.015% + cetrimide 0.15% (具有消毒及
清潔功能）
兩者比較來說黃色比粉紅色殺菌能力較強，但若長期使用會較易出現過敏� 。

紅水(PROSEPT / UNISEPT)：成份是 chlorhexidine gluconate 0.05%(主要用作消毒)

黃水(TISEPT)：成份是 chlorhexidine gluconate 0.015% + cetrimide 0.15% (具有消毒及清潔功能)

生理鹽水(NORMASOL)的主要成份是 9% sodium chloride w/v (主要用作清洗傷口)
由此可見，如果只係一般被割傷嘅傷口，用紅水會最合適；而如果係戶外弄傷，傷口上有受外來物
污染，此時黃水就最為合用。
至於生理鹽水，由於含有鹽份，而且成份接近人體體液，具有較溫和的殺菌功能。 除了清洗傷口
外，亦能作清洗眼睛及鼻腔之用。
Lecture 7 Wound Dressing
Purposes

由開始過程，都要清楚知道邊啲可以掂邊啲唔可以掂

如果掂左唔可以掂個部份，要識點處理

見到個傷口之後，除左要 assess，仲要諗點 prepare PT 同用品先係最方便自己做野
Aseptic Non-touch Technique

Key parts: equipment

Key sites: PT’s body

Protections
o
ANTT
o
Aseptic field management
o
Standard precautions
9 Principles
1. Sterile 一定要 Sterile
a.
Check equipment
i. stored for only prescribed time
ii. Dry & Intact
iii. Expiry date
b. Chemical indicators of sterilization
c.
Package: “sterile”
d. Clean trolley with alcohol towel
2. Sterile 掂到 unsterile = unsterile
a.
Discard / Resterilize
b. Questionable  assume “unsterile”
3. Out of sight = unsterile
a.
Keep sterile objects in view
b. Keep sterile gloved hands in view & touch sterile objects only
4. Prolong exposure to airborne microorganisms = “unsterile”
a.
Keep hair neat and tidy + Surgical cap
b. Don’t always in and out
c.
NO sneezing / coughing over a sterile field
d. Minimize talking to prevent droplet
5. Fluids flow to exit, not flow back
a.
Forceps
b. Surgical hand wash
6. Moisture / Solution 倒既位置
a.
Away from sterile field
b. Above the container 2.5-5cm
c.
Avoid splashing 陰力倒
d. Opened bottle of solution valid for 24 hours only
7. Edge of sterile field = unsterile
a.
Out of 2.5 cm = unsterile
8. Skin = unsterile
a.
Sterile gloves
9. 如有懷疑，請立即舉報
a.
Set up the field if u need right now, otherwise, do not set it up for future use
Types of wounds


Approximated edge
o
good healing process
o
minimal scarring
Unapproximated edge
o
delayed healing process
o
ugly scarring
What is meant by the term "well approximated edges" in nursing?
That the edges of a wound or incision are lined up neatly along side each other, making a repair neat and
easy. To be poorly approximated is to suggest the edges of the wound are chewed up and fit back together
poorly.
Well approximated wounds result in minimal scarring. Poorly approximated wounds typically leave ugly
scars.
Clinical alerts:
1. Ensure adequate light when doing wound dressing
2. Prepare the patient prior to open the dressing set
a.
Move patient to a side if needed
b. Pillow
c.
Underpad on the PT
d. Height of the bed & table
3. Opened solution valid for 24hours only
4. Clean from “clean” to “less clean”
Pat Dry wound surrounding ONLY
Clinical procedure for reference
AT Skill Demonstration with Fion (23 March 2022)
Alert:
1. 開完 dressing set 要 perform hand hygiene
2. Forceps always tip down
3. 拎 foreceps 拎高啲位置, 手指唔好掂到太多
4. 洗完傷口唔洗拎太高，靠手腕力屈返上嚟
5. Circular wound: 中間開始，半月形，洗個陣係愈洗愈出
6. Pat dry Circular wound: 如果塊 gauze 太大，折多一下，make sure surrounding skin 的細菌帶入 wound
7. Pat dry Circular wound: 用 non-woven ball pat dry
8. Pat dry 技巧：唔好條條 fing，同時個 forecep 唔好拮到 PT
9. HKSH Nursing Procedures: 未倒藥水已經拎左對 foreceps  dump
10. Other hospitals Procedures: 未倒藥水已經拎左對 foreceps  put the foreceps inside working area
11. 洗完傷口 ＋pat dry 完 ＝ dump dressing foreceps
Home Practice of AT
Date
7 March
Findings / Improvement / Questions / Mistakes
M: Pat 左傷口，pat dry 只 pat 周邊皮膚
M: 錯左 step，冇倒 solution.
正確：Remove inner dressing  Pour solution
9 March
F: 用 dominant hand 係易啲清潔傷口
F: 要係非領空範圍上活動及停留
I: Step 正確
Lecture 8 Spiritual Health
Exam: As a nurse, what do you do in this case? (Case study)

