COMPONENT TASK
HANDING OVER THE WARD
1. Welcomes the in-coming staff
2. Gives ward report on patients to in-coming nurse to read
3. Enquires from in-coming nurse if she needs further explanation on issues
4. Hands over sensitive information about patient at the nurse's office e.g. condition of
patient
5. Interacts with patients while handing over
6. Checks and confirms information about patients' charts
7. Checks with incoming staff that gadgets on patients are functioning e.g. cardiac
monitor, intravenous line, oxygen flow meter etc.
8. Checks and hands over controlled drugs and any other relevant resources available
9. Hands over ward annexes for in-coming nurse to ensure they are clean
10. Reports on any defects on equipment and requests made for urgent repairs
11. Reports on departmental instructions and other important information in the ward
diary
TAKING OVER A WARD
1. Greets staff on duty
2. Asks for oral information on major happenings on the ward from the outgoing nurse
3. Reads written ward report
4. Enquires sensitive information about patients at the nurses office
5. Takes over ward from bed to. bed verifying the state of a" patients; especially very ill
patients
6. Establishes rapport with patients during taking over and asks about state of health
7. Conducts inspection of ward with the outgoing staff
8. Ensures resources needed for work are available and adequate and takes over controlled
drugs
9. Counter-signs written ward report
10. Notes important issues in the ward diary
11. Congratulates out-going staff
TASK: ADMISSION OF A PATIENT (AMBULANT)
REQUIREMENT ON TROLLEY

sheets for an admission bed

Vital signs tray

Admission and discharge book

Ward state

Admission sheets such as vital signs chart, nurses’ notes, costing sheet, intake and
output chart etc
COMPONENT TASK
1. Welcomes patient and relatives to the nurses’ station and makes them comfortable.
Introduces herself and any staff present.
2. Collects necessary documents, admission notes and any other information from the
accompanying nurse.
3. Identifies and confirms patient’s name, particulars and reassures him.
4. Sends patient to bedside and introduces him to other patients near him.
5. Checks vital signs and record and collects specimen if ordered
6. Administers urgent prescribed drugs if ordered.
7. Assist patient to change into his night dress or pyjamas.
8. Takes care of the patient’s valuable according to the institutions policy.
9. Let patient or legal guardian sign a consent form for treatment etc. Where necessary.
10. Explains national health insurance system to patient and relatives.
11. Informs relatives about visiting time and allows them to see patient and say goodbye
12. Orientate patient to ward and its annexes
13. Uses the nursing process to plan care
14. Enter patients name into the admission and discharge book and onto the ward state
and document in the nurses’ notes.
TASK: ORIENTATION OF PATIENT TO WARD ENVIRONMENT (AMBULANT)
COMPONENT TASK
1. Establish rapport with patient by introducing herself.
2. Mentions the name of the ward to him.
3. Introduces patient to ward staff around and other patients.
4. Shows patient the nurses office, shows patient his bed.
5. Shows patient the bathroom and the toilet.
6. Shows patient dinning hall and dayroom.
7. Shows patient the patients’ cupboard and bed locker.
8. Informs patient of ward activities.
9. Tells patient whom to contact for any information.
10. Encourages patient to ask questions.
11. Thank patient and put him to bed.
TASK: DISCHARGING A PATIENT FROM THE HOSPITAL
Requirement
Admission and discharge book
Ward state
COMPONENT TASK
1. Inform patient about discharge
2. Educate patient and relatives on the need for continuing treatment and follow–up care.
3. Ensure the patients’ hospital bill is worked out and submitted to patients’ relative
early for settlement.
4. Ensure that discharge papers are duly signed by discharging doctor.
5. Make sure that the hospital bills are settled and all receipts are entered in admission
and discharge book and hand over receipt to patient.
6. Direct relatives to collect drugs for patient from the pharmacy.
7. Educate them on drugs. I.e. indication, dosage, side effect etc.
8. Help patient to pack his belongings.
9. Hand over any valuables in the nurses’ custody to the patient and relatives and record
and sign with a witness.
10. Remind patient and relatives the review date and stresses on its important. Tell them
where to report.
11. Bid them good bye.
12. Ensure linen is removed and bed decontaminated.
EDUCATING PATIENT ON CONDITION
Requirement
Patient folder
Flip chart on the disease condition
A leaflet on the disease condition
1. Establishes rapport and explains the need for education on condition to patient
2. Makes patient comfortable either sitting or lying down
3. Sits comfortably by patient's side
4. Ensures enabling and relaxed environment and maintains privacy
5. Finds patient's level of awareness of condition
6. Builds on what the patient knows with scientific data of condition in language
that patient understands
7. Explains to patient the rationale for treatment and possible outcome
8. Ensures patient understands the teaching and co-operates with health team
9. Allows patient to ask questions for clarification
10. Provides patient with clear simple pamphlets if available
11. Thanks patient and documents education
EDUCATING A PATIENT ON MEDICATION PRIOR TO DISCHARGE
A Tray containing
The patient’s medication
Patient folder
1. Identify client's treatment chart and medication
2. Establishes rapport with patient
3. Uses language client understands
4. Involves client's or a significant others
5. Speaks audibly to patient
6. Explains procedure to client and family
7. Assesses patient's previous knowledge on medication
8. Shows type of drug(s) to patient
9. Informs patient about method of administration
10. Instructs patient on dosage of drugs to take at a time
11. Explains action of the drug
12. Describes the side effect of the drug
13. Instructs client to report to hospital when serious side effects occur
14. Demonstrates to patient how to store drug at home safely
15. Allows patient to repeat instruction and ask questions
16. Responds to questions appropriately
17. Thanks patient for co-operating and documents procedure
TASK: MAKING A SIMPLE UNOCCUPIED BED
REQUIREMENTS
Two chairs/ cardiac table
The following requirement on trolley

