MEDICAL COLLEGES OF NORTHERN PHILIPPINES
Alimannao Hills, Peñablanca, Cagayan
INSTRUCTIONAL
LEARNING GUIDE
FUNDAMENTALS OF
NURSING PRACTICE
(Laboratory)
SECOND SEMESTER F.Y. 2021-2022
1
AUTHOR
NINA ANNE BERNADETTE PARACAD, MSN
MCNP Research Coordinator/ BSN Level I Coordinator
Clinical Instructor
College of Nursing
Medical College of Northern Philippines
Reviewer
REYNALDO M. ADDUCUL, JD
PHOTO
Dean, College of Nursing
Medical College of Northern Philippines
2
PREFACE
Medical Colleges of Northern Philippines is committed to deliver quality instruction to its
students through various platforms. The Instructional Learning Guide is one of the initiatives of
the institution to address the learning demands of students in Distance Learning. This guide
specifically designed for the subject Fundamentals of Nursing which contains learning materials
and assessment tools prepared by the instructor based on a structured syllabus. The contents
have been carefully planned and reviewed to suit the learning styles of students. It is a collection
of discussions from various resources such as textbooks, journals and online references that are
deemed appropriate to meet the course objectives and Intended learning Outcomes.
How to Use this Learning Guide:
The Instructional Learning Guide (ILG) assist the students in the completion of the course. All
lectures and activities are given in this material for the students to follow.
Intended Learning Outcomes are provided in the beginning of each chapter to serve in identifying
the desired knowledge and skills that the students must acquire upon completion of the lessons
and activities.
Lecture notes are provided based from the various references of the subject summarized by the
teachers to guide the students for better understanding of the topics. Teacher’s insights are
included to further explain the concepts and relate them to practice.
Guide questions are also given to assess the understanding of the students of the topic, and to
test their critical thinking. These can be part of the student portfolio, or may be used by the
instructor to facilitate inquiry and interactive discussion during scheduled counselling.
At the end of each chapter are exercises to evaluate the students’ level of learning and
understanding. An answer sheet is provided to be part of the student portfolio. The scores will
be a basis for the instructors in the computation of grades.
Specific Instructions are given in each activities that students are required to comply. In case
students have queries or clarifications, the students may contact the subjects teacher for
reference (please check the email address, facebook account and cell phone number in the
helpline section).
Features of the Instructional Learning Guide:
1.
2.
3.
4.
5.
6.
7.
8.
Chapter Outcomes
Key Terms
Lectures Notes
Discussion / Teachers Insights
Critical Thinking Applicaton
Other Activities (to be included in Portfolio Assessments)
Appendices
Summary of Additional References
3
COURSE DETAILS
Subject: Fundamentals of Nursing Practice (Laboratory)
Units: 2 Units
No. Of Class Hrs: 6 hours Lecture/ week
Year Level: First
Course: Bachelor of Science in Nursing
Subject Teacher: Nina Anne Paracad, MSN
Contact Number: 0916-473-1031
Consultation Time: ____
Schedule: __________
Course Description:
This course provides the students with the overview of nursing as a science, an,
art, and a profession. It deals with the concept of man as holistic being comprised of biopsycho- socio- and spiritual dimensions. It includes a discussion on the different roles of
a nurse emphasizing health promotion, maintenance of health as well as prevention of
illness utilizing the nursing process. It includes the basic nursing skills needed in the care
of individual clients.
Course Outcomes:
COURSE OUTCOMES (CO):
At the end of the course and given actual or simulated situations/ conditions, the
student will be able to:
1. Utilize the nursing process in the holistic care of client for the promotion and
maintenance of health
1.1. Assess with the client his/ her health status and risk factors affecting
health
1.2. Identify actual wellness/ at risk nursing diagnosis
1.3. Plan with client appropriate interventions for the promotion and
maintenance of health
1.4. Implement with client appropriate interventions for promotion and
maintenance of health
1.5. Evaluate with client outcomes of a healthy status
2. Ensure well- organized recording and reporting system
3. Observe bioethical principles and the core values
4. Relate effectively with clients, members of the health care team and others in
work situations related to nursing and health; and,
5. Observe bioethical concepts/ principles and core values and nursing standards in
the care of the clients
4
Methodology of Implementation:
This is a distance learning strategy where students and teachers are physically at a distance with
each other while the teaching and learning process is going on. The teacher shall meet students
thru different modes of communication (social network, online class, text messaging, email,
messenger etc.) to provide an orientation of the program and instructions for the students to
follow throughout the duration of the course.
Guidelines are prepared by the teachers based on institutional policies to ensure that students
will be able to follow through the different activities set for the course. There is no face to face
activity which means students are not required to report to school to attend classes, rather, they
shall interact with their teachers in different technology based communication strategies set by
the teachers for the course.
Topics shall be assigned according to the syllabus of the subject. Activities are given at predetermined time to be completed by the students. At the completion of each topic, students are
required to take the evaluation examinations which shall be given by the teachers which
determine applicability of the lessons learned.
During the duration of the course, students can consult their teachers from time to time to address
their difficulties or challenges they may encounter along the way.
The subjects are structured in sequential order. Course materials and references shall be
provided by the teachers in advance to facilitate teaching and learning process.
5
PRELIMINARY COVERAGE
(36 Hours)
CHAPTER 1
This chapter includes discussion of infection and asepsis. It also contains step
by step procedures for hand hygiene, gloving and bed making.
Intended Learning Outcomes:
At the completion of this coverage, the students shall be able to:
1. Discuss the importance of infection control and aseptic techniques.
2. Discuss the elements of hand washing and its procedures.
3. Enumerate the necessary equipment in performing hand washing, gloving and making
occupied and unoccupied bed.
4. Perform Handwashing, hand hygiene, donning and removing of sterile gloves, making
an occupied and unoccupied bed.
Specific Instructions in the completion of this Chapter:
1.
2.
3.
4.
Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
Prepare the following materials:
1.
Fundamentals of Nursing Practice Text Books, laboratory manual and other
references
2.
Notebooks and other writing materials
3.
Materials and equipment needed during return demonstration
Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You are also given an electronic copy of this
module along with other materials such as video clips to further assist you.
As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided after each module
Key Terms
Aseptic Technique
Infection
Medical asepsis
Surgical Asepsis
6
Let’s Start!
LECTURE OF RELATED CONCEPT
(3 Hours)
Asepsis


state of being free from disease-causing contaminants (such as bacteria, viruses, fungi,
and parasites) or, preventing contact with microorganisms.
The term asepsis often refers to those practices used to promote or induce asepsis in an
operative field in surgery or medicine to prevent infection.
Medical asepsis



Includes all practices intended to confine a specific microorganism to a specific area
Limits the number, growth, and transmission of microorganisms
Objects referred to as clean or dirty (soiled, contaminated)
Surgical asepsis




Sterile technique
Practices that keep an area or object free of all microorganisms
Practices that destroy all microorganisms and spores
Used for all procedures involving sterile areas of the body
Principles of Aseptic Technique
1. Only sterile items are used within sterile field.
2. Sterile objects become unsterile when touched by unsterile objects.
3. Sterile items that are out of vision or below the waist level of the nurse are considered
unsterile.
4. Sterile objects can become unsterile by prolong exposure to airborne microorganisms.
5. Fluids flow in the direction of gravity.
6. Moisture that passes through a sterile object draws microorganism from unsterile
surfaces above or below to the surface by capillary reaction.
7. The edges of a sterile field are considered unsterile.
8. The skin cannot be sterilized and is unsterile.
9. Conscientiousness, alertness and honesty are essential qualities in maintaining surgical
asepsis
Infection

1.
2.
3.
4.
Signs of Localized Infection
Localized swelling
Localized redness
Pain or tenderness with palpation or movement
Palpable heat in the infected area
7
5. Loss of function of the body part affected, depending on the site and extent of
involvement

Signs
1.
2.
3.
4.
5.
of Systemic Infection
Fever
Increased pulse and respiratory rate if the fever high
Malaise and loss of energy
Anorexia and, in some situations, nausea and vomiting
Enlargement and tenderness of lymph nodes that drain the area of infection
Chain of Infection


The chain of infection refers to those elements that must be present to cause an
infection from a microorganism
Basic to the principle of infection is to interrupt this chain so that an infection from a
microorganism does not occur in client
1.
Infectious agent; microorganisms capable of causing infections are
referred to as an infectious agent or pathogen
2.
Modes of transmission: the microorganism must have a means of
transmission to get from one location to another, called direct and
indirect
3.
Susceptible host describes a host (human or animal) not possessing
enough resistance against a particular pathogen to prevent disease or
infection from occurring when exposed to the pathogen; in humans this
may occur if the person’s resistance is low because of poor nutrition, lack
of exercise of a coexisting illness that weakens the host.
4.
Portal of entry: the means of a pathogen entering a host: the means of
entry can be the same as one that is the portal of exit (gastrointestinal,
respiratory, genitourinary tract).
5.
Reservoir: the environment in which the microorganism lives to ensure
survival; it can be a person, animal, arthropod, plant, oil or a combination
of these things; reservoirs that support organism that are pathogenic to
humans are inanimate objects food and water, and other humans.
6.
Portal of exit: the means in which the pathogen escapes from the
reservoir and can cause disease; there is usually a common escape route
for each type of microorganism; on humans, common escape routes are
the gastrointestinal, respiratory and the genitourinary tract.
Asepsis and Infection Control

1.

Breaking the Chain of Infection
Etiologic agent
Correctly cleaning, disinfecting or sterilizing articles before use
8

2.






3.


Educating clients and support persons about appropriate methods to clean, disinfect,
and sterilize article
Reservoir (source)
Changing dressings and bandages when soiled or wet
Appropriate skin and oral hygiene
Disposing of damp, soiled linens appropriately
Disposing of feces and urine in appropriate receptacles
Ensuring that all fluid containers are covered or capped
Emptying suction and drainage bottles at end of each shift or before full or according to
agency policy
Portal of exit
Avoiding talking, coughing, or sneezing over open wounds or sterile fields
Covering the mouth and nose when coughing or sneezing
4. Method of transmission










5.