Spiritual health – religion

Take care of patients who have religion
o


Jewish: Kosher meal
How a nurse deal with a PT needs spiritual healthcare?
o
Contact chaplaincy 牧師
o
Provide a separated room for spiritual activities
o
Listening actively (等個 PT 呻下，安慰佢，通常呻完就舒服 D)
o
Withhold judgmental comments
o
Acknowledge PT’s feelings
Nurse DOES NOT resolve PT’s spiritual problem, we just support
Nursing Diagnosis
According to NANDA International, a nursing diagnosis is “a judgment based on a comprehensive nursing assessment.”

Assessment / Observation  identify problems  make clinical judgment  determine a plan & possible
interventions
o
Intervention: intentionally involved in a difficult situation to improve it (Improvement)
Example:
"Ineffective breathing patterns related to pulmonary hypoplasia as evidenced by intermittent subcostal and
intercostal retractions, tachypnea, abdominal breathing, and the need for ongoing oxygen support."
(Problem) related to (Eitology) as evidence by (Signs & Symptoms)
"Ineffective airway clearance related to gastroesophageal reflux (GERD) as evidenced by retching, upper
airway congestion, and persistent coughing."
“Breathing difficulty related to COVID-19 infection as evidenced by nose flaring, cyanosis, and the need of
oxygen support.”
病歷書寫常用字彙與句型範例
Lecture 9 Sexual Health
Nursing Process
Assessment

Subjective Data = Told by patient

Objective Data = Physical examination
What info we need to get from a female PT?

Menstrual history
o 你對上一次月經係幾時？
o 你第一次經期幾時？

Obstetric history
o 之前有冇懷孕？

有：幾時？幾次？
o 之前有冇生過小朋友？

有：幾次？
o G：大肚次數；P：經歷過生仔次數

Gynecological history
Four Phases of Menstrual Cycle
1. Menstrual Phase 月經期
2. Follicle Stage 子宮內膜增生期
3. Ovulation 排卵期
4. Corpus Luteum Stage 卵巢黃體期、子宮內膜分泌期
Which part of brain control reproductive system?

Hypothalamic-Pituitary-Ovarian axis 下視丘-腦下垂體-卵巢軸
How does hypothalamus control reproductive system?

下視丘分泌的 GnRH  腦 下腺分 泌 FSH 及 LH 卵巢  分泌動情激素(Estrogen)、黃體 素激
素(Progesterone)  子宮 內膜發生變化  月經
Uterus Cycle 子宮週期

子宮內膜的週期性變化
1. Menstrual Flow Phase 月經
2. Proliferative Phase 子宮內膜增生變厚
a. 行經期之後，排卵之前 （約十日）
3. Secretory Phase 分泌期
a. 子宮內膜持續增生  子宮內膜便會因黃體退化而 開始壞死、剝落，進入下一個子宮
週期的行經期。
Birth Control Patch
卵巢的一生
Lecture 11 Use of Restraint (Minimum of discomfort?_?)
What is restraint?

Against patient’s will

Limit the mobility of the patient for purposes stated below

Immobilize the freedom of movement of the patient
Purposes:

Prevent potential injury

Minimize the interference to other patients

Proceed medical treatment smoothly
Other than restraint, any alternatives?