Two bed sheet

A draw mackintosh

A draw sheet

Counterpane

Pillow case

Pillow
COMPONENT TASK
1. Collect arrange items on trolley and send to bedside.
2. Arrange items in order of use on a chair or heart table.
3. Places bottom sheet on the bed.
4. Tucks the sheet evenly under the mattress at the top and bottom using envelope
corners.
5. Pulls sheet tight so that there are no creases. Tucks in at the sides.
6. Places draw mackintosh across bed and covers with draw sheets.
7. Places pillow on bed with open end away from the ward entrance.
8. Places top sheet on bed with the wrong side uppermost.
9. Folds over at the bottom and tucks in loosely.
10. Places bed cover/counterpane on at the bottom end using envelope corners.
11. Folds top sheet over the counterpane at the top end.
12. Tucks in side under mattress
13. Remove trolley and chair.
MAKING AN ADMISSIONS BED
Requirement
Extra requirement to be added for those of simple bed
A trolley with a long mackintosh
Two bath blanket
Bed blocks
Bed cradle back rest or any other bed accessory depending on the patient’s condition.
COMPONENT TASK
1. Collects, arranges items on trolley and sends to bedside
2. Arranges items in order of use on a chair or heart table
3. Places bottom sheet evenly on the bed
4. Tucks the sheet evenly under the mattress at the top and bottom corners
5. Places draw mackintosh across bed and covers with draw sheet
6. Places long mackintosh on the bed
7. Uses one bath blanket or sheet over and tucks in all around or folds under itself
8. Places second bath blanket over the bed
9. Puts in hot water bottles if necessary
10. Puts on top bed clothes
11. Places counterpane loosely over the top bed clothes
12. Tucks in the bed clothes on the other side
13. Folds the bed clothes on the other side nearest to the door, leaving it open to facilitate
quick admittance.
TASK: MAKING AN OPERATION BED
REQUIREMENTS
Extra requirements to be added to that of simple bed
1. Small mackintosh and towel
2. One blanket
3. Hot water bottle
4. Bed accessories to suit patient’s conditions.
a. Drip stand.
b. post anaesthetic tray containing the following vomitus bowel
c.
dressing towel receiver.
d. kidney dish (containing tongue holding forceps swab holding forceps, spatula)
e. Oxygen cylinder.
f. Bed blocks.
g. Suctioning machine
12. Gallipot containing gauze sab
13. An injection tray( gallipot containing spirit, gallipot with swabs, receiver for used
swabs, sterile gloves, syringes, sterile water or water for injection, tourniqeutte )
14. Mouth gag
15. Receiver for soiled swab
16. Gallipot with cold water
17. A receiver to receive mouth wash
18. Vital signs tray
19. Charts for recording
Procedure
1. Prepares trolley and sends to bedside
2. Arranges items in order of use on a chair or cardiac table
3. Places bottom sheet evenly on bed and tucks it under the mattress using envelope corners
4. Pulls sheet tight so that there are no creases and tucks in at the sides
5. Places draw mackintosh across bed and covers with draw sheet
6. Places dressing mackintosh and towel at top of bed
7. Leaves pillow on chair by the bed
8. Spreads blanket on bed
9. Places top sheet on with the wrong side uppermost and turns back the bottom end
10. Folds the top bed clothes at the open side in three parts over the bed for easy admission of
patient
11. Places a post anaesthetic tray by bed side containing vomit bowl, dressing towel, kidney
dish containing swab holding forceps, dissecting forceps, tongue holding forceps and
spatula
12. Arranges other bed accessories by bedside - drip stand, bed rail, blood pressure apparatus
TASK: CARDIAC BEB
TASK: CHANGING BOTTOM SHEET FROM TOP TO BOTTOM
REQUIREMENTS

Two chairs/cardiac table

Requirement on trolley
 Bed sheet
 Draw sheet and draw mackintosh
COMPONENT TASK
1. Explains the need for education to patient.
2. Make patient comfortable either sitting or lying down.
3. Sit comfortable by patient’s side.
4. Ensures enabling and relaxing environment to maintain privacy and individuality of
patient.
5. Find patients level of awareness of condition/diet.
6. Build on what the patient knows with scientific data on condition and in a language
that patient understands.
7. Explain to patient the rational for treatment and possible outcome.
8. Ensure patient understand the teaching and cooperate with the health team.
9. Allows patient to ask question for clarification.
10. Provides patient with clear simple pamphlet if available.
11. Thank patient and document education.
TASK: CHANGING BOTTOM SHEET OF PATIENT FROM SIDE TO SIDE
REQUIREMENTS
Two chairs/cardiac table
Requirement on trolley

bed sheet

draw sheet and draw mackintosh
COMPONENT TASK
1. Explain procedure to patient and ensure privacy.
2. Collects and arranges items on trolley.
3. Arranges sheets in order of use on chairs or heart table.
4. Loosen sheets at side of bed leaves patient with only one pillow and covers her with
top sheet.
5. Turns patient to one side of the bed supported by another nurse and draws mackintosh
and sheet.
6. Rolls dirty bottom sheet under patient.
7. Covers the bed with a clean rolled bottom sheet half way in the middle of the bed.
8. Put on draw mackintosh and draw sheet across bed tucking in greater part nearest to
the door.
9. Removes dirty bottom sheet and places it in a receptacle.
10. Pull tight and tucks in bottom sheet.
11. Covers patient with top sheet and bed cover, leaves him comfortable.
12. Clears equipment and removes screen.
13. Washes and dry hands.
EXAMINING PATIENT FROM HEAD TO TOE
1. Establishes rapport, explains procedure to patient
2. Provides privacy and washes and dries hands
3. Observes patient's general appearance and body built, in relation to the patient's age and
health
4. Observes the skin for lesions, pallor and texture
5. Examines the size and shape of the head. The eyes for discharge, pallor, jaundice, colour
of the eye and photophobia
6. Examines the ears for shape, size and discharge
7. Inspects the nostrils for patency, discharges and abnormalities, palpates and percusses
sinuses
8. Inspects the lips for cracks, soreness, pallor, jaundice and any abnormalities
9. Inspects the teeth for artificial or natural dentitions, dental caries and bleeding gums
10. Examines mouth for coated or furred tongue and foul breath, sores of the palates
11. Inspects the throat for inflamed tonsils, sore throat and swallowing reflexes
12. Examines the neck size and palpate for cervical lymph nodes and swelling e.g. goitre
13. Inspects the breast size, shape, nipple cracks and discharge, and palpates for lumps and
axillae for swollen lymph nodes
14. Examines the chest for shape, size and auscultates for any abnormality.
15. Inspects the abdomen for scar, lesions, linear alba and palpate for distension, retraction,
rigidity and observes for visible peristalsis.
16. Inspects the back for scars and kyphosis.
17. Inspects the genitalia for inflammation, discharges, swellings and lesions and examines
for pubic lice, warts and anus for growth.
18. Examines the lower extremities for motor reflexes, fingertips for clubbing, and nails for
pallor.
19. Observes for the functions of various senses, touch, smell, taste, sight and hearing.
20. Thanks patient, makes patient comfortable, washes and dries hands and documents
findings
TASK: BED BATH
REQUIREMENT ON TROLLEY
Top shelf