6.


Proper hand hygiene
Instructing clients and support persons to perform hand hygiene before handling food,
eating, after eliminating and after touching infectious material
Wearing gloves when handling secretions and excretions
Wearing gowns if there is danger of soiling clothing with body substances
Placing discarded soiled materials in moisture-proof refuse bags
Holding used bedpans steadily to prevent spillage
Disposing of urine and feces in appropriate receptacles
Initiating and implementing aseptic precautions for all clients
Wearing masks and eye protection when in close contact with clients who have
infections transmitted by droplets from the respiratory tract
Wearing masks and eye protection when sprays of body fluid are possible
Portal of entry
Using sterile technique for invasive procedures, when exposing open wounds or
handling dressings
Placing used disposable needles and syringes in puncture-resistant containers for
disposal
Providing all clients with own personal care items
Susceptible host
Maintaining the integrity of the client’s skin and mucous membranes
Ensuring that the client receives a balanced diet
9

Educating the public about the importance of immunizations
Teacher’s Notes
Nosocomial infections also referred to as healthcare-associated infections (HAI), are
infection(s) acquired during the process of receiving health care that was not present during the time
of admission. To prevent the spread of infection nurses and health care professionals must be
knowledgeable in asepsis technique which is a means using practices and procedures to prevent
contamination from pathogens. It involves applying the strictest rules to minimize the risk of infection.
Healthcare workers use aseptic technique in surgery rooms, clinics, outpatient care centers, and other
health care settings.
Chapter Evaluation
Answer briefly the following questions. Encode your answer in a short bond
paper using Tahoma 11 font style.
1.
2.
Identify the elements of the chain of infection in COVID-19 Infection.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
_______________________________________________________.
How can we break the chain of infection is COVID-19 Infection?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
_______________________________________________________.
10
Skill 1: Performing Hand Hygiene Using Soap and Water (Handwashing)
(6 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Gather the necessary supplies. Stand in front of the sink. Do
not allow your clothing to touch the sink during the washing
procedure.
2. Remove jewelry, if possible, and secure in a safe place. A plain
wedding band may remain in place.
3. Turn on water and adjust force. Regulate the temperature until
the water is warm.
4. Wet the hands and wrist area. Keep hands lower than elbows
to allow water to flow toward fingertips.
5. Use about 1 teaspoon liquid soap from dispenser or rinse bar
of soap and lather thoroughly. Cover all areas of hands with the
soap product. Rinse soap bar again and return to soap dish.
6. With firm rubbing and circular motions, wash the palms and
backs of the hands, each finger, the areas between the fingers,
and the knuckles, wrists, and forearms. Wash at least 1″ above
area of contamination. If hands are not visibly soiled, wash to
1″ above the wrists.
7. Continue this friction motion for at least 15 seconds.
8. Use fingernails of the opposite hand or a clean orangewood
stick to clean under fingernails.
9. Rinse thoroughly with water flowing toward fingertips.
10. Pat hands dry with a paper towel, beginning with the fingers
and moving upward toward forearms, and discard it immediately.
Use another clean towel to turn off the faucet. Discard towel
immediately without touching other clean hand.
11. Use oil-free lotion on hands if desired.
Correctly
Done
Incorrectly
Done
Not Done
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________
Score : ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
11
Skill 2: Performing Hand Hygiene Using an Alcohol-Based Hand Rub
(3 Hours)
Performing Hand Hygiene Using an Alcohol-Based Hand Rub
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Remove jewelry, if possible, and secure in a safe place. A plain
wedding band may remain in place.
2. Check the product labeling for correct amount of product
needed.
3. Apply the correct amount of product to the palm of one hand.
Rub hands together, covering all surfaces of hands and fingers.
4. Rub hands together until they are dry.
5. Use oil-free lotion on hands if desired.
Correctly
Done
Incorrectly
Done
Not Done
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________.
Score: ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
12
Skill 3: Putting on Sterile Gloves and Removing Soiled Gloves
(6 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify the patient. Explain the procedure to the patient.
2. Perform hand hygiene.
3. Check that the sterile glove package is dry and unopened. Also
note expiration date, making sure that the date is still valid.
4. Place sterile glove package on clean, dry surface at or above
your waist.
5. Open the outside wrapper by carefully peeling the top layer
back. Remove inner package, handling only the outside of it.
6. Place the inner package on the work surface with the side
labeled “cuff end” closest to the body.
7. Carefully open the inner package. Fold open the top flap, then
the bottom and sides. Take care not to touch the inner surface of
the package or the gloves.
8. With the thumb and forefinger of the nondominant hand, grasp
the folded cuff of the glove for dominant hand, touching only the
exposed inside of the glove.
9. Keeping the hands above the waistline, lift and hold the glove
up and off the inner package with fingers down. Be careful it does
not touch any unsterile object.
10. Carefully insert dominant hand palm up into glove and pull
glove on. Leave the cuff folded until the opposite hand is gloved.
11. Hold the thumb of the gloved hand outward. Place the fingers
of the gloved hand inside the cuff of the remaining glove. Lift it
from the wrapper, taking care not to touch anything with the
gloves or hands.
12. Carefully insert nondominant hand into glove. Pull the glove
on, taking care that the skin does not touch any of the outer
surfaces of the gloves.
13. Slide the fingers of one hand under the cuff of the other and
fully extend the cuff down the arm, touching only the sterile
outside of the glove. Repeat for the remaining hand.
Correctly
Done
Incorrectly
Done
Not Done
14. Adjust gloves on both hands if necessary, touching only sterile
areas with other sterile areas.
15. Continue with procedure as indicated.
13
Removing Soiled Gloves
16. Use dominant hand to grasp the opposite glove near cuff end
on the outside exposed area. Remove it by pulling it off, inverting
it as it is pulled, keeping the contaminated area on the inside.
Hold the removed glove in the remaining gloved hand.
17. Slide fingers of ungloved hand between the remaining glove
and the wrist. Take care to avoid touching the outside surface of
the glove. Remove it by pulling it off, inverting it as it is pulled,
keeping the contaminated area on the inside, and securing the
first glove inside the second.
18. Discard gloves in appropriate container and perform hand
hygiene.
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________.
Score : ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
14
Skill 4: Making an Occupied Bed
(6 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify patient. Explain procedure to patient. Check chart for
limitations on patient’s physical activity.
2. Perform hand hygiene.
3. Assemble equipment and arrange on bedside chair in the order
the items will be used.
4. Close door or curtain.
5. Adjust bed to high position. Lower side rail nearest you, leaving
the opposite side rail up. Place bed in flat position unless
contraindicated.
6. Check bed linens for patient’s personal items. Disconnect the
call bell or any tubes/drains from bed linens.
7. Put on gloves if linens are soiled. Place a bath blanket over
patient. Have patient hold onto bath blanket while you reach
under it and remove top linens. Leave top sheet in place if a bath
blanket is not used. Fold linen that is to be reused over the back
of a chair. Discard soiled linen in laundry bag or hamper. Keep
soiled linen away from uniform.
8. If possible and another person is available to assist, grasp
mattress securely and shift it up to head of bed.
9. Assist patient to turn toward opposite side of the bed, and
reposition pillow under patient’s head.
10. Loosen all bottom linens from head, foot, and side of bed.
11. Fan-fold soiled linens as close to patient as possible.
12. Remove your gloves, if used. Use clean linen and make the
near side of the bed. Place the bottom sheet with its center fold
in the center of the bed. Open the sheet and fan-fold to the
center, positioning it under the old linens. Pull the bottom sheet
over the corners at the head and foot of the mattress.
13. If using, place the drawsheet with its center fold in the center
of the bed and positioned so it will be located under the patient’s
midsection. Open the drawsheet and fan-fold to the center of the
mattress. Tuck the drawsheet securely under the mattress. If a
protective pad is used, place it over the drawsheet in the proper
area and open to the centerfold. Not all agencies use drawsheets
routinely. The nurse may decide to use one.
14. Raise side rail. Assist patient to roll over the folded linen in
the middle of the bed toward you. Reposition pillow and bath
blanket or top sheet. Move to other side of the bed and lower
side rail.
Correctly
Done
Incorrectly
Done
Not Done
15
15. Put on clean gloves, if linen is soiled. Loosen and remove all
bottom linen. Place in linen bag or hamper. Hold soiled linen away
from your uniform. Remove gloves, if used.
16. Ease clean linen from under patient. Pull the bottom sheet
taut and secure at the corners at the head and foot of the
mattress. Pull the drawsheet tight and smooth. Tuck the
drawsheet securely under the mattress.
17. Assist patient to turn back to the center of bed. If pillowcase
is soiled with blood or body fluids, put on unsterile gloves.
Remove pillow and change pillowcase. Open each pillowcase in
the same manner as you opened other linens. Gather the
pillowcase over one hand toward the closed end. Grasp the pillow
with the hand inside the pillowcase. Keep a firm hold on the top
of the pillow and pull the cover onto the pillow. Place the pillow
under the patient’s head. Remove gloves, if worn.
18. Apply top linen, sheet and blanket if desired, so that it is
centered. Fold the top linens over at the patient’s shoulders to
make a cuff. Have patient hold onto top linen and remove the
bath blanket from underneath.
19. Secure top linens under foot of mattress and miter corners.
Loosen top linens over patient’s feet by grasping them in the area
of the feet and pulling gently toward foot of bed.
20. Raise side rail. Lower bed height and adjust head of bed to a
comfortable position. Reattach call bell.
21. Dispose of soiled linens according to agency policy. Perform
hand hygiene.
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________.
Score : ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
16
Skill 5: Making an Unoccupied Bed
(6 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Assemble equipment and arrange on a bedside chair in the
order in which items will be used.
2. Perform hand hygiene.
3. Adjust bed to high position and drop side rails.
4. Disconnect call bell or any tubes from bed linens.
5. Put on gloves if linens are soiled. Loosen all linen as you move
around the bed, from the head of the bed on the far side to the
head of the bed on the near side.
6. Fold reusable linens, such as sheets, blankets, or spread, in
place on the bed in fourths and hang them over a clean chair.
7. Snugly roll all the soiled linen inside the bottom sheet and place
directly into the laundry hamper. Do not place on floor or
furniture. Do not hold soiled linens against your uniform.
8. If possible, shift mattress up to head of bed. If mattress is
soiled, clean and dry according to facility policy before applying
new sheets.
9. Remove your gloves. Place the bottom sheet with its center
fold in the center of the bed. Open the sheet and fan-fold to the
center.
10. If using, place the drawsheet with its center fold in the center
of the bed and positioned so it will be located under the patient’s
midsection. Open the drawsheet and fan-fold to the center of the
mattress. If a protective pad is used, place it over the drawsheet
in the proper area and open to the centerfold. Not all agencies
use drawsheets routinely. The nurse may decide to use one.
11. Pull the bottom sheet over the corners at the head and foot
of the mattress. Tuck the drawsheet securely under the mattress.
12. Move to the other side of the bed to secure bottom linens.
Pull the bottom sheet tightly and secure over the corners at the
head and foot of the mattress. Pull the drawsheet tightly and tuck
it securely under the mattress.
13. Place the top sheet on the bed with its center fold in the
center of the bed and with the hem even with the head of the
mattress. Unfold the top sheet. Follow same procedure with top
blanket or spread, placing the upper edge about 6″ below the top
of the sheet.
14. Tuck the top sheet and blanket under the foot of the bed on
the near side. Miter the corners.
15. Fold the upper 6″ of the top sheet down over the spread and
make a cuff.
Correctly
Done
Incorrectly
Done
Not Done
17
16. Move to the other side of the bed and follow the same
procedure for securing top sheets under the foot of the bed and
making a cuff.
17. Place the pillows on the bed. Open each pillowcase in the
same manner as you opened other linens. Gather the pillowcase
over one hand toward the closed end. Grasp the pillow with the
hand inside the pillowcase. Keep a firm hold on the top of the
pillow and pull the cover onto the pillow. Place the pillow at the
head of the bed.
18. Fan-fold or pie-fold the top linens.
19. Secure the signal device on the bed according to agency
policy.
20. Adjust bed to low position.
21. Dispose of soiled linen according to agency policy. Perform
hand hygiene.
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____________________.
Score : ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
18
References:
Textbooks:
Kozier and Erb’s Fundamentasl of Nursing: Concepts, Process and Practice 10th edition by
Berman, 2016
Others:
1. Fundamental Concepts and Skills for Nursing, 4th edition by Dewit, 2014
2. Lippincott Manual of Nursing Practice 1oth edition by Nettina, 2014
3. Funadamentals of Nursing Human Health and Function, 7th edition by Craven, 2013
4. Nursing Theory 7th edition by Alligod, 2010
Journals :
1. American Journal of Nursing
2. Journal on Critical Care Nursing
3. Nursing care management
19
MIDTERM COVERAGE
(30 Hours)
CHAPTER 2
This chapter includes discussion of hygiene concepts. It also contains step by
step procedures for Shampooing a patient’s hair, Giving bed bath, Assisting the
patient with oral care, Providing denture care and Assisting the patient to shave.
Intended Learning Outcomes:
At the completion of this coverage, the students shall be able to:
1. Discuss hygiene concepts.
2. Explain the importance and rationale of the procedures of shampooing, giving
bed bath, oral care and shaving.
3. Identify the equipment necessary in performing the procedures.
4. Perform shampooing of patient’s hair, giving bed bath, providing oral care and
shaving.
Specific Instructions in the completion of this Chapter:
1.
2.
3.
4.
Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
Prepare the following materials:
1.
Fundamentals of Nursing Practice Text Books, laboratory manual and other
references
2.
Notebooks and other writing materials
3.
Materials and equipment needed during return demonstration
Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You are also given an electronic copy of this
module along with other materials such as video clips to further assist you.
As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided after each module
Key Terms
Hygiene
Bathing
Oral Care
Shampooing
20
Factors Affecting Hygiene Practices
1.
2.
3.
4.
5.
6.
Culture
Religion
Environment
Developmental Level
Health and energy
Personal preference
Skin Care
General Guidelines for Skin Care
1.
2.
3.
4.
5.
6.
An intact, healthy skin is the body’s first line of defense
The degree to which the skin protects the underlying tissues from injury depends on
the amount of subcutaneous tissue and the dryness of the skin.
Moisture in contact with the skin can result in increased bacterial growth and
irritation.
Body odors are caused by resident skin bacteria acting on the body secretions.
Cleanliness is the best deodorant.
Skin sensitivity to irritation and injury varies among individuals and in accordance
with their health.
Agents used for skin care have selective actions and purposes. E.g. soap, detergent,
bath oil, cream, lotion, powder, deodorant, and antiperspirant.
Problem and Appearance
Abrasion
Superficial layers of the skin are scraped or
rubbed away. Area is reddened and may
have localized bleeding or serous weeping.
Excessive Dryness
Skin can appear flaky and rough.
Nursing Implication
1. Prone to infection; therefore,
wound should be kept clean and
dry.
2. Do not wear rings or jewelry
when providing care to avoid
causing abrasions to clients.
3. Lift, do not pull, a client across a
bed.
Use two or more people for assistance.
1. Prone to infection if the skin
cracks; therefore, provide
alcohol-free lotions to moisturize
the skin and prevent cracking.
2. Bathe client less frequently; use
no soap or use nonirritating soap
and limit its use. Rinse skin
thoroughly because soap can be
irritating and drying.
21
Ammonia Dermatitis (Diaper Rash)
Caused by skin bacteria reacting with urea in
the urine. The skin becomes reddened and is
sore.
Acne
Inflammatory condition with papules and
pustules.
Erythema
Redness associated with a variety of
conditions, such as rashes, exposure to sun,
elevated body temperature.
Hirsutism
Excessive hair on a person’s body and face,
particularly in women.
3. Encourage increased fluid intake
if health permits to prevent
dehydration.
1. Keep skin dry and clean by
applying protective ointments
containing zinc oxide to areas at
risk (e.g., buttocks and
perineum).
2. Boil an infant’s diaper or wash
them with an antibacterial
detergent to prevent infection.
Rinse diapers well because
detergent is irritating to an
infant’s skin.
1. Keep the skin clean to prevent
secondary infection.
2. Treatment varies widely.
1. Wash area carefully to remove
excess microorganisms.
2. Apply antiseptic spray or lotion to
prevent itching, promote healing,
and prevent skin breakdown.
1. Remove unwanted hair by using
depilatories, shaving, electrolysis,
or tweezing.
2. Enhance client’s self concep
Bathing