Minimize the use of restraint: All bed’s rail raise 上晒四邊床欄

Restraint is the last resort
**任何工具都可以達到約束效果，不過䏲你點運用**
Types of Restraint Equipment:
抆 Ryle’s Tube 病人
Limb Holder
Clinical Alerts:
1. 如果病人太過 aggressive，可以搵多 2-3 個識用 restraint 的同事，甚至叫呀 Sir 嚟幫手。
2. 每次 on 左 restraint 都要立刻 assess PT’s current conditions
a. Circulation – 禁手指同指甲有冇血流通
b. Tightness – 2 個手指位
c. Risk of developing pressure injury – 工具突出位置唔好壓住 Patient 皮膚
d. Skin integrity
e. Skin temperature
3. Re-assess every hour + Q15 min Observation
4. On 左 Restraint 之後，一定要 maintain PT’s safety, comfort, dignity, elimination needs
a. Safety:
i. Circulation – 禁手指同指甲有冇血流通
ii. Tightness – 2 個手指位 (太鬆又冇成效)
iii. Risk of developing pressure injury – 工具突出位置唔好壓住 Patient 皮膚
b. Comfort:
i. On 左之後問 PT 有冇邊到唔舒服，邊個位要 adjust
ii. 需唔需要枕頭墊住
c. Elimination Needs
i. 定時定候入去問需唔需要去洗手間
ii. 如果用緊尿片，要 releases 左先（不過睇情況，8-4 都係用住 Mitt 嚟換）
5. Informed family members / guardian
a. Get consent within 24 hours
Every 15 mins:
monitor the all “Yes”
Every hour:
roundup check
Every 2 hours:
motion exercise
Removed:
motion exercise
Monitor for Medical-Surgical Use of Restraint
Reference: https://www.healthyhkec.org/healthcare/eldercare/techniques/
Lecture 12 First Aid
Purpose: Provide prompt care prior to the arrival of the ambulance
Principles:
1. 現場環境安全  安全先施救
2. 自己安全
a. Infection Control e.g. Korean offers a tissue paper to Crystal
3. 比適合的 Treatment (唔好 out of 自己能力)
Dealing with Casualty
1. 現場環境安全  安全先施救
2. 自我介紹  建立信任
3. 考慮對方性別、年齡
a. 唔好亂意
Triage = Break into three pieces

Prioritize the treatments based on the gravity (seriousness) of the injuries

Invented by French Imperial Guard’s chief surgeon, Dominique-Jean Larrey
Hong Kong HA Triage System (All A&E Departments)
Patients are divided into five categories according to their medical condition:

critical
 Immediate

emergency
 within 15 mins

urgent
 within 30 mins

semi-urgent

non-urgent
For patients whose clinical conditions are triaged as Category I to III, HA has set performance pledges on
the waiting time for their treatment.

Triage Category I (critical cases): Immediate treatment

Triage Category II (emergency cases): 95% of patients triaged as emergency will be treated within
15 minutes

Triage Category III (urgent cases): 90% of patients triaged as urgent will be treated within 30
minutes
Alert:
1. Aspirin (阿斯匹靈) should never be given to age under 16
a. 非類固醇消炎藥
b. 減少疼痛和腫脹（肌肉痛、牙痛、一般感冒、頭痛和關節炎）
c. 可作為流行性感冒症狀或疼痛之解除用途
d. 降低發燒
e. 小朋友食易誘發雷氏綜合症
Lecture 15 First Aid Second Part
Main idea: Different types of incident – Outdoor / Indoor
1. Bleeding
a. 止血先，等 PT 有命去急症室，先再處理 wound
b. Arterial bleeding: firmly press the wound site
2. Shock
a. Lie down & Raise legs (over heart level)
b. Lossen tight clothing
c. Monitor Pulse / BP / Breathing
d. Never ever provide O2 to patient
3. Internal bleeding
a. 特徵：肚漲 ＋臉青/灰
b. Pelvic fracture: 見到 PT 下體出現藍紫黑瘀  OT Immediately
c. 工業意外：串燒工人 ICU
4. Burns
a. Lose the functions of skin  First defence lost
b. Different types of burn: Dry burn, chemical burn, electrical burn
c. Degree of burning:
i. First: Outermost layer
ii. Second: Blister
iii. Third: Loss of feeling  can’t feel pain, die with infection
iv. Rules of Nine: 9% + 1%  追水
5. Airways Burn
a. 見到 nose / mouth / face 有黑黑灰灰
b. Airway 會腫得好緊要  can’t breath
Lecture 16 Bandage
Main idea:

Purpose of bandage

Injury – Banding method
o Reassessment: check circulation

Management of wound
Principle:
1. 跟返傷口形態嚟包，例如 elbow 位同 knee 位有隻鳳眼
2. 做左 Assessment 先包
3. 包完再做 Assessment
4. 包係 from distal to proximal
5. 手趾腳趾外露 for reassessment
a. Capillary refill <2s
b. Skin temp
c. Skin colour of fingers
Ideally recheck every 10 min
d. Limb activity
e. Symptoms of edema
f. Any pain
6. 開始包兩圈，完結包兩圈 (固定)
7. 個扣扣係 Bandage 外面，避免 Pressure Injury
a. HKSH: Micropore
Lecture 18 Bandage 2
Main idea:
1) Principle is the backbone of learning first-aid