A bowl or basin

2 jugs (one containing cold water and the other hot water)

Soap in a soap dish

A face towel

Two medium size towel or a large towel

Sponge

A pail

Pomade, powder

Hair Comb or brush

Mirror
Lower Shelf

Receiver for used water

Bath blanket and a long mackintosh or bed sheet and long mackintosh

Patient garment

Receptacle for soiled linen
COMPONENT TASK
1. Explain procedure to the patient and provide privacy.
2. Prepare and take trolley to bed side.
3. Offers bed pan or urinal if required
4. Loosens and removes top bed clothes and arranges on a chair / bed table.
5. Removes patients’ cloths and covers him with a bath sheet/ cloth.
6. Protect bed and pillow with long Macintosh/ plastic sheet and draw sheet.
7. Maintain individuality of patient by asking him if he would like soap on the face,
temperature of water or if he will like to clean the gentalia himself.
8. Washes rinses and dry patients face beginning from the inner to the outer canthus of each
eye.
9. Washes rinses and dries the rest of the face, ears and neck.
10. Washes and rinses and dries patients arm farther away from the nurse, then washes, rinses
and dries patients arm near to the nurse.
11. Washes rinses and dries the chest and abdomen paying attention to the skin folds.
12. Washes rinses and dries the legs in the same way as the arms.
13. Turns patient on his side and washes, rinses and dries the back.
14. Examines and treat pressure areas.
15. Changes bottom linen and rolls patient on his back.
16. Cleans patients genitalia (performs vulva toileting if a female).
17. Groom and dresses patient in clean clothes.
18. Makes patients comfortable and thanks him.
19. Discards trolley, washes and dries hands properly.
20. Document procedure and reports abnormalities.
TASK: ASSISTED BED BATH
COMPONENT TASK
1. Explain procedure to patient and provide privacy.
2. Prepares requirement and arranges them on a locker or trolley or heart table in a
position where patient can easily reach for them.
3. Remove bed cloth and cover patient with a sheet of cloth.
4. Help patient into a suitable position.
5. Allow patient to do much for himself as his condition permits and completes the
procedure for him e.g. washing patients back, feet’s etc.
6. Assist patient to groom himself and make him comfortable.
7. Collects toiletries, puts them away.
8. Put bowl etc away, washes and dry hands.
9. Documents procedure and reports findings.
GIVING AN ASSISTED BATHROOM BATH
1. Establishes rapport and explains procedure to patient
2. Prepares bathroom, collects the necessary articles and arranges them for easy reach
3. Sends patient to the bathroom
4. Ensures water temperature is of patient preference
5. Provides privacy
6. Assists or encourages patient to undress
7. Assists patient to bath when necessary washing the back, feet as the case may be
8. Assist patient to dry up with towel
9. Assist patient to groom and wear new clothes if necessary
10. Sends patient to bedside and sits him comfortably in a chair as desired
11. Makes patients bed and discard dirty clothing and makes patient comfortable
12. Collects toiletries, tidies bathroom, washes and dries hands
13. Documents procedure and report findings
TEPID SPONGING
Requirement on trolley

A bowl

2 jugs ( on for hot and the other for cold water)

Six flannels ( 0r face towels)

A temperature tray

Long mackintosh and bath blankets

A receiver for used water
1. Explains procedure to patient and provides privacy
2. Prepares trolley and sends to the bedside
3. Washes and dries hands
4. Takes patient's temperature, pulse and respiration and records
5. Arranges top bed clothes leaving top sheet
6. Protects bottom sheet and undresses the patient
7. Washes and dries face to refresh patient
8. Leaves a flannel rung out of cold water on the patient's forehead
9. Places 6 pieces of flannel into basin or tepid water
10. Places a wet flannel in each axilla and groin, squeezes out excess water
11. Changes the wet flannel frequently to keep them tepid
12. Sponges upper arms, trunk, lower limbs and back in strokes leaving small drops of water
on the skin
13. Changes water as often as necessary
14. Leaves patient for 15-20 minutes
15. Dresses patient up and rechecks temperature and records
16. Thanks and makes patient comfortable
17. Washes and dries hands and serves cold drink if necessary
18. Documents procedures and reports findings
TASK: CARE OF THE MOUTH
REQUIREMENTS ON TRAY

Bowl for dentures

Tooth paste and brush

A sputum mug or receiver for used water

Mackintosh and towel

Napkin

Orange sticks

Mirror
COMPONENT TASK
1. Explain procedure to patient.
2. Arrange requirement for patient.
3. Assist patient into a suitable and comfortable position.
4. Places towel under chin for protection.
5. Give brush with paste/ chewing sponge /stick to him.
6. Encourage patient to brush the teeth.
7. Cleans the mouth thoroughly but gently inside the cheeks, both sides of gums, tongue and
palate.
8. Give water or mouth wash and void content into a receiver.
9. Make patient comfortable in bed
10. Clears away used items
11. Washes and dries hands, records procedure and reports any abnormalities.
TASK: MOUTH CARE FOR A SERIOUSLY ILL/ UNCONSCIOUS PATIENT
REQUIREMENTS ON TRAY