1.
2.
3.
4.
Bathing removes accumulated oil, perspiration, dead skin cells, and some bacteria.
Excessive bathing, can interfere with the intended lubricating effect of sebum, causing
dryness of the skin.
Bathing stimulates circulation
Bathing offers an excellent opportunity for the nurse to assess all clients.
Cleaning baths
Given chiefly for hygiene purposes and include these types:
Complete bed bath. The nurse washes the entire body of a dependent client in bed.
Self- help bed bath. Clients confined to bed are able to bathe themselves with help
from the nurse for washing the back and perhaps the feet.
Partial bath (abbreviated bath). Only the parts of the client’s body that might cause
discomfort or odor, if neglected, are washed: the face, hands, axillae, perineal area
and back.
Bag bath. This bath is a commercially prepared product that contains 10 to 12
presoaked disposable washcloths that contain no- rinse cleanser solution.
22
5.
Tub bath. Tub baths are often preferred to bed baths because it is easier to wash
and rinse in a tub.
Shower. Many ambulatory clients are able to use shower facilities and require only
minimal assistance from the nurse.
6.
Ear Care
Nursing Interventions
1.
2.
3.
Cleanse the pinna with moist wash cloth
Remove visible cerumen by retracting the ears downward. If this is ineffective, irrigate
the ear as ordered.
Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen.
These can rupture the tympanic membrane or traumatize the ear canal. Cotton- tipped
applicators can push wax into the ear canal, which can cause blockage.
Eye Care
Nursing Interventions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Cleanse the eyes from the inner cantus to the outer cantus. Use a new cotton ball for
each wipe. To prevent contamination of the nasolacrimal ducts.
If the client is comatose, cover the ayes with sterile moist compresses. To prevent
dryness and irritation of the cornea.
Eyeglass should be cleaned with warm water and soap; dried with soft tissue.
Clean contact lens as directed by the manufacturer
To remove artificial eyes, wear clean gloves, depress the client’s lower eyelid.
Hold the artificial eye with thumb and index finger
Clean the artificial eye with warm normal saline, then place in a container with water
or saline solution.
Avoid rubbing the eyes. This may cause infection.
Maintain adequate lighting when reading.
Avoid regular use of eye drops
If dirt/ foreign bodies get into eyes, clean them with copious, clean, tepid water as an
emergency treatment.
Nose Care
Nursing Interventions
1.
2.
3.
Clean nasal secretions by blowing the nose gently into the soft tissue.
Both nares should be open when blowing the nose to prevent forcing debris into the
middle ear, via Eustachian tube.
May use cotton tipped applicator moistened with saline or water to remove encrusted,
dried secretions. Insert only up to cotton tip.
23
Oral Cavity Care
Measures to Prevent Tooth Decay
1.
2.
3.
Brush the teeth thoroughly after meals and at bedtime.
Floss the teeth daily.
Ensure adequate intake of food rich in calcium, phosphorous, Vit. A, C and D and
fluoride.
Avoid sweet foods and drinks between meals
Eat coarse, fibrous foods (cleansing foods) such as fresh fruits ant raw vegetables.
Have dental check up every 6 months.
Have topical fluoride applications as prescribed by the dentists.
4.
5.
6.
7.
Brushing and Flossing the Teeth
Purposes
1.
2.
3.
4.
To
To
To
To
remove food particles from around and between the teeth.
remove dental plaque.
enhance the client’s feelings of well- being
prevent sores and infection of the oral tissues.
Common Problems of the Mouth