CAB
GCS
Maintain life first
2) Purpose of bandage: 固定位置
1. Bone fracture
a. Principles
i. Immobilized
ii. Padding for support
Principles
iii. On sling
iv. Hospitalization
b. Types
i. Open fracture
1. Prevent infection 血肉模糊
ii. Closed fracture
Lecture 19 First Aid Part 3

Unconscious
o Fainting  Raise up legs above heart level
o CPR  refer to BSL
o Convulsion (Adult / Children)

Bites and Stings
o Animals
o Insect  Allergy reaction
o Snake  Hands lower your heart level
o Sea creatures  Soak in warm water

Foreign Objects
o Eyes
- 眼白
o Ear
- Water / Hospital
o Nose - Breath by mouth

Poisoning
Allergy Reaction (Insect bite / blood transfusion)
1. Ensure airway is not blocked
- If blocked, provide O2 therapy asap
2. 打 IV (Hydrocortisone = corticosteroid)
Hydrocortisone skin treatments can be used to treat
swelling, itching and irritation.
3. Monitor vital signs
Convulsion
Epilepsy
Disturbance in electrical activity of brain
Experience shared by Crystal:
病發者抽之前感受到自己即將抽筋，發作個陣唔知自己做緊咩，個腦會斷片，事後唔會記得發生咩
事。嚴重者會大小便失禁。通常幾分鐘後醒。
What you can do (as a student nurse) in the ward?
(1) Move the patient away from heat and sharps
(2) Loosen the tight clothes
(3) Place the PT in recovery position
- 冇左抽蓄
- PT 透到氣
Recovery Position (PT 左邊)
- 覆檢 PT PP, Pulse (摸頸動脈)
(4) Record:

幾點發生？

發生左幾耐？

PT 有咩 movement? 有冇流口水、大小二便失禁、四肢抽蓄？

檢查 vital signs
Lecture 13 Demonstration of Wound Dressing
Please kindly refer to the videos in your mobile phone.
Lecture 14 Feeding Procedures
Assessment:

Auscultate for bowel sounds

Palpate abdomen

Check marking

Any food allergy / diarrhea
Equipment:

Lopez Valve

Nutrition formula

Warm water

Food thermometer

Disposable feeding set

Syringe 50ml

Feeding cup

Sterile container

pH indicator strip

Stethoscope

Label
Lecture 15 Last Office
Main idea:
1. As a RN, how do you handle the emotional needs of the dying patient and family
2. As a RN, how do you handle Last Office procedure properly.
a. Any procedures?
3. Grief
a. 5 Stages of Grief is not always in order  subject to everyone  different level of stage
i. Denial
ii. Anger
iii. Bargaining
iv. Depression
v. Acceptance
4. Types of Loss
a. Actual loss

o The care is different from person-to-person
i. limb
b. Perceived loss
Provide compassionate care

Maintain emotional resiliency
i. friendship
ii. loved one
Two legal considerations:
1. Organ donation
a. Vital 活體捐贈
i. Heart
ii. Lungs
Can be donated after death:
iii. Liver
Eyes, bone, skin
iv. Pancrase
v. Kidneys
b. “Brain death”
i. Death of brain stem
ii. Supported by ventilator / pacemaker
腦死亡與植物人的分別
雖然腦死亡的病人與植物人同樣陷於昏迷，但分別在於腦死亡者的腦幹已完全破壞及失去功能，
沒有自主呼吸和無法調節血壓及體溫，大腦永遠不會再感受到外界的環境或刺激，因此腦死亡等
同死亡；
而植物人的部份腦幹功能仍然存在，可以維持自主呼吸或部份腦幹反應，大腦亦有可能感受到外
界的環境或刺激，因此植物人並未死亡。
2. Autopsy
a. unusual death  find out the exact cause
臨終 Signs & Symptoms:
1. Loss of muscle tone
a. X Facial muscles  X Facial expression
b. Difficulty of speaking / swallowing
c. Loss of sphincter control  Incontinence
2. Slowing of circulation
a. 手腳藍瘀
b. 皮膚冰冷
c. Pulse, BP slow down
3. Changes in respiratory
a. 潮式呼吸
b. Mouth breathing
4. Sensory impairment
a. Impaired sensation  can’t taste anything
Dying patient:
1. Keep warm
2. Speak normally
3. Be truthful
4. Try not to use an indwelling catheter
a. replaced by diaper / underpad
5. Not to force to eat / drink
死亡 Signs:

床邊慢慢死亡 Cessation of apical pulse / RR / BP

人工呼吸機：Flat encephalogram = absence of cerebral activity

Rigor mortis = Stiffening of body muscles

Livor mortis = The change in skin colour after death
Post Mortem Care –
Assessment:

Certified patient’s death by doctor

Request autopsy?