Two gallipots ( for mouth cleaning lotion and cotton wool or gauze )

Bottle containing the mouth cleaning lotion ( e.g. normal saline, sodium bicarbonate,
weak strength of hydrogen peroxide, maxolon mouthwash)

Padded Spatula

Mouth gag

Artery, sponge or dressing forceps

Dissecting forceps

Bowl for dentures

Glycerine or Vaseline

Receiver for used swabs

Orange sticks (toothpick)
COMPONENT TASK
1. Explain procedure to patient and provide privacy
2. Prepare a tray and takes it to the patient’s bedside
3. Put patient in a suitable position
4. Protects patients’ gown and bed linen with mackintosh and towel.
5. Pour lotion into gallipots washes and dry hands.
6. Cleans lips and outer part of teeth. Opens mouth with padded spatula.
7. Inspect mouth for any abnormality and remove dentures.
8. Take swab with forceps dip into cleansing lotion and squeeze out excess.
9. Cleans mouth thoroughly but gently, i.e. from inside the cheeks, both sides of the gum,
tongue and palate changing swabs frequently.
10. Controls movement of the tongue with spatula.
11. Uses tooth pick to clean in between of teeth.
12. Cleans mouth with water or any mouth wash.
13. Cleans lips and applies Vaseline.
14. Make patient comfortable in bed and removes screen.
15. Discard tray, decontaminates, washes and sterilizes instruments.
16. Washes hands and documents procedures and findings.
TASK: WASHING OF PATIENTS HAIR IN BED
REQUIREMENTS ON TROLLEY

Gallipot containing cotton balls to plug the ears and protect the eyes

A long mackintosh

A mackintosh and towel

A pail

Hair comb

Shampoo

2 jugs for hot and cold water

A basin/bucket

A receptacle for used water

Towel

Hair drier

Hair cream
COMPONENT TASK
1. Explain procedure t patent and provide privacy.
2. Prepare and send trolley to bed side.
3. Puts patient in a suitable position.
4. Arrange long mackintosh into a trough, fashion under the patients’ shoulders neck and
head and extend it down into a bowl or bucket.
5. Covers mackintosh with a bath towel under the patients’ shoulders, neck and around the
shoulders.
6. Combs, removes tangles, wet hair and applies soap/ shampoo.
7. Massages hair well, rinse and repeats till clean.
8. Wipes any moisture around the eyes, face and neck.
9. Squeezes hair gently and ties hair up in a towel and dries thoroughly with a towel or hand
drier.
10. Applies pomade, combs and styles hair to patients liking.
11. Remove mackintosh and towel and leaves patient dry and comfortable in bed.
12. Discard trolley, washes and dries hands.
13. Document procedure and report findings.
SHAVING A BEARD
1. Explains procedure to patient
2. Sends tray to bedside or place of treatment
3. Provides privacy when necessary
4. Gathers the equipment the patient prefers to use and modifies any equipment for potential
safety hazard
5. Places patient in a sitting up position
6. Covers patients with protective clothing
7. Determines the patient's usual shaving routine
8. Inspects the face for elevation moles, birthmarks or lesions
9. Lather the face with shaving cream or soap
10. Washes and hands
11. Using short strokes with razor, shaves in the direction or the hair growth
12. Starts from the upper face and lip and extend to the neck
13. Instructs patient to tilt his head to help shave in hollow or curved areas
14. Uses the hand without the razor to pull the skin below the area being shaved
15. Rinses the razor after each stroke.
TASK: TREATMENT OF PRESSURE AREAS
REQUIREMENTS ON TROLLEY
Top shelf

A bowl or basin

2 jugs (one containing cold water and the other hot water)

Soap in a soap dish

towel

Sponge

Barrier cream (Zinc oxide,/powder )
Lower shelf

Receiver for used water

Bath blanket and a long mackintosh or bed sheet and long mackintosh

Patient garment

Receptacle for soiled linen
In the absence of a trolley, cardiac table or a bed side locker can be used.
COMPONENT TASK
1. Establishes report and explains procedure to patient
2. Prepares look warm water for procedure
3. Sets trolley and sends to patients bed side and provides privacy
4. Remove patients bedclothes and cover with sheet
5. Protect bed with a mackintosh and a draw sheet
6. Protects bed with a mackintosh and draw sheet
7. Roll patient onto the side
8. Cleans all pressure areas with soap and water in a soft towel with gloved hands
9. kneads all pressure areas with pad of fingers one area at a time.
10. Rinses and dry skin with a soft dry towel
11. Applies moisturizing cream or alcohol-free barrier cream/films
12. Groom and makes patient comfortable in bed
13. Thanks patient and discards trolley
14. Washes and dry hands and document procedure and findings
15. Inform charge-nurse of any abnormality
TASK: CARE OF HANDS AND FEET
REQUIREMENTS ON TROLLEY

Two Jug (for cold and warm water)

A bowl

Nail clipper

Nail file

Nail brush

A receiver

Soap in a soap dish

Two Towels

A draw mackintosh and sheet

A receptacle for used water

Vaseline
COMPONENT TASK
1. Explain procedure to patient.
2. Provide privacy and take tray or trolley to bed side.
3. Position patient comfortably.
4. Puts mackintosh and dressing towel on bed.
5. Puts bowl of warm water on the mackintosh and towel.
6. Wet fingers in a bowl of warm water and cut finger nails to the shape of finger tips using
a pair of scissors or nail clipper.
7. Wet and cut toe nails across to prevent in growing toe nails.
8. Puts all nail clippings into a receiver.
9. Put hand into the bowl of warm water and scrubs nails gently with nail brush.
10. Wash hands thoroughly using soap and sponge.
11. Alternately put feet into the bowl of water and washes feet thoroughly using soap and
sponge.
12. Change warm water and rinses hands and feet alternately after washing them.
13. Dries hands and feet thoroughly.
14. Applies petroleum jelly to hands and feet.
15. Remove mackintosh and towel making patient comfortable and thank him.
16. Discards tray washes hands and dries them, document procedure.
TASK: FEEDING A HELPLESS PATIENT
REQUIREMENTS
TRAY ONE