Plaque. An invisible soft film of bacteria, saliva, epithelial cells and leukocytes that
adhere to the enamel surface of the teeth.
Tatar. A visible, hard deposit of plaque and bacteria that forms at the gum lines.
Halitosis. Bad breath.
Glossitis. Inflammation of the tongue.
Gingivitis. Inflammation of the gums.
Stomatitis. Inflammation and dryness of oral mucosa.
Parotitis. Inflammation of the parotid salivary glands (mumps).
Sordes. Accumulation of foul matter (food, microorganisms, and epithelial elements) on
the gums and teeth.
Periodontal disease. Gums appear spongy and bleeding (pyorrhea). If you’re noticing
some issues with your teeth and gums, you might have to get some dental implants.
This is a painless process however you should do everything you can to avoid having to
have a dental procedure.
Cheilosis. Cracking of the lips.
Dental Caries. Teeth have darkened area, may be painful (cavities).
Hair Care


The appearance of the hair may reflect a person’s sense of well being and health status.
Brushing and combing the hair stimulate circulation of blood in the scalp; distribute the
oil along the hair shaft; help to arrange the hair.
24
Hair shampoo
Purposes


To stimulate the circulation of the blood in the scalp through massage.
To clean the hair and improve the client’s sense of well-being.
Common Hair and Scalp Problems
Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus (seborrheic dermatitis).
Alopecia. Lair loss or baldness.
Pediculosis. Infestation with lice.


The usual treatment for pediculosis is gamma benzene hexachloride (Kwell), which
comes in lotion, cream and shampoo. Pubic lice are difficult to remove, so the shampoo
may be applied and left on 12 to 24 hours.
Linens and clothing used by clients should be washed in hot water.
Scabies. Contagious skin infestation by the itch mite. The characteristic of the lesion is the
burrow produced by the female mite as it penetrates the skin. The burrows are short, wavy,
brown, or black threadlike lesions.
Hirsutism. Excessive growth of body hair.
Foot Care












Wash the feet daily, and dry them well especially the interdigital spaces.
Use warm water for foot soak, to soften the nails and loosen debris under them.
Caution: soaking the feet of diabetic clients is no longer encouraged because excessive
moisture can contribute to skin breakdown.
Use cream or lotion to moisten the skin and soften calluses.
Use deodorant sprays or foot powder to prevent or control unpleasant odor
File toe nails straight across. To prevent nail splitting and tissue injury around nail.
Change socks or stocking daily.
Wear comfortable, well-fitted pair of shoes
Do not go bare footed
Exercise the feet to improve circulation
Avoid using constricting clothing or round garters which may decrease circulation
Avoid crossing the legs
Avoid self-treatment for corns or calluses
Common Foot Problems


Callus. Painless, flat, thickened epidermis, a mass of keratotic material. Often caused by
pressure from the shoe on bony prominence.
Corn. Keratosis caused by friction and pressure from a shoe. It commonly affects the
fourth and fifth toe. It appears circular and raised.
25





Unpleasant odors. This results from perspiration and its interaction with microorganism.
Plantar warts. Caused by virus papova-virus hominis . They appear on the sole of the
foot and are moderately contagious. They are painful and make walking difficult.
Fissures. Caused by dryness and cracking of the skin.
Tinea pedis. Characterized by scaling and cracking of the skin, particularly between the
toes, caused by a fungus. There may be blisters. (also Athlete’s foot, ringworm of the
foot.)
Ingrown Toenail. Inward growth of the nail, causing trauma into soft tissues. It is
usually due to trimming the lateral edges of the toenails.
Nail Care