Inform family members / significant others

Assess any catheters / tubes
Planning:

Check organ donation / 大體老師

Prepare equipment for cleaning

Transport the body to Room 01
Equipment:

Bathing wipe

Disposable Dressing Set (塞一粒濕一粒乾入肛門)

Shroud 包屍袋
o Light blue: Category 1 (non-transmission)
o Transparent: Category 2,3

Category card (Light blue, Yellow, Red)

Record of cadaver
Clinical alert:
1. Explain the procedures to the patient step by step even he/she passed away
2. 岩岩死左  醫生宣布死亡  器官捐贈 / 無言老師  冇  移除天地線 & 清潔身體  遺物歸
家屬
a. 01 房清潔
b. 問家屬有冇一套衫幫病人更換
c. 眼：用 non-woven ball 沾水，禁眼瞼位置 30 秒
d. 塞肛：先濕後乾 (Preset 10,000 ppm)
e. 正確描述遺物 「綠色的手額」
f. 告知病人睇完禁鐘  入嚟用 quilt cover 頭部
3. Wound / Drain / Cuts 用防水膠布遮蓋
4. Wound drainage / Needle puncture holes 要消毒同用防水膠布遮蓋
5. 包屍袋出面放張「屍體紀錄」及 「屍體識別標籤」
6. 「屍體識別標籤」：藍黃紅
7. 透明包屍袋：Category 2 & 3
8. 死者雙手放兩旁 & 整理好衣物（拉直）
9. 簽 “Consent for Last Office Arrangement” & “Reminder for Deceased Body Collection”
處理遺體過程：
Lecture 16 Suicide Intendency
Nurse’s role:

Identify PT who has suicidial ideation

Implement preventive measures inside the hospital
o Restraint tools
o Listen and companion
Policy for Handling Patients and Suicidal Tendency
Delirium
夜晚期間，Fion 收到醫院電話，話佢公公突然好混亂，打護士，要 restraint。
點解突然咁亂？Underlying cause: Unbalanced electrolyte
Clinical Alert:
1. 聽到 PT 話想死，要同同事講，比個 Alert 大家
2. 留意 PT 對你講既說話，有 hints 話比你知佢係咪有自殺念頭
3. 同有自殺念頭的 PT 講過既野要紀錄底
4. 收埋所有促成自殺的工具
a. 教導家屬唔好帶促成自殺的工具，因為 PT 會收埋
5. 鼓勵家屬嚟陪 PT
6. 當 PT 有自我攻擊行為，可以 transfer 去 treatment room 或 近 station 房
7. 唔好信有自殺念頭的 PT 話自己唔會尋死
a. even 簽左 “contract”
Lecture 17 Pain Management
Main idea:
1. 收症時問 Effective Questions about Pain
2. PCA
What is pain?

Subjective experience that can be influenced by
o past experience (唓我以前痛過，我知有幾痛。某程度上幫自己打左個底)
o gender
o age


Infant / young children: express pain by body language / facial expression / crying

Adolescent: tell you directly

Adult: tell you directly

Elderly: deny the pain / withdrawal attitude
The subject experience of “pain” can be changed over time
Why we need the sense of pain?

Protection mechanism
o 掂到熱水會縮

Indication of Disease / Inflammation (Your body is asking for HELP!)
所以，當有 Patient 同你講邊到痛個到痛，要留意 Body language / Facial expression. 之後
就問佢痛既位置係邊同有幾痛。
 Location
o Localized / Radiating
o Referred / Visceral
 Duration
o Acute
o Chronic
o Cancer-related
 Intensity
o Mild
o Moderate
o Severe
 Aetiology
o 個 PT 做左咩嚟攪到有「痛」出現？
What does “pain” tell you?
Location

Localized pain
o Kidney in 2020

Radiating pain 擴散式
o Pat pat to toes

Referred pain (refer 返某個 organ)
o 心口痛 – 膊頭痛

Visceral pain
o 腸胃炎肚痛
Duration

Acute
o Kidney in 2020

Chronic
o 老母長期背痛
How does this affect the daily life of my
mother?