Small Mackintosh and towel
TRAY TWO

Peg


Plate/bowl or cup containing food
Mouth wash


Cutlery set /spoon
Jug of water


Jug of water/ fruit juice
Sputum mug


Cup
Napkin


Flower
Bowl


Napkin
Soap in a dish
COMPONENT TASK
1. Explain procedure to the patient.
2. Consider the patients like and dislike and disuses menu with him/her to stimulate appetite.
3. Ensure clean atmosphere, clear all bedpans, urinals and vomit bowl on the ward
4. Put patient in a comfortable position if patient’s condition will allow it.
5. Put patient in a sitting up position and arranges pillow on the back rest to support him. If
bed table is available places it across the bed and uses it as a dinning table before the
patient.
6. Places prepared tray on the bed table or patient’s locker.
7. Washes patient’s hands with soap and water and dry with a clean towel.
8. Washes hands before serving meals (NURSE).
9. Places mackintosh and napkin /serviette across the chest to protect bed linen and patient’s
dress.
10. Sits at the bed side of patient if convenient to make patient feel relaxed.
11. Cut feed into bite sizes ( e.g. Yam) and feed patient with level spoonful a little at a time.
12. Allow him enough time to chew and swallow
13. Observes the rate at which the patient eats.
14. Co-ordinate the opening of the mouth and introduction of food into the mouth.
15. Places the spoon or fork accurately into the mouth. i.e. not too far back to produce
gagging.
16. Serve sips of water in between feeding and at the end of the meal to rinse mouth using a
spoon or flexible straw
17. Clean or wipe patient mouth and chin during and after the meal when necessary.
18. Serve water, removes used napkin/serviette and clears tray.
19. Congratulate patient for efforts made in eating.
20. Encourage patient to comment on the food served/procedure.
21. Document in the nurses’ notes/ fluid intake and output chart.
22. Make patient comfortable
23. Washes hands with soap and water and dry with lean towel.
TASK: SPOON FEEDING AN ADULT PATIENT
TRAY ONE
TRAY TWO

Mackintosh and draw sheet

Mackintosh and towel

Peg

Peg

Mouth wash

Plate/bowl or cup containing food

Jug of water

Cutlery set /spoon

Sputum mug

Jug of water/ fruit juice

Napkin

Cup

Bowl

Flower

Soap dish

Napkin
COMPONENT TASK
1. Washes hands and prepares meal tray with food, spoon, jug of drinking water, cup
and napkin.
2. Tell patient she wants to feed him and offers a bedpan if required.
3. Put patient in a comfortable position, washes and dries hands.
4. Give patient a mouth wash.
5. Brings food in a tray to patient’s bedside and protects clothing with napkin.
6. Places herself in a comfortable position and ask patient if prayer is preferred.
7. Take food by spoon in small bits into patient’s mouth.
8. Allows patient time to chew and swallow.
9. Repeats step 7-8 until patient is satisfied.
10. Give water intermittently as required by patient or gives water after feeding.
11. Cleans patient’s lips and gives a mouth wash.
12. Removes napkin and makes patient comfortable.
13. Congratulates patient and discards tray.
14. Washes hands and documents on nurses notes.
ADMINISTRATION OF MIXTURE
COMPONENT TASK
Requirement on tray

Medication

Bib or protective towel

Napkin

Medication cup

Measuring cup

Spoon

Jug of water

Cup

medication chart/treatment sheet/ patients folder
1. Identifies and checks for the right patient, right drug and right time, dose and route
2. Establishes rapport, explains procedure to patient and sends tray to bedside
3. Identifies patient by mentioning the name and checks with treatment sheet.
4. Reads and compares the label on the bottle with patient's treatment sheet
22
5. Shakes the bottle well
6. Removes the cork and holds it with the little or ring finger, compares label on the bottle a
second time with patient's treatment sheet
7. Picks the medicine glass and with the thumb nail marks the level of the measure to be
taken
8. Pours out the prescribed dose at eye level in bright light, holding the bottle with the label
upper most
9.
Replaces the cork, reads the label a third time, compares with patient's treatment sheet
and dose in the glass
10. Carries medicine to the patient on a tray or saucer, a teaspoon may be added for stirring if
it is a suspension
11. Supervises patient to drink the medicine and serves water if necessary
12. Congratulates patient and makes him comfortable in bed
13. Discards tray, washes and dries hands
14. Documents procedure and signs treatment sheet
TASK: ADMINISTRATION OF TABLET
REQUIREMENTS ON TRAY
A patient treatment chart and folder

Medication container containing patients’ medication

Jug of water

Cup

A saucer and spoon / a medication cup

Napkin

Treatment chart
COMPONENT TASK
1. Identifies patient by mentioning the name and checks treatment sheet against doctors’
order.
2. Explain procedure to patient and sends tray to the bed side.
3. Check for the right patient, right drug, right time and right dose.Ensures patients right
to know/consent and right to refuse.
23
4. Read the label on the container and compare with patients treatment sheet.
5. Assesses patients’ condition and level of consciousness and checks vital signs where
necessary. e.g. digoxin.
6. Remove lid of container, check label on container and compares with patients’
treatment sheet for the third time.
7. Pours out water into a drinking glass or cup.
8. Take the tablet with a spoon.
9. Gives the tablet to the patient and ensure that patient swallows it.
10. Congratulates patient and makes him comfortable in bed.
11. Discards tray, washes and dries hands.
ADMINISTRATION OF RECTAL MEDICATION
A tray containing