Trim nails straight across, or follow the contour of the fingers.
File nails to have smooth edges.
Do not trim nails at the lateral corners to prevent ingrowns.
Diabetic clients are advised against cutting hangnails or cuticles.
Ingrown is also called unguis incarnate.
Separation of the nail from the nail bed is onycholysis.
Inflammation of the skin fold at the nail margin is paronychia.
Perineal- Genital Care
Purposes of Perineal-Genital Care
1. To remove normal perineal secretions and odor.
2. To prevent infection.
3. To promote comfort.
Teacher’s Notes
Hygiene includes care of the skin, along with the hair, hands, feet, eyes, ears, nose, mouth,
back, and perineum. This includes the bath, components of the bath, bed making, and assisting the
patient in the use of the bed pan, urinal, and bedside commode.
The bath stimulates circulation in the skin and underlying tissues; it cleans and refreshes,
promoting health and comfort; it provides some exercise for the patient; and similar to the
opportunities available in making the occupied patient’s bed, it provides excellent opportunities for
observation of the patient’s physical and emotional condition and for patient-centered conversation
to promote good interpersonal relationships.
26
Skill 5: Shampooing a Patient’s Hair
(6 hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify the patient. Explain procedure to patient.
2. Assemble equipment on overbed table within reach.
3. Close the room door or curtain.
4. Perform hand hygiene. If you suspect there are any cuts of the
scalp or blood in the hair, put on disposable gloves. Lower head
of bed.
5. Remove pillow and place protective pad under patient’s head
and shoulders.
6. Fill the pitcher with warm water (43º–46ºC [110º–115ºF]).
Position the patient at the top of the bed, in a supine position.
Have the patient lift his head and place shampoo board
underneath patient’s head. If necessary, pad the edge of the
board with a small towel.
7. Place bucket on floor underneath the drain of the shampoo
board.
8. If the patient is able, have him or her hold a folded washcloth
at the forehead. Pour pitcher of warm water slowly over patient’s
head, making sure that all hair is saturated. Refill pitcher if
needed.
9. Apply a small amount of shampoo to patient’s hair. Massage
deep into the scalp, avoiding any cuts, lesions, or sore spots.
10. Rinse with warm water (43º–46ºC [110º–115ºF]) until all
shampoo is out of hair. Repeat shampoo if necessary.
11. If patient has thick hair or requests it, apply a small amount
of conditioner to hair and massage throughout. Avoid any cuts,
lesions, or sore spots.
12. If bucket is small, empty before rinsing hair. Rinse with warm
water (43º–46ºC [110º–115ºF]) until all conditioner is out of hair.
13. Remove shampoo board. Place towel around patient’s hair.
14. Pat hair dry, avoiding any cuts, lesions, or sore spots. Remove
protective padding but keep one dry protective pad under
patient’s hair.
15. Gently brush hair, removing tangles as needed.
16. Blow-dry hair on a cool setting if allowed and if patient wishes.
17. Change patient’s gown and remove protective pad. Replace
pillow.
18. Remove gloves. Perform hand hygiene.
Correctly
Done
Incorrectly
Done
Not Done
27
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________.
Score: ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
28
Skill 7: Giving Bed Bath
(12 hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Review chart for any limitations in physical activity. Identify the
patient. Discuss procedure with patient and assess patient’s
ability to assist in the bathing process, as well as personal hygiene
preferences.
2. Bring necessary equipment to the bedside stand or overbed
table. Remove sequential compression devices and antiembolism
stockings from lower extremities according to agency protocol.
3. Close curtains around bed and close door to room if possible.
Adjust the room temperature if necessary.
4. Offer patient bedpan or urinal.
5. Perform hand hygiene.
6. Raise bed to a comfortable working height.
7. Lower side rail nearer to you and assist patient to side of bed
where you will work. Have patient lie on his or her back.
8. Loosen top covers and remove all except the top sheet. Place
bath blanket over patient and then remove top sheet while
patient holds bath blanket in place. If linen is to be reused, fold
it over a chair. Place soiled linen in laundry bag. Take care to
prevent linen from coming in contact with your clothing.
9. Remove patient’s gown and keep bath blanket in place. If
patient has an IV line and is not wearing a gown with snap
sleeves, remove gown from other arm first. Lower the IV
container and pass gown over the tubing and the container.
Rehang the container and check the drip rate.
10. Raise side rail. Fill basin with a sufficient amount of
comfortably warm water (110º–115ºF). Change as necessary
throughout the bath. Lower side rail closer to you when you
return to the bedside to begin the bath.
11. Put on gloves, if necessary. Fold the washcloth like a mitt on
your hand so that there are no loose ends.
12. Lay a towel across patient’s chest and on top of bath blanket.
13. With no soap on the washcloth, wipe one eye from the inner
part of the eye, near the nose, to the outer part. Rinse or turn
the cloth before washing the other eye.
14. Bathe patient’s face, neck, and ears, avoiding soap on the
face if the patient prefers. Apply appropriate emollient.
15. Expose patient’s far arm and place towel lengthwise under it.
Using firm strokes, wash arm and axilla, lifting the arm as
necessary to access axillary region. Rinse, if necessary, and dry.
Apply appropriate emollient.
Correctly
Done
Incorrectly
Done
Not Done
29
16. Place a folded towel on the bed next to patient’s hand and
put basin on it. Soak patient’s hand in basin. Wash, rinse, if
necessary, and dry hand. Apply appropriate emollient.
17. Repeat Actions 15 and 16 for the arm nearer you. An option
for the shorter nurse or one prone to back strain might be to
bathe one side of the patient and move to the other side of the
bed to complete the bath.
18. Spread a towel across patient’s chest. Lower bath blanket to
patient’s umbilical area. Wash, rinse, if necessary, and dry chest.
Keep chest covered with towel between the wash and rinse. Pay
special attention to skin folds under the breasts.
19. Lower bath blanket to perineal area. Place a towel over
patient’s chest.
20. Wash, rinse, if necessary, and dry abdomen. Carefully inspect
and clean umbilical area and any abdominal folds or creases.
21. Return bath blanket to original position and expose far leg.
Place towel under far leg. Using firm strokes, wash, rinse, if
necessary, and dry leg from ankle to knee and knee to groin.
Apply appropriate emollient.
22. Fold a towel near patient’s foot area and place basin on it.
Place foot in basin while supporting the ankle and heel in your
hand and the leg on your arm. Wash, rinse, if necessary, and dry,
paying particular attention to area between toes. Apply
appropriate emollient.
23. Repeat Actions 21 and 22 for the other leg and foot.
24. Make sure patient is covered with bath blanket. Change water
and washcloth at this point or earlier if necessary.
25. Assist patient to prone or side-lying position. Put on gloves, if
not applied earlier. Position bath blanket and towel to expose only
the back and buttocks.
26. Wash, rinse, if necessary, and dry back and buttocks area.
Pay particular attention to cleansing between gluteal folds, and
observe for any redness or skin breakdown in the sacral area.
27. If not contraindicated, give patient a backrub. Back massage
may be given also after perineal care. Apply appropriate emollient
and/or skin-barrier product.
28. Raise the side rail. Refill basin with clean water. Discard
washcloth and towel. Remove gloves and put on clean gloves.
29. Clean perineal area or set up patient so that he or she can
complete perineal self-care. If the patient is unable, lower the
side rail and complete perineal care. Raise side rail, remove
gloves, and perform hand hygiene.
30. Help patient put on a clean gown and assist with the use of
other personal toiletries, such as deodorant or cosmetics.
31. Protect pillow with towel and groom patient’s hair.
32. Change bed linens, as described in Skills 7-9 and 7-10.
Remove gloves and perform hand hygiene. Dispose of soiled
linens according to agency policy.
30
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________.
Score: ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
31
Skill 8: Assisting the Patient with Oral Care
(6 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify the patient. Explain procedure to patient.
2. Perform hand hygiene and put on disposable gloves.
3. Assemble equipment on overbed table within reach.
4. Provide privacy for patient. Adjust height of bed to a
comfortable position. Lower one side rail and position patient on
the side, with head tilted forward. Place towel across patient’s
chest and emesis basin in position under chin.
5. Open patient’s mouth and gently insert a padded tongue blade
between back molars if necessary.
6. If teeth are present, brush carefully with toothbrush and paste.
Remove dentures if present and use a toothette or gauze-padded
tongue blade moistened with water or dilute mouthwash solution
to gently clean gums, mucous membranes, and tongue. Clean the
dentures before replacing.
7. Use gauze-padded tongue blade or toothette dipped in
mouthwash solution to rinse the oral cavity. If desired, insert the
rubber tip of the irrigating syringe into patient’s mouth and rinse
gently with a small amount of water. Position patient’s head to
allow for return of water or use suction apparatus to remove the
water from oral cavity
8. Apply lubricant to patient’s lips.
9. Remove equipment and return patient to a position of comfort.
Remove your gloves. Raise side rail and lower bed.
10. Perform hand hygiene.
Correctly
Done
Incorrectly
Done
Not Done
32
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________.
Score: _______________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
33
Skill 9: Providing Denture Care
(3 Hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify patient. Explain procedure to patient.
2. Perform hand hygiene. Put on disposable gloves.
3. Assemble equipment on overbed table within reach.
4. Provide privacy for patient.
5. Lower side rail and assist patient to sitting position if permitted,
or turn patient onto side. Place towel across patient’s chest. Raise
bed to a comfortable working position.
6. Apply gentle pressure with 4 × 4 gauze to grasp upper denture
plate and remove. Place it immediately in denture cup. Lift lower
dentures with gauze, using slight rocking motion. Remove, and
place in denture cup.
7. Place paper towels or washcloth in sink while brushing. Using
the toothbrush and paste, brush all surfaces gently but
thoroughly. If patient prefers, add denture cleaner to cup with
water and follow directions on preparation.
8. Rinse thoroughly with water. Apply denture adhesive if
appropriate.
9. Use a toothbrush or toothette moistened with water or dilute
mouthwash solution to gently clean gums, mucous membranes,
and tongue. Offer mouthwash so patient can rinse mouth before
replacing dentures, if desired.
10. Insert upper denture in mouth and press firmly. Insert lower
denture. Check that the dentures are securely in place and
comfortable.
11. If the patient desires, dentures can be stored in the denture
cup in cold water, instead of returning to the mouth. Label the
cup and place in the patient’s bedside table.
12. Remove gloves and perform hand hygiene.
Correctly
Done
Incorrectly
Done
Not Done
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
__________________________________________________________________________
Score: _______________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
34
Skill 10: Assisting the Patient to Shave
(3 hours)
Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if skill
is not performed correctly; and Not Done if the student failed to perform the skill.
Procedure
1. Identify patient. Explain procedure to patient.
. Assemble equipment on overbed table within reach.
3. Close the room door or curtain.
4. Perform hand hygiene and put on disposable gloves.
5. Cover patient’s chest with a towel or waterproof pad. Fill bath
basin with warm (43º–46ºC [110º–115ºF]) water. Moisten the
area to be shaved with a washcloth.
6. Dispense shaving cream into palm of hand. Rub hands
together, then apply to area to be shaved in a layer about 0.5″
thick.
7. With one hand, pull the skin taut at the area to be shaved.
Using a smooth stroke, begin shaving. If shaving the face, shave
with the direction of hair growth in downward, short strokes. If
shaving a leg, shave against the hair in upward, short strokes.
8. Wash off residual shaving cream.
9. If patient requests, apply aftershave or lotion to area shaved.
10. Remove and discard gloves and perform hand hygiene.
Correctly
Done
Incorrectly
Done
Not Done
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________.
Score: ________________________________________
Evaluated by: ________________________________ Date of Evaluation: ________________
(Signature over Printed Name)
35
References:
Textbooks:
Kozier and Erb’s Fundamentasl of Nursing: Concepts, Process and Practice 10th edition by
Berman, 2016
Others:
1. Fundamental Concepts and Skills for Nursing, 4th edition by Dewit, 2014
2. Lippincott Manual of Nursing Practice 1oth edition by Nettina, 2014
3. Funadamentals of Nursing Human Health and Function, 7th edition by Craven, 2013
4. Nursing Theory 7th edition by Alligod, 2010
Journals :
1. American Journal of Nursing
2. Journal on Critical Care Nursing
3. Nursing care management
36
SEMI-FINALS COVERAGE
(30 Hours)
CHAPTER 3
This chapter discusses the procedure of providing back massage and assisting
with patient feeding. It also includes discussion of concepts of pain and special diets.
Intended Learning Outcomes:
At the completion of this coverage, the students shall be able to:
1.
2.
3.
4.
Discuss the pathophysiology and mechanisms of pain.
Enumerate and explain the different special diets.
Demonstrate provision of back massage
Demonstrate skill of assisting patient feeding.
Specific Instructions in the completion of this Chapter:
1.
2.
3.
4.
Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
Prepare the following materials:
1.
Fundamentals of Nursing Practice Text Books, laboratory manual and other
references
2.
Notebooks and other writing materials
3.
Materials and equipment needed during return demonstration
Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You are also given an electronic copy of this
module along with other materials such as video clips to further assist you.
As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided after each module
Key Terms
Pain
Nociceptors
Back Massage
Special Diets
Nutrition
37
Let’s Start!
Pain
• Pain is a highly unpleasant and very personal sensation that cannot be shared with
others.
• One of the most complex human experiences; an individual phenomenon influenced by
the interaction of affective, behavioral, cognitive and physiologic-sensory factors.
Nociceptors
• Sensory pain receptors are free nerve endings in the tissue that respond to
tissueinjuring stimuli (noxious stimuli).
• Receptors that respond to noxious temperature
changes(thermoreceptors),chemicals(chemoreceptor), or pressure (mechanical
receptors) transmit the pain if the noxious stimuli are sufficiently strong.
• Found in the skin, blood vessels, subcutaneous tissue, muscle, fascia, periosteum,
viscera, joints and other structures.
• Nociceptors are located on two types of peripheral nerve cells that are responsible for
transmitting pain from the tissues to the central nervous system.
Algology-- study of pain
Cycle of Pain
1.Pain perception (awareness)---presence of noxious stimuli (example ant bite).
2. Pain transmission- nerve impulses travel to AFFERENT nerves going to Substantia
Gelatinosa (found in the spinothalamic tract, lumbar level)---this where the Gate control theory
happens:
-if gate is open---(+)pain
-if gate is close--(-) pain
3. Pain Modulation (brain area) ---the brain process the impulse to the Dorsal Horn where
interpretation happens resulting into the quality and intensity of pain
4. Pain transduction (response) - The brain send the response to the EFFERENT neurons
producing response.
Theories of Pain
Gate Control Theory

According to Melzack and Wall’s gate control theory, small diameter peripheral nerve fibers
carry signals of noxious stimuli to the dorsal horn, where these signals are modified when
they are exposed to the substantia gelatinosa that maybe imbalanced in an excitatory or
inhibitory direction.
38

It conceptualizes that there is gate in the spinal cord the substantia gelatinosa. When the
gate is open, pain stimulus is transmitted, thus, pain is perceived. When the gate is closed,
stimulus is blocked thus, no pain is perceived.
Specificity Theory



It states that there are specific nerve receptors for particular stimuli.
According to Rene Decartes, specific pain system carried messages directly from pain
receptors in the skin in the brain.
It is considered as an independent sensation with specialized peripheral sensory receptors,
which respond to damage and send signals through pathways in the nervous system to
target centers of the brain.
Pattern Theory

Consider that the peripheral sensory receptors,responding to touch,warmth and other
non-damaging as well as to damaging stimuli, give rise to non-painful or painful
experiences as aresult of differences in the pattern of the signals sent through the nervous
system.
Affect Theory