Breakthrough
突然下背勁痛，痛下又唔痛下，但係好痛
- Rapid in onset
- Location
- Intensity
- Pattern: Intermittent
- Intensity
What control the sense of pain?

Sympathetic Nervous System

Parasympathetic Nervous System
問症時的 Effective Questions about Pain:
OPQRST
In the clinic:
At the midnight of 26 March, I suffered abdomen pain in right lower quadrant. I could not sleep well because
of the intermittent pain.
Region (location)

abdomen pain in right lower quadrant
Onset of the event




Sudden and intermittent
Half min each time
Last for a night and morning
Feel like my intestine is twisted hardly

Intermittent pain lasting for overnight

Dr asked if I had cold sweating  no

Dr asked me if I want to vomit  yes, nausea

Asked me what time did the pain occur

How long the pain lasted for
Severity (score):

Didn’t ask me the pain score. I just described the pain
Provocation:

The doctor palpated my abdomen and asked if that palpation made me feel
Quality of pain
Time:
painful. I tried to palpate myself. Both felt nothing.
Classification of Pain:
Location: Localized / Radiating / Referred / Visceral
Duration: Acute pain / Chronic pain / Cancer-related pain
Intensity: Mild / Moderate / Severe
Etiology: Nociceptive pain / Somatic pain / Visceral pain / Neuropathic pain
Hot pad & Ice pad Application
Hot Pad
Goals
Ice Pad
- Soothe and heal damaged tissue
- Slow circulation & blood flow to an affected
area
- Reduce swelling
(Because cold temporarily reduces nerve
activity around the affect area)
When to use?
- Muscle pain
- Swelling
- Muscle soreness
- Bruising
- Sprain
- Bleeding
- Fractures
- Spasms
Alert
- Never apply on swelling site
- Unlike hot pad, ice pad should not be used for
long period
- Should not be used for tight muscle
People who have a sensory disorder that might prevent them from sensing pain shouldn’t
Alert
use ice / heat therapy without a doctor’s supervision.
Pain Management

Pharmacological
o Opioids

Morphine

Fentanyl

Oxycodone

Codeine
o Non-opioids

NSAIDS

Ibuprofen

Celecoxib

Naproxen

Arcoxia

Voltaren
Any advantages / disadvantages?
o Adjuvant

Non-Pharmacological
o Massage
o Electrical stimulation
Use of PCA
 睇 Doctor’s prescription

計 Concentration

入機 (921)

Interventions
Interventions
1. Assess the physical and cognitive ability of patient.
a. If the patient is unconscious, he / she could not physically control the PCA
b. If the patient is cognitively unable, he / she could not receive the education of using PCA
well.
c. Therefore, it is no point of offering PCA if the patient fails in physical and cognitive
function.
2. Check the setting of the program and connection of PCA to ensure proper function of tube
a. If the setting is against the doctor’s prescription, it may overdose the opioids, resulting in
harm to patient.
3. Educate the patient and family member
a. It is vital to give clear instructions to patient as PCA helps he /she to relieve the pain and
speed up the healing progress.
b. Some family members frequently press the patient control button as they perceive that the
patient is suffering a terrible pain. Yet, it may exaggerate the actual pressing frequency,
leading to a misleading report in PCA.
c. Therefore, it is our responsibility to explain the purpose and usage of PCA to prevent
misleading figures.
4. Check the patient and family member’s understanding in terms of using PCA
a. After a clear explanation, we should allow time for patient / family member to ask questions
regarding the use of PCA.
b. We could know whether they understand the proper way of using PCA as well as clarify
misunderstanding.
5. Inform doctor about the effectiveness of PCA and evaluate the necessity of dosage adjustment
a. Be aware of the patient’s reaction of using PCA. For example, any lung decompression, dry
mouth and constipation.
b. Once there are symptoms induced by the use of PCA, we should inform doctor and see if any
adjuvant will be offered to the patient.
Lecture 18 Removal Sutures & Staples
Skill-wise:
1. Sterile gloves
2. Remove sutures & staples
a. Layout sterile forceps & scissors (食西餐)
b. Transfer forceps (左右手)
Knowledge-wise:
1. Types of sutures / stitches
Sterile Staple Extractor
Intermittent
Mattress
Staple
When to remove sutures / staples?
1. “OT day 幾…”
2. 睇牌板：睇 OFF 得未同用咩 solution
Principles of removing sutures & stitches
Before

Count the total number of stitches
During

Remove intermittent stitches (2-4-6-8)
(睇傷口有冇滲漏、裂開)
After

一手陰力拉高線頭，一手鈍頭入

Never pull contaminated stitch through tissue (面線唔落底)