Medication

Mackintosh and dressing towel

Receiver

Folder and medication sheet and nurses notes

gallipot containing water

gallipot containing cotton wool

gloves
1. Identifies patient by mentioning the name and checks treatment sheet against doctor's
order
2. Establishes rapport and explains procedure to patient and encourage him to empty bowel
3. Sends tray to bedside, provides privacy and clean anal area with water and cotton wool
swabs
4. Observes the ten (10) rights of medication administration
5. Reads the label and compares with patient's treatment sheet
24
6. Protects bed with dressing mackintosh and towel at the buttocks
7. Assists patient to a left lateral or left Sim's position, with the upper leg flexed
8. Fold back the top bedclothes to expose the buttocks
9. Removes medication, checks label and compares with patient's treatment sheet the third
time
10. Wears glove on the hand used to insert the suppository
11. Unwraps the suppository, lubricate the smooth rounded end with gloved index finger
12. Encourages the patient to relax by breathing through the mouth presses the patient's
buttocks together for few minutes
13. Asks the patient to remain in the left lateral or supine position at least for five (5) minutes
or according to manufacturer's instruction
14. Congratulates patient and makes him comfortable in bed
15. Removes gloves, clears tray, washes and dries hands
16. Documents procedure on treatment sheet and nurses notes
PREPARING TROLLEY FOR INTRAVENOUS INFUSION
Washes and dries hands, and sets trolley with the following items:
Top Shelf
A galipot with sterile swabs, galipot for cleansing agent
Bottom Shelf
1. Infusion bottle/bag
2. Giving set
3. Sterile syringe and needles
4. Infusion stand
5. Scalp vein needle/right size of cannula
25
6. Strapping and scissors
7. Sterile glove pack
8. Cleansing agent e.g. methylated spirit or povidine
9. Protective mackintosh
10. Tourniquet/sphygmomanometer
11. Receiver for used swabs
12. Bottle holder
13. Intake and output chart
GIVING INTRAMUSCULAR INJECTION
REQUIREMENT
A tray containing

An ampule/vial

Diluent

Gallipot containing swabs

Gallipot with a lid or container with antiseptic solution

Syringe

Needle

receiver
1. Identifies and checks for the right patient, right drugs, right route and right time
2. Establishes rapport, explains procedure to patient and provides privacy
3. Prepares and takes tray to patient's bedside
4. Checks details again with patient's treatment sheet
5. Washes and dries hands
6. Assembles syringe and needle using aseptic technique
7. Files and breaks ampoule or removes metal cap of vial with a clean swab, draws
drug and discards ampoule or vial
8. Replaces needle with a new one and expels air (if drawn from a vial)
9. Assists patient into a comfortable position and exposes site for injection
26
10. Cleans site with swab dipped in antiseptic lotion (upper outer quadrant of buttocks if
buttocks is used and outer aspect if thigh is used)
11. Inserts the needle quickly and firmly deep into the muscle at right angle
12. Withdraws piston a little to ensure needle is not in a blood vessel
(if blood appears withdraws needle, and repeat step 10)
13. Pushes to release drug into the tissue
14. Withdraws the syringe and needle quickly and with a swab gently applies pressure
to the site of injection
15. Discards syringe and needle into a "safety box" or container
16. Thanks patient and leaves him comfortable in bed
17. Washes and dries hands, signs treatment sheet and documents any findings
ADMINISTRATION OF I.V. MEDICATION
(AMPOULE RECONSTITUTED DRUG)
REQUIREMENT
A tray containing

An ampule/vial

Diluent

Gallipot containing swabs

Gallipot with a lid or container with antiseptic solution

Syringe

Needle

receiver
1. Establishes rapport and explains procedure
2. Checks the physician's order for the type of medication and the ten rights
of drug administration
3. Checks medication label and be sure before reconstituting as per manufacturer
instructions especially expiry date
27
4. Washes hands, reconstitutes and examines for cloudiness, sediments
Draws medication and expels air from the barrel of the syringe
5. Protects bed linen with a dressing mackintosh and towel and positions patient
comfortably
6. Washes hands, wears gloves and cleans entry port of cannula with
methylated spirit and cotton wool swab
7. Fixes syringe into the empty port of cannula and pushes medication slowly
using the push-stop-push-stop technique till administration is completed whiles observing
patient.
8.
Continue observing patient even after injecting medication 5 to 10 minutes later
9. Encourages patient to inform the nurse for any adverse reaction
10. Thanks patient and makes him comfortable in bed
11. Removes dressing mackintosh and towel and discards used items
12. Washes and dries hands and record procedure on treatment chart and on the.
nurses notes
TASK: SETTING UP I.V. INFUSION
REQUIREMENT
A trolley for serving bed pan if required
A trolley containing
Prescribed solution
Giving set
Vital signs tray
Gloves
Adhesive tape (Plaster)
Giving set
Intake and output chart
Cannula
Tourniquet
28
Gallipot containing swab
Gallipot/ container containing methylated spirit
1. Establishes rapport and explains procedure and its purpose to patient and
reassures him
2. Checks the physician's order for the type of solution and checks the rights of drug
administration
3. Ensures quality of the infusion (checks for cloudiness, sediments, other particles
and expiry date) Sends prepared trolley and other equipment to the patient's
bedside
4. Encourages patient to use bedpan and checks vital signs
5. Selects and inspects sites and shave if necessary
6. Places infusion stand at the side of the bed and prepares plaster strips/tape
7. Inserts the piercing needle of giving set into the rubber seal of the infusion
bag/bottle and hangs the bottle/bag on the drip stand
8. Makes patient comfortable in bed and instructs him to notify nurse
when there is a problem
9. Checks infusion rate accuracy after 5 minutes and continue to observe the
site of insertion for swelling
10. Thanks patient, discards tray, washes and dries hands
11. Records time of setting up, type and amount of fluid on the intake and
output chart
12. Documents procedure on nurses notes
RECORDING OF INTAKE AND OUTPUT
1. Establishes rapport and explains the procedure to patient
2. Sets tray with the required items
3. Records amount of infusion/transfusion and other fluid intake on intake column in
millilitres
4. Records any output such as urine, watery stool, vomitus on output column
5. Totals intake and output for 24hours depending on hospital policy
6. Finds fluid balance by subtracting output from intake
29
7. Informs the nurse in charge/doctor immediately if amount of output is greater than the
amount taken in or when there is abnormally low output.
TASK: SERVING A BEDPAN TO A HELPLESS PATIENT
REQUIREMENT ON TROLLEY
Top shelf