It avers that the pain is emotional. The intensity of pain perceived depends on the value
of the organ affected to the individual.
Parallel Processing Model

It believes that the physiologic or neurologic deciphering of the pain sensation and the
cognitive emotional properties occur.
Types of Pain
1. Acute Pain





Short duration(less than 6 months)
Has identifiable and immediate onset “fast pain”
Limited predictable duration (self-limiting)
Reversible or controllable
Elicits sympathetic symptoms(tachycardia, diaphoresis, guarding, tachypnea and focus on
pain.
2. Chronic Pain
 Long term(usually more than 6 months)
 Continual, persistent and recurrent
 Has identifiable cause, has qualities of slow pain
 More difficult to treat
 Has sympathetic adaptation
3. Visceral Pain
39
4.
5.
6.
7.
8.
 Results from stimulation of pain receptors in the abdominal cavity, cranium and thorax.
Radiating Pain
 Pain perceived at the source but extends to nearby tissue.
Referred Pain
 Pain felt in a part of the body that is considerably remote from the tissues causing the
pain.
Intractable Pain
 Pain that is highly resistant to relief
Neuropathic Pain
 Long lasting unpleasant with episode of sharp, shooting pain resulting from damage to
peripheral nerves or CNS.
Phantom Limb Pain
• Pain perceived in a body part that is missing (amputated)or paralyzed
Pain Management
 It is the alleviation of pain or reduction in pain to a level of comfort that is acceptable to
the client.
 It includes two types of NURSING interventions: Pharmacologic & Non-Pharmacologic.
1. Pharmacologic Pain Management
 It involves the use of Opioids(narcotics), non-opiods/NSAID, adjuvants, or co-analgesic
drugs.
 Opiods Analgesics – include opium derivatives, such as morphine and codeine.
 Non-opoid – include NSAID such as aspirin , acetaminophen, and ibuprofen.
 (decrease or inhibit prostaglandin release)
 Adjuvant analgesics –are medication that developed for uses other than analgesia but
have found to reduce certain types of chronic pain.
e.g. mild sedatives or tranquilizers, diazepam; Antidepressant(Elavil),
2. Nonpharmacologic pain Management.
 Goal of Physical intervention :
 Provide comfort
 Correct physical dysfunction
 Alter physiologic responses
 Reduce fears associated with pain-related immobility or activity restrictions.
A. Cutaneous stimulation – can provide effective temporary pain relief. It distracts the
client & focuses attention on the tactile stimuli, away from the painful sensations, thus,
reducing pain perception.
 Create the release of endorphins that block the pain stimuli.
 Stimulate large diameter A-beta sensory nerve fibers thus decreasing the
transmission of pain impulses through the smaller A-delta & C fibers

Example of Cutaneous stimulation:
1) Massage (Effleurage,Tapotement,Petrissage)
2) Application of heat & colds
40
3) Acupressure – based on the ancient chinese healing of acupuncture.
4) Contralateral stimulation – stimulating the skin in an area opposite to the
painful area.
B. Immobilization – Immobilizing painful body parts.
C. Transcutaneous Electric Nerve Stimulation (TENS) – same function as cutaneous
stimulation.

Goals of Cognitive-Behavioral Interventions:
 Alter pain perception
 Alter pain behavior
 Provide clients with greater sense of control over pain.
A. Distraction - it draws the client’s attention away from the pain & lessen the perception
of pain.
- e.g. slow rhythmic breathing, masssage & slow-rhythmic breathing, Active listening,
Guided imagery.
B. Hypnosis – is an altered state of consciousness in which an individual’s concentration is
focused and distraction is minimized.
Special Diets
TYPES OF BASIC AND THERAPEUTIC DIETS
1. Regular / Standard / House Diet
 for patients who doesn’t have special needs or dietary modification
 Omitted: foods that produce flatus (cabbage), highly seasoned, and fried foods
2. Diet as Tolerated (DAT)
 when patient’s appetite, ability to eat, and tolerance for food may change
 ex. 1st post op day patient may be given clear liquid. If no nausea occurs, normal
intestinal motility returned (active bowel sounds, passes gas, and feels like eating)
diet may be advanced to full liquid or regular diet
3. Cold Liquid Diet
 Purposes: Blood Clotting
o Post tonsillectomy
o Post thyroidectomy
o Post adenoidectomy
o Post dental extraction
 Cold Foods allowed
o Plain ice cream (vanilla)
o Sherbet
o Cold milk
o Cold Traditional Iced Tea
41
4. Liquid Diets
Purpose




Foods
allowed







Foods
not
allowed
CLEAR LIQUID
Initial diet after complete bowel rest
to:
o prevent and correct
dehydration
o relieve thirst
o minimize gastric stimulation
Provides fluid and carbohydrates
(sugar)
Short – term diet for 24 – 36 hrs
Indications:
o post surgery
o acute inflammatory of GIT
(diarrhea, gastroenteritis,
pancreatitis)
o burns and illness
water, coffee (decaf/regular), tea
carbonated drinks
fat free strained bouillon or broth
(soup stock)
clear or diluted fruit juices (apple,
grape, cranberry)
popsicles
gelatin
hard candy
FULL LIQUID
Intermediate diet between clear
liquid & soft diet
 Foods that melt or liquefy at body
temp
 To provide additional calories to
clients who are unable to tolerate
solid foods.
 Indications
o unable to tolerate solid or semisolid foods
o GIT disturbances
o burns and illness

all in clear liquid diet
milk and milk drinks
eggs (in pudding and custards)
plain ice cream, sherbet
yogurt
orange juice
vegetable juices
cream, butter, margarine, smooth
peanut butter
 strained cream soups








 Dairy products and milk
 Fruit juices with pulp
5. Modified Consistency Diets
Purpose



SOFT DIET
diet after full liquid
easily chewed and digested
low – residue or low fiber diet
Indications
o chewing and swallowing difficulties
o stroke patient
o mandibular fractures, broken jaw
PUREED DIET
 Modification of soft diet
 Any food that is added with water
and blended to produce a semi-solid
consistency
 To supply nutrition to clients with
NGT or gastrostomy tubes (osterized
feeding – food is placed into a sterile
bottle and discarded after 24hrs)
Indications
o mobility or refused food as
obstruction of esophagus
o Anorexia nervosa
42
o
o
Foods
allowed
Foods
not
allowed
 all foods in liquid diet
 lean, tender, cooked, minced
ground meat, poultry, and fish
(chopped / shredded)
 scrambled egg, omelet, poached
eggs, cottage cheese, and mild
cheeses
 low fiber fruits without skin and
seeds (banana, mango, sectioned
orange, papaya)
 low fiber cooked chopped
vegetables (mashed potato, carrots,
chayote, squash)
 Rice, Pasta, soft bread, soft cake,
bread pudding
long fibers, hard fried foods, highly
seasoned, foods with skin/nuts/seeds,
raw and gas forming fruits and
vegetables (apple, beans, cabbage,
celery, onions, cherries, coconut, egg
plant, melons, onions, wheat)
6. Content – Modified Diets
High – Fiber or High
Residue
Purpose  To prevent and
treat constipation
and diverticulitis
Foods
allowed
 fruits (apples,
oranges)
 vegetables
(broccoli, carrots,
corn)
 whole grain
(cereals, wheat,
grain)
Severe burns
Comatose
 pureed and blended foods
Sodium Restricted
 To treat cardiovascular,
renal, and liver disorder
 Fresh fruits and
vegetables
 NO CANNED products,
seafoods, and dairy
products
Diabetic Diet
 To control blood sugar
level
 Diet varies with
individual, severity of
diseases type and
extent of insulin
therapy received.
 Balanced diet
 Use dietary list
exchange
o 1 cup rice = 1
half burger
o 1 egg = ¼
cottage cheese
o 1 tsp margarine =
2 tsp mayonaise
43
7.
Electrolyte Reinforced Diets
Purpose
Foods
allowed
High Potassium
 To maintain skeletal
and cardiac muscle
activity
 Coffee
 Milk
 Meat
 Fruits (banana,
cantaloupe,
avocado, raisins,
strawberry)
 Vegetables
High Calcium
 To provide rigidity and
structure to bones