Count the total number of stitches  Ensure pre & post removal are the same

Inspect wound union
Assessment
*Materials depends on the wound situation

位置

Size

傷口現時情況

Surrounding skin 情況
Inspect wound & Surrounding skin
Collect Equipment

Trolley + Alcohol towel + Plastic bag

Non-sterile gloves + Sterile gloves + Alcohol towel

Dressing Pack

Compound Dressing + Adhesive tape / Tegaderm

Sterile scissors + Sterile stainless steel forceps + Sterile gloves

Solution  Prescribed by Doctor
Implementation
準備用品
無菌手套
洗傷口

打開 Dressing set, compound dressing, scissors 包裝 etc

Layout – 用黃鉗排用品，Solution 近傷口

Remove inner dressing  Dispose

Pour solution (2nd / 3rd check)

Disinfect the area

Perform HH

Don sterile gloves (GAMMEX Latex)

Display sterile towel – 用藍鉗 + 1 隻 stainless steel forcep

Layout sterile towel  extend sterile field

Place a gauze inside kidney dish

Place the kidney dish on the sterile towel
Transfer : Stainless steel forcep
Clean : 藍鉗
拆線

Dispose 藍鉗

Transfer Stainless steel forcep to left hand

Transfer Stainless steel forcep to left hand

Take the scissors by right hand

Count the total number of stitches (Principle 1)

2-4-6-8, 一手陰力拉高線頭，一手鈍頭入

剪完的線放好係 kidney dish

剪完就再 double check:
- 線數目係咪同拆前一樣
- 有齊 1234 線
洗傷口

將 stainless steel forcep dump 落 kidney dish

將 kidney dish 移去 slide table

Transfer : 藍鉗

Clean : Stainless steel forcep

Pat dry: 藍鉗

Put compound dressing: 藍鉗

Adhesive tape
Staple Removal:
唔好拎錯方向 (Up / Down)
Stitches
Staples
Knowledge-wise:
Lecture 20 Drainage System

Types of drain

Clean wound by AT Technique

Shortening
o closed drain – safety pin
o open drain – safety pin

Removal of drain

Empty drain
Key words:
Surgical drains
Serosanguinous fluid
Purulent = Discharging pus
Inserted and sutured
Why do we need drainage system?
Without a drain

remove unwanted / excessive fluid and gas
 heal on surface but trap the discharge inside

promote healing of underlying tissues
the wound

做完手術，某傷口既位置仲流緊血。如果就咁封線埋口而冇排走體液，就會令入面 tissue 無
法癒合
Robotic Surgery
體內有限的空間往往令外科醫生感到困惑，在進行複雜手術中迫不得已地開多個切口，對身體造成創傷。傳
統的機械人手術有助減輕創傷，但仍需要開多達六個切口，而外科醫生亦只能感受到有限的觸覺反饋。
這嶄新外科手術機械人系統（NSRS）具備觸覺（力度）反饋，能夠以單切口或經自然腔道進行手術，讓外
科醫生感覺到在病人身上施行的力度，從而提升手術的精確度。
外科手術機械人系統是個便攜式平台，可裝設在任何標準手術床上。它配備三維攝像機，亦可同時放入三支
或更多配備不同儀器的機械臂。每支機械臂由內置微型馬達驅動，並可作七個自由度轉動，而整個機械人系
統可作十個自由度的轉動。
外科手術機械人系統是應用了理大團隊所熟識的航天科技，配備體積細小但力度足夠的馬達，可以在人體內
進行各項手術。
Novel surgical robotic system (NSRS) with haptic (tactile) feedback and capable of single incision or natural
orifice (incision-less) robotic surgery was initialled by HKU.
NSRS has fully internally motorized surgical arms which can enter the human body through one tiny incision,
or even a natural orifice, for various abdominal or pelvic surgical operations.
Single-Port Robotic Surgery
Types of Drains
Open end drains
Passive drain (by gravity)
Penrose
Corrugated drain
Yeates drain
HKSH: 交由醫生處理，除左拆一條線
HA: 自己親手做
Closed wound drainage system
Active drain (by electric suction / portable drainage)
Jackson-Pratt drain
Hemovac drain
Chest drain
Low vaccum drain
T-tube drain
Assessment
1. Check AAA History
a. Allergy
b. Adverse Drug Reaction
c. Alert
2. Check wound
a. Location
b. Size
c. Depth
d. Odour
e. Any discharge / redness / signs of infection
i. volume
ii. characteristics
f. Type of drain
i. open
ii. closed
g. Suction status
h. Surrounding skin
3. Explain procedures to PT
a. DO NOT TOUCH EVERYTHING!
Collect Equipment for Implementation
1. Disinfect the trolley  alcohol towel
2. Get ready
Main