A bowl

A jug of water

Soap in a soap dish

A towel

Toilet roll

Disposable gloves

Draw sheet and mackintosh( this is brought along so that in a situation where the draw
sheet in place gets soiled it can be replaced)
Bottom shelf

A warm bed pan

Receptacle for used toilet roll
COMPONENT TASK
1. Provide privacy
2. Bring a covered bedpan to the bed side and explain procedure to the patient
3. Stand at the right side of the bed with assistant on the other side
4. Lift patient with the assistant onto bedpan
5. Lift patient again with assistant to remove the bedpan after use , cover the bed pan
immediately
30
6. Cleans patient
7. Arrange bed clothes and leave patient comfortable in bed
8. Allow patient to wash hand with soap and water and dry hands
9. Take bed pan to the sluice room and inspect content before emptying it.
10. Measure urine if any and when necessary and records.
11. Empties bed pan and decontaminates, washes and sterilises it.
12. Washes and dries hand and removes screen
13. Documents procedure and reports any abnormalities
TASK: COLLECTION OF STOOL SPECIMEN FROM A PATIENT CONFINED TO
BED
COMPONENT TASK
Requirement of trolley
(Just as that for serving a bed pan)

Plus a specimen container

Request form

Spatula
1. Explains procedure to the patient and parent if child and provides privacy
2. Sets trolley and sends it to patient's bedside with stool specimen container
3. Washes and dries hands and puts on gloves and serves' bedpan.
4. Leaves patient till he has finished
5. Assists to clean up and removes bedpan and covers immediately
6. Allows patient to wash and dry hand
7. Thanks patient and make him comfortable
8. Uses wooden spatula to take most representative stool specimen from the bedpan,
including mucus, blood, pus if any into the specimen container and covers it
9. Wraps the wooden spatula in paper towel and discards.
10. Disposes stool, decontaminates bedpan and removes disposable gloves and Discards
11. Washes and dries hand
12. Document procedure and findings
13. Reports any abnormality to the nurse in charge
14. Labels and sends specimen to the laboratory immediately with signed request from
31
TASK: DRESSING OF WOUND WITH ASSISTANT
REQUIREMENTS
Top shelf

2 kidney dishes with a cover (one containing cotton wool balls and gauze)

A probe

2 galipots(one of the cleaning lotion and the other for the lotion used in
dressing the wound)

Dressing forceps (2)/A pair of Sterile gloves if the dressing will be done with
the hands

Dissecting forceps (2) ( insituations where the hand is used in cleaning the
wound only one dissecting forceps will be required to pick the last layer of old
dressing on the wound after washing of hands)

Bottom shelf

Mackintosh and towel

Receptacle for soiled dressing

Lotions for dressing e.g. povidone iodine, normal saline, hydrogen peroxide

Face mask

Scissors

Bandage

Face mask

Disposable gloves

Plaster
COMPONENT TASK
1. Explain procedure to patient and ensure privacy.
2. Put on mask, prepare and take trolley to bed side.
3. Ask for assistant for.
i.
Put patient in desire position
ii.
Protect bed cloths and expose area.
32
iii.
Pour out lotion into gallipots
iv.
And remove plaster or bandage
4. Washes and dries hands and wears sterile gloves or uses sterile forceps.
5. Removes soiled dressing using dissecting forceps and discards.
6. Cleans wound with swabs soaked in normal saline using sterile forceps / worn sterile
gloves starting from the inner part of the wound to outer region using one swab at a time.
7. Cleans wound with series of swabs until clean.
8. Applies sufficient sterile dressings and secures into position with a plaster or bandage.
9. Informs patient about state of wound, thanks and makes him comfortable in bed.
10. Discards trolley, decontaminates used items and removes gloves.
11. Washes and dries hands and removes screen.
12. Documents and reports state of wound.
TASK: DRESSING WOUND WITHOUT ASSISTANT
REQUIREMENTS
Top shelf

2 kidney dishes with a cover ( one containing cotton wool balls and gauze)

A probe

2 galipots

Dressing forceps (2)

Dissecting forceps (2)

A pair of peeled Sterile gloves if the dressing will be done with the hands
Bottom shelf

Mackintosh and towel

Receptacle for soiled dressing

Lotions for dressing e.g. povidone iodine, normal saline, hydrogen peroxide

Face mask

Scissors

Bandage

Face mask

Disposable gloves
33

Plaster
COMPONENT TASK
1. Explain procedure to patient and ensure privacy.
2. Prepare and take trolley to the patient’s bedside.
3. Position patient comfortably and protects bed clothes.
4. Exposes area of wound and removes plaster or bandage.
5. Washes and dry hands, assemblies instruments and pours lotion into galipots.
6. Removes soiled dressings with dissecting forceps or gloved hand and discard and washes
and dry hands.
7. Dabs or leans wound with sterile forceps/gloves using prescribed lotion or gently irritate
lean wound with syringe and normal saline from within outwards and cleans the
surrounding skin.
8. Cleans, dabs wounds with series of swabs until it is clean. Applies sterile dressing using
prescribed dressing lotion and secures into position or leaves exposed where necessary.
9. Makes patient comfortable in bed, explains relevant finding to patient and thanks him.
10. Discards trolley and decontaminates instruments and washes hands.
11. Removes gloves and decontaminates instruments and washes hands.
12. Discards trolley ad decontaminates instruments and washes hands.
13. Removes gloves and screens, washes and dry hands.
14. Discards trolley and decontaminates instruments and washes hands.
15. Removes gloves and screen, washes and dries hands.
16. Document and reports state of the wound.
TASK: REMOVAL OF STITCHES
REQUIREMENT ON TROLLEY