Dairy and milk products
Green leafy vegetables
Small fish with bones
Tuna
Sardines
High Phosphorous
 To treat
hypophosphotemia
 Soft drinks
 Chocolate
 Milk
1. Bland Diet
 Diet to allow stomach lining to heal (doesn’t stimulate gastric secretion)
 Indications
o diarrhea
o indigestion
o gastritis
o gall bladder disease
o ulcer
 Foods Allowed
o mild flavour
o soft and smooth in texture
 Not Allowed
o Fibrous, hard meats, herbs and spices, coffee, tea, citrus fruits, very hot and cold
beverages
o strong flavoured vegetables (cabbage, onion, leek, cauliflower, turnip)
2. Candidiasis Diet
 Free of:
o Fruits
o Fermented Foods
o Sugar
o Yeast
3. Acid – Ash Diet
 To alkalinize urine
 To soothe irritated bladder or urethra
 Foods: Citrus fruits and vegetables
 Not Allowed: Prune juice and cranberry juice (both produce acidic urine)
4. Ash – Acid Diet
 For UTI – to acidify urine
 Give protein, meat, poultry
44
5.
Culture Related Diets (Religion and Their Dietary Practices)
HALAL
KOSHER
VEGAN
Mormon
s
Protestan
ts
Purpos
e
To maintain
dietary
requiremen
ts of
Muslim
Clients
(Islamic)
To maintain
dietary
requirements of
Jewish Clients
(Judaism/Jewi
sh Faith)
(The
Church
of Jesus
Christ of
the latter
day
saint)
(Greek
Orthodox)
Foods
No pork
No gelatin
No alcohol
Kosher foods
can’t be prepared
using the utensils
that was
prepared in a
non – kosher
food
To maintain
dietary
requiremen
ts of
Seventh
Day
Adventist
Clients
Full
Vegetarian
diet
No
Coffee,
Alcohol,
Tea
No dairy
Products
and meat
during
Fasting
Milk and meat
are not eaten
together but may
be eaten 6 – 12
hrs apart
May lead to
VB12
deficiency
No coffee,
alcohol,
tea,
No pork
Roman
Catholic
Fasting
before
communio
n
and
during
Holy
Week
45
Assisting With Patient Feeding
Procedure
1. Check the physician’s order for the type of diet.
2. Identify the patient.
3. Explain procedure to patient.
4. Perform hand hygiene.
5. Assess level of consciousness, for any physical limitations,
decreased hearing or visual acuity. If patient uses a hearing aid
or wears glasses or dentures, provide as needed. Ask if the
patient has any cultural or religious preferences and food likes
and dislikes, if possible.
6. Pull the patient’s bedside curtain. Assess the abdomen. Ask the
patient if he/she has any nausea. Ask the patient if he/she has
any difficulty swallowing. Assess the patient for nausea or pain
and administer an antiemetic or analgesic as needed.
7. Offer to assist the patient with any elimination needs.
8. Provide hand hygiene and mouth care as needed.
9. Remove any bedpans or undesirable equipment and odors if
possible from the vicinity where meal will be eaten.
10. Open the patient’s bedside curtain. Assist or position the
patient in a high Fowler’s or sitting position. Position the bed in
the low position.
11. Place protective covering or towel over the patient if desired.
12. Check tray to make sure that it is the correct tray before
serving. Place tray on the overbed table so patient can see food
if able. Ensure that hot foods are hot and cold foods are cold. Use
caution with hot beverages, allowing sufficient time for cooling if
needed. Ask the patient for his/her preference related to what
foods are desired first. Cut food into small pieces as needed.
Observe swallowing ability throughout the meal.
13. If possible, sit facing the patient while feeding is taking place.
It patient is able, encourage to hold finger foods and feed self as
much as possible. Converse with patient during the meal as
appropriate. Play relaxation music if patient desires.
14. Allow enough time for the patient to adequately chew and
swallow the food. The patient may need to rest for short periods
during eating.
15. When the meal is completed or the patient is unable to eat
any more, remove the tray from the room. Note the amount and
types of food consumed.
16. Reposition the overbed table, remove the protective covering,
offer hand hygiene as needed, and offer the bedpan. Assist the
patient to a position of comfort and relaxation.
17. Perform hand hygiene.
Correctly
Done
Incorrectly
Done
Not Done
46
Giving a Back Massage
Procedure
1. Identify the patient. Offer a back massage to the patient and
explain the procedure.
2. Perform hand hygiene and put on nonsterile gloves, if
indicated.
3. Close room door and/or curtain.
4. Assess the patient’s pain, using an appropriate assessment tool
and measurement scale.
5. Raise the bed to a comfortable working height and lower the
side rail nearest you.
6. Assist the patient to a comfortable position, preferably the
prone or side-lying position. Remove the covers and move the
patient’s gown just enough to expose the patient’s back from the
shoulders to sacral area. Drape the patient as needed with the
bath blanket.
7. Warm the lubricant or lotion in the palm of your hand, or place
the container in small basin of warm water.
8. Using light gliding strokes (effleurage), apply lotion to patient’s
shoulders, back, and sacral area.
9. Place your hands beside each other at the base of the patient’s
spine and stroke upward to the shoulders and back downward to
the buttocks in slow, continuous strokes. Continue for several
minutes.
10. Massage the patient’s shoulder, entire back, areas over iliac
crests, and sacrum with circular stroking motions. Keep your
hands in contact with the patient’s skin. Continue for several
minutes, applying additional lotion as necessary.
11. Knead the patient’s skin by gently alternating grasping and
compression motions (pétrissage).
12. Complete the massage with additional long stroking
movements that eventually become lighter in pressure.
13. During massage, observe the patient’s skin for reddened or
open areas. Pay particular attention to the skin over bony
prominences.
14. Use the towel to pat the patient dry and to remove excess
lotion. Apply powder if the patient requests it.
15. Reposition patient gown and covers. Raise side rail and lower
bed. Assist patient to a position of comfort.
16. Remove gloves, if worn, and perform hand hygiene.
17. Evaluate the patient’s response to interventions. Reassess
level of discomfort or pain using original assessment tools.
Reassess and alter plan of care as appropriate.
Correctly
Done
Incorrectly
Done
Not Done
47
References:
Textbooks:
Kozier and Erb’s Fundamentasl of Nursing: Concepts, Process and Practice 10th edition by
Berman, 2016
Others:
1. Fundamental Concepts and Skills for Nursing, 4th edition by Dewit, 2014
2. Lippincott Manual of Nursing Practice 1oth edition by Nettina, 2014
3. Funadamentals of Nursing Human Health and Function, 7th edition by Craven, 2013
4. Nursing Theory 7th edition by Alligod, 2010
Journals :
1. American Journal of Nursing
2. Journal on Critical Care Nursing
3. Nursing care management
48
FINALS COVERAGE
(30 Hours)
CHAPTER 4
This chapter discusses the procedure of assisting with the use of a bedside
commode, urinal and bedpan. It also includes review of the physiology of urination.
Intended Learning Outcomes:
At the completion of this coverage, the students shall be able to:
1.
2.
3.
4.
Discuss the pathophysiology of Urinary system.
Discuss the physiology of Urination
Enumerate and describe the different alterations in urination.
Demonstrate the process of assisting with the use of a bedside commode, urinal and
bedpan. It also includes review of the physiology of urination.
Specific Instructions in the completion of this Chapter:
1.
2.
3.
4.
Set your learning goals. At the end of this module you are expected to attain the
Intended Learning Outcomes stated above.
Prepare the following materials:
1.
Fundamentals of Nursing Practice Text Books, laboratory manual and other
references
2.
Notebooks and other writing materials
3.
Materials and equipment needed during return demonstration
Lecture notes are provided for you. BE SURE NOT TO SKIP the lecture. Read and
understand before answering the activities. You are also given an electronic copy of this
module along with other materials such as video clips to further assist you.
As you go on, you will encounter exercises that will test your knowledge and
understanding as well as your critical thinking. Read the instructions carefully, and write
your answers to the space provided after each module
Key Terms
Urination
Altered Urinary Frequency
Altered Urine Production
Bedside Commode
Urinal
Bedpan
49
Let’s Start!
Urinary Elimination
Anatomy and Physiology of the Urinary System
The major role of the urinary system is to maintain homeostasis by maintaining body fluid
composition and volume. The components of the urinary system are as follows: kidneys, ureters,
urinary bladders and urethra.
The Kidneys










The kidneys are two bean-shaped organs located retroperitoneally at the level of the
twelfth thoracic and third lumbar vertebra.
The right kidney is slightly lower than the left kidney due to the presence of the liver on
the right side of the abdomen.
The kidneys are divided into renal cortex, medulla and pelvis. The medulla is composed
of series of pyramids.
Functional units of the kidneys are the nephrons. The nephrons are composed of
glomerulus and the renal tubules.
The glomerulus is a turf of semi-permeable capillaries, surrounded by the Bowman’s
capsule.
The three regions of the renal tubules are as follows: proximal convoluted tubules, loop
of Henle and the distal convoluted tubules.
The primary function of the nephrons is formation of urine.
About 1200 ml of blood flows to the kidneys per minute, which is 20-25% of the cardiac
output.
Through the formation of urine, the kidneys remove waste products from the body,
regulate fluid volume, maintain electrolytes concentration, blood pressure and pH within
the body.
The glomerular filtration rate (GFR) is 125 ml/min. From this, the kidneys form 0.5 to 1
ml per minute, 60 ML per hour, approximately 1500 ml per day of urine.
The Ureters


The ureters are two small tubes about 25 cm long. They transport urine from the renal
pelvis to the urinary bladder.
The ureters enters the urinary bladder obliquely and is guarded by ureter vesicular
sphincter. These two factors prevent reflux of urine as the bladder contracts.
The Urinary Bladder



The urinary bladder serves as reservoir for urine.
It is composed of three layers of detrusor muscles. Contraction of the these muscle expels
urine from the bladder.
The bladder is guarded by internal urethral sphincter in the junction of its opening into
the urethra.
50


The trigone is triangular region in the floor of the bladder that is marked by the openings
for the two ureters and the internal urethral orifice.
The approximate maximum capacity of the bladder is 1000 ml of urine.
The Urethra



The urethra is the passageway of the urine into the external environment.
The internal urethral sphincter is an involuntary muscle, while the external urethral
sphincter is a voluntary muscle.
The female urethra is 1 ½ to 2 ½ inches while the male urethra is 5 ½ to 6 ½ inches
up to 8 inches in length. The shorter urethra among females increase propensity to urinary
tract infection.
Urine Formation
Three steps of formation of urine by the kidneys are as follows:
a. Glomerular filtration. Water and solutes move from the blood to the glomerular
capsule. The fluid that enters the capsule is called glomerular filtrate.
b. Tubular reabsorption. It is the movement of the substance from the filtrate in the
kidney tubules into the blood in the peritubular capillaries. Only 1% of the filtrate remains
in the tubules and becomes urine.
 Water and other substances that are useful to the body are reabsorbed. Water is
reabsorbed by osmosis, while most solutes are reabsorbed by active transport.
c. Tubular secretion. It is the transport of substances from the blood into the renal
tubules. Potassium and hydrogen are primarily eliminated from the body. Ammonia, uric
acid, some f=drug metabolites are likewise eliminated.
Micturition