PPE + Gloves

Basic dressing pack

Sterile scissors

Sterile forceps

Sterile gloves

Sterile kidney dish

Sterile safety pin

Solutions

Combined dressing

Keyhole dressing  drain wound

Gauze & Balls

Cotton-tip if needed

Adhesive remover if needed

Non-sterile gloves

Disposal bag

Alcohol hand rub
Inspect Wound  Equipment  Wound dressing  拆線 + Shift / Shift only  Wound dressing (Safety
Pin + Keyhole dressing)  Compound dressing  Empty dressing
Shortening /Shift Drain
Skill 1: 一手用 gauze 一手拎住 stainless steel forcep 用陰力夾住條 drain，180 度咁轉手碗，跟手 tum
條 drain 出來
Skill 2: Strong resistance  停手交比醫生
Clinical Alert:
1. 如果 PT 做完手術返上嚟有唔同 drains 佈滿係身，要知邊條打邊條。至於 naming 就跟返醫生
naming / 該樓層做法
2. 尿喉就出尿，drain 出血。如果出左啲唔應該出既液體，要立即 report
3. Main wound ＝ 開大刀 ＝有 suture / staple
4. 如果 Single-port robotic surgery 的 drain wound 埋得唔好會影響埋 main wound
5. 倒 drain 落白碗，倒個陣要輕手，以免濺出。
6. No empty = 磅 drain,不是倒
Principles:
1. 洗 main wound 先至洗 drain wound
Rationale: Exudate which is considered dirty is made in a drain wound.
2. 用 AT Technique 洗 wound
3. Shift drain ＝shortening drain
4. 條管仔出左來，就唔好入返體內
5. 小心 safety pin 拮親自己同 PT
Lecture 22 Wound Irrigation Demonstration (Crystal and Vikko)
Layout:
 唔同 Wound 唔同數量的 equipment (e.g.要多對 forceps,要多 d cotton balls etc)

要知 layout equipment 擺位及次序

用完的 equipment 放位置
Skill-wise:
 戴 Sterilized gloves

用 Syringe 抽水

進行 irrigation
o 操作 Syringe


Pre-Packing
Packing
已打開
Layout Equipment:
Barrel
Plunger
Solution & 近 Kidney Dish
 123rd checks
 Pour solution into the kidney dish （有距離地倒）
GAMMEX Sterilized Gloves
 Latex-powder free
 Different sizes
o 自己：搵岩 size 手套戴
o 同事：問人要咩 size
逢親有分 size 的用品,都要問人戴咩 size
捉角打開
2 Sterilized Kidney Dishes
 倒 Solution
 放 PT 傷口旁邊，接住啲 return fluid，凹位對 Patient
*遠放 PT 傷口旁邊 ; 近放 Solution
2 Blue forceps [Disposable]
 Open sterilized field (Page 1,3)
 Transfer 遠 Kidney dish

Clean the obvious dirt on the wound if needed
Pull to open
Syringe 抽水




抽水
Marking 對自己
有 bubbles 就彈兩下
推 Plunger，水到針口位就停
Irrigation [Re-sterilized: Syringe]

Underpad 要發揮到防水作用，ensure 唔會濺
到 PT

2-3cm 距離

由上而下咁比 solution

洗到得返清水為止
抽 Plunger 手勢
Pat Dry [Re-sterilized: 1 灰色 Forceps]


Surrounding skin
Wound Bed 太濕先印一印
Packing [Re-sterilized: 1 灰色 Forceps & Stainless Steel forceps]


Stainless steel forceps: rolled
灰色 forceps: roll

扭乾水

Z 形放係 wound 入面
 尾巴要明顯被下一手見到
*make sure ribbon gauze 係完全濕晒水
包裝 Wound



Move the kidney dish on the trolley
Take off sterilized gloves
Put on micropore on the new dressing
收尾

Sluice room 解決
Flow:
 Prepare PT (Underpad)

Layout equipment on the trolley

Remove old dressing

Pour solution

Don sterilized gloves

Layout sterilized field & Kidney dish

Syringe  Pat dry  Packing  Micropore  Cleaning
醫療用品
一心醫療用品