Same as dressing of wounds

Plus Stitch scissors
COMPONENT TASK
1. Explain procedure to patient and ensure privacy.
34
2. Put on mask, prepare and take trolley to bed side.
3. Ask assistant to:
a. Put patient in desire position, protect bed cloths and expose area to be dressed only.
b. Pour out lotion into gallipots
c. And remove plaster or bandage
4. Washes and dries hands
5. Removes soiled dressing using dissecting forceps and discards.
6. Cleans wound with series of swabs soaked in antiseptic lotion using sterile forceps.
Places sterile swab near the wound.
7. Takes dissecting forceps and stitch removing scissors, grasp ends of the stitch with
dissecting forceps and pulls gently to expose an area between the knot and the skin.
8. Cuts stitch between the knot and the skin, pulls out sutures gently and slowly.
9. Inspect carefully to make sure sutures are removed and discarded on a piece of gauze,
noting number of sutures removed.
10. Cleans wound, applies dressing and secures in position.
11. Thanks and makes patient comfortable in bed..
12. Discards trolley, decontaminates instruments
13. Removes gloves, washes and dries hands
14. Removes screen
15. Documents and reports state of wound.
REMOVAL OF CLIPS
A trolley for dressing of wounds (In addition a clip remover is added)
1.
Establishes rapport and explains procedure to the patient
2.
Wears mask, prepares dressing trolley and takes to bedside and provides privacy
3.
Puts patient into desired position, adjusts bed clothes to expose area to be dressed and
protects bed linen
4.
Pours out lotions into gallipots and removes plaster or bandage
5.
Washes and dries hands and puts on gloves
6.
Removes soiled dressing with dissecting forceps and discards
7.
Swabs wound with antiseptic lotion using another sterile forceps and places sterile
swab near the wound
8.
Takes clip removing forceps and dissecting forceps, steadies the clip with the
35
dissecting forceps and inserts one blade of the clip remover on top of it
9.
Presses the blades together and then frees the clip from the skin on either sides and
places it on the swab, noting number of clips removed
10.
Cleans wound, applies dressing and secures into position
11.
Thanks and makes patient comfortable in bed
12.
Discards trolley and decontaminates instruments
13.
Removes gloves, washes and dries hands
14.
Documents procedure and reports finding
TASK: TAKING A WOUND SWAB
REQUIREMENT ON TROLLEY
Top shelf
2 kidney dishes with a cover( onecontaining cotton wool balls and gauze)
A probe
2 galipots
Dressing forceps (2)
Dissecting forceps (2)
A pair of Sterile gloves if the dressing will be done with the hands
Sterile Specimen container with a swab stick
Bottom shelf
Mackintosh and towel
Receptacle for soiled dressing
Lotions for dressing e.g. povidone iodine, normal saline, hydrogen peroxide
Face mask
Scissors
Bandage
Face mask
Disposable gloves
Plaster
36
COMPONENT TASK
1. Explain procedure to patient and provide privacy
2. Puts on face mask and prepares trolley and takes it to the bed side.
3. Instruct assistant to:
a. Put patient in a comfortable position and protect bed linen.
b. Pour out lotion into galipot.
c. Expose wound area.
d. Remove plaster/ bandage
4. Washes and dry hands and put on gloves.
5. Removes soiled dressings with dissecting forceps and discards
6. Removes swab sticks gently from sterile container and swabs wound from the most
discharging part.
7. Replaces stick into container and corks it to avoid contamination.
8. Clean wound, applies dressing and secures into position.
9. Thanks and makes patient comfortable in bed.
10. Discards and decontaminate instruments.
11. Removes gloves, washes and dry hands.
12. Removes screen and labels specimen.
13. Documents procedure and report on the state of the wound.
14. Ensures specimen is sent to the lab with the request form.
TASK: PROCESSING INSTRUMENTS AFTER USE
REQUIREMENT ON TRAY
A pair of Utility gloves
A bucket containing 5% chlorine solution
Sponge
Soap in a soap dish or liquid soap
A receptacle to collect the cleaned instruement
A veronica bucket containing warm or cool water or a standing
A sink or bowled for used water
Soft bristled scrubbing brush
Towel for drying instrument
COMPONENT TASK
37
1. Immerseall used instruments in a plastic bucket of freshly prepared 1-10 parazone
solution for at least 10 minutes.
2. Put on utility gloves and remove instruments from the parazone 1-10 after 10minutes.
3. Rinse the instrument in warm or cool water.
4. Scrubs instrument using a soft brush with liquid detergent pay attention to the
crevices/serrated ends.
5. Rinse instrument thoroughly with clean water to remove all detergent
6. Boil for 20 minutes in a steriliser with a lid well covered.
OR dries by air or clean with clean towel if to be sterilised (CSSD).
TASK: PRE-OPERATIVE PREPARATION OF PATIENT FOR SURGERY
REQUIREMENTS
A trolley containing

A covered Kidney dish containing gauze,

A bottle containing antiseptic lotion

Soap dish containing soap

bowel of water(jug of water and a bowl)

container containing Sponge

Operation towel

theatre gown

disposable gloves

Vital signs tray and B/P apparatus

Mackintosh and draw sheet

Name tag
COMPONENT TASK
1. Prepare a trolley with the following items:
38
Shaving material, gauze, antiseptic lotion, bowel of water, soap and sponge, operation
towel, operation gown, B/P apparatus, thermometer, mackintosh.
2. Explain procedure to patient and reassures him.
3. Sends trolley to bed side and provide privacy.
4. Places patient into desired position.
5. Exposes the area to be prepared and protects the bed clothes.
6. Wears gloves, washes the area with soap, sponge and water.
7. Dries and cleans with antiseptic lotion.
8. Covers area with operating towel and secures it in position with adhesive strapping.
9. Gowns patient with a clean theatre gown.
10. Ask patient to empty bladder and remove dentures of any.
11. Check vital signs and record TPR and BP.
12. Thank patient, discards trolley and washes hands.
13. Gives prescribed medication when patient is ready for the theatre.
TASK: PREPARING A PATIENT AND TROLLEY FOR CHEST ASPIRATION AND
ASSISTING WITH THE PROCEDURE
REQUIREMENTS ON TROLLEY
Two plain dissecting forceps
Sterile towel
Sterile dressing
Sterile gloves and masks
1 artery forceps
39
Sterile