It is the act of expelling urine from the bladder.
Synonymous to urination or voiding
The parasympathetic nervous system initiates voiding. Whereas the sympathetic
nervous system inhibits voiding. The micturition reflex is involuntary, but it can be
inhibited by higher brain centers.
Normal Characteristics of the Urine
Color
Odor
Transparency
pH
Specific gravity
amber/straw
aromatic-upon voiding
Clear
slightly acidic (range:4.6 -8 average of 6)
1.010-1.025 (this is measures by urinometer)
51
Problems in Urinary Elimination
A. Altered Urine Composition
Presence of RBC
Presence of WBC
Presence of Pus
Presence of Bacteria
Presence
Presence
Presence
Presence
of
of
of
of
Albumin
Protein
Glucose
Ketones
Hematuria
Pyuria
Bacteriuria
Albuminuria
Proteinuria
Glycosuria
Ketonuria
Urinary Tract Infection
Diabetic Ketoacidosis
B. Altered Urine Production
1. Polyuria. The production of excessive amount of urine, such as a more than 100ml/hr
or 2500 ml/day (also dieresis)
2. Oliguria. The production of decreased amount of urine, such as less than 30 ml/hr or
less than 500 ml/24hrs
3. Anuria. The absence of production of urine by the kidneys such as a 0 to 10 ml/hr
(also urinary suppression)
C. Altered Urinary Frequency
1. Frequency. Voiding at frequent intervals
2. Nocturia. Increased frequency at night.
3. Urgency. The strong feeling that the person wants to void. There may or may not be
great amount of urine in the bladder.
4. Dysuria. Voiding that is either painful or difficult.
5. Hesistancy. Difficulty in initiating voiding.
6. Enuresis. Repeated involuntary voiding beyond 4-5 years of age.
7. Pollakuria. Frequent, scanty urination
8. Urinary incontinence.
a. Total incontinence. A continuous and unpredictable loss of urine.
b. Stress incontinence. The leakage of less than 50 ml of urine because of sudden
increase in intra-abdominal pressure, e.g., when one coughs, sneezes, laughs or
exerts physically.
c. Urge incontinence. Follows a sudden strong desire to urinate and leads to
involuntary detrusor contraction.
d. Functional incontinence. The involuntary unpredictable passage of urine.
e. Reflex incontinence. Is an involuntary loss of urine occurring at somewhat
predictable intervals when specific bladder volume is reached.
9. Retention. The accumulation of urine in the bladder with associated inability of the
bladder to empty itself.
 250-450 ml of urine in the bladder triggers micturition reflex.
52
Assisting With the Use of a Bedside Commode
Correctly
Done
Procedure
1. Identify the patient. Discuss procedure with patient and assess
patient’s ability to assist with the procedure, as well as personal
hygiene preferences. Review chart for any limitations in physical
activity.
2. Bring the commode and other necessary equipment to bedside.
Obtain assistance from another staff member, if necessary.
Perform hand hygiene. Put on disposable gloves.
3. Close curtains around bed and close door to room if possible.
4. Place the commode close to and parallel with the bed. Raise or
remove the seat cover.
5. Assist the patient to a standing position and to pivot to the
commode. While bracing one commode leg with your foot, ask
patient to place his or her hands one at a time on the arm rests.
Assist the patient to slowly lower himself/herself onto the
commode seat.
6. Cover the patient with a blanket. Place call device and toilet
tissue within easy reach. Leave patient if it is safe to do so.
7. Remove gloves and perform hand hygiene.
Assisting Patient Off Commode
8. Perform hand hygiene and put on disposable gloves.
9. Assist the patient to a standing position. If patient needs
assistance with hygiene, wrap toilet tissue around your hand
several times, and wipe patient clean, using one stroke from the pubic area
Incorrectly
Done
Not Done
toward the anal area. Discard tissue in an appropriate receptacle, according to
facility policy, and continue with additional tissue until patient is clean.
10. Do not place toilet tissue in the commode if a specimen is required or if
output is being recorded. Replace or lower the seat cover.
11. Remove your gloves. Return the patient to the bed or chair.
If the patient returns to the bed, raise side rails as appropriate.
Ensure that the patient is covered and call device is readily within
reach.
12. Offer patient supplies to wash and dry his or her hands,
assisting as necessary.
13. Put on clean gloves. Empty and clean the commode,
measuring urine in graduated container, as necessary. Remove
gloves and perform hand hygiene.
53
Assisting With the Use of a Bedpan
Procedure
1. Identify the patient. Discuss procedure with patient and assess
patient’s ability to assist with the procedure, as well as personal
hygiene preferences. Review chart for any limitations in physical
activity.
2. Bring bedpan and other necessary equipment to bedside.
Perform hand hygiene. Put on disposable gloves.
3. Warm bedpan, if it is made of metal, by rinsing it with warm
water.
4. Unless contraindicated, apply powder to the rim of the bedpan.
5. Place bedpan and cover on chair next to bed. Close curtains
around bed and close door to room if possible.
6. If bed is adjustable, place it in high position. Place the patient
in a supine position, with the head of the bed elevated about 30
degrees, unless contraindicated.
7. Fold top linen back just enough to allow placement of bedpan.
If there is no waterproof pad on the bed and time allows, consider
placing a waterproof pad under patient’s buttocks before placing
bedpan.
8. Ask the patient to bend the knees. Have the patient lift his or
her hips upward. Assist patient, if necessary, by placing your hand
that is closest to the patient palm up, under the lower back and
assist with lifting. Slip the bedpan into place with other hand.
9. Ensure that bedpan is in proper position and patient’s buttocks
are resting on the rounded shelf of the regular bedpan or the
shallow rim of the fracture bedpan.
10. Raise head of bed as near to sitting position as tolerated,
unless contraindicated. Cover the patient with bed linens.
11. Place call device and toilet tissue within easy reach. Place the
bed in the lowest position. Leave patient if it is safe to do so. Use
side rails appropriately.
12. Remove gloves and perform hand hygiene.
Removing the Bedpan
13. Perform hand hygiene and put on disposable gloves. Raise
the bed to a comfortable working height. Have a receptacle, such
as plastic trash bag, handy for discarding tissue.
14. Lower the head of the bed, if necessary, to about 30 degrees.
Remove bedpan in the same manner in which it was offered,
being careful to hold it steady. Ask the patient to bend the knees
and lift the buttocks up from the bedpan. Assist patient, if
necessary, by placing your hand that is closest to the patient palm
up, under the lower back and assist with lifting. Place the bedpan
on the bedside chair and cover it.
Correctly
Done
Incorrectly
Done
Not Done
54
15. If patient needs assistance with hygiene, wrap tissue around
the hand several times, and wipe patient clean, using one stroke from the
pubic area toward the anal area. Discard tissue, and use more until patient is
clean. Place patient on his or her side and spread buttocks to clean
anal area.
16. Do not place toilet tissue in the bedpan if a specimen is required or if output
is being recorded. Place toilet tissue in appropriate receptacle.
17. Return the patient to a comfortable position. Make sure the
linens under the patient are dry. Replace or remove pad under
the patient as necessary. Remove your gloves and ensure that
the patient is covered.
18. Raise side rail. Lower bed height and adjust head of bed to a
comfortable position. Reattach call bell.
19. Offer patient supplies to wash and dry his or her hands,
assisting as necessary.
20. Put on clean gloves. Empty and clean the bedpan,
measuring urine in graduated container, as necessary. Discard
trash receptacle with used toilet paper per facility policy.
Perform hand hygiene.
55
Assisting With the Use of a Urinal
Procedure
1. Identify the patient. Discuss procedure with patient and assess
patient’s ability to assist with the procedure, as well as personal
hygiene preferences. Review chart for any limitations in physical
activity.
2. Bring urinal and other necessary equipment to bedside.
Perform hand hygiene. Put on disposable gloves.
3. Close curtains around bed and close door to room if possible.
4. Assist the patient to an appropriate position as necessary:
standing at the bedside, lying on one side or back, sitting in bed
with the head elevated, or sitting on the side of the bed.
5. If the patient remains in the bed, fold the linens just enough
to allow for proper placement of the urinal.
6. If the patient is not standing, have him spread his legs slightly.
Hold the urinal close to the penis and position the penis
completely within the urinal. Keep the bottom of the urinal lower
than the penis. If necessary, assist the patient to hold the urinal
in place.
7. Cover the patient with the bed linens.
8. Place call device and toilet tissue within easy reach. Have a
receptacle, such as plastic trash bag, handy for discarding tissue.
Place the bed in the lowest position. Leave patient if it is safe to
do so. Use side rails appropriately.
9. Remove gloves and perform hand hygiene.
Removing the Urinal
10. Perform hand hygiene and put on disposable gloves.
11. Pull back the patient’s bed linens just enough to remove the
urinal. Cover the open end of the urinal. Place on the bedside
chair. If patient needs assistance with hygiene, wrap tissue
around the hand several times, and wipe patient clean. Place tissue in
Correctly
Done
Incorrectly
Done
Not Done
receptacle.
12. Return the patient to a comfortable position. Make sure the
linens under the patient are dry. Remove your gloves and ensure
that the paitent is covered.
13. Ensure patient call bell is in reach.
14. Offer patient supplies to wash and dry his or her hands,
assisting as necessary.
15. Put on clean gloves. Empty and clean the urinal, measuring
urine in graduated container, as necessary. Discard trash
receptacle with used toilet paper per facility policy. Remove
gloves and perform hand hygiene.
56
References:
Textbooks:
Kozier and Erb’s Fundamentasl of Nursing: Concepts, Process and Practice 10th edition by
Berman, 2016
Others:
5. Fundamental Concepts and Skills for Nursing, 4th edition by Dewit, 2014
6. Lippincott Manual of Nursing Practice 1oth edition by Nettina, 2014
7. Funadamentals of Nursing Human Health and Function, 7th edition by Craven, 2013
8. Nursing Theory 7th edition by Alligod, 2010
Journals :
4. American Journal of Nursing
5. Journal on Critical Care Nursing
6. Nursing care management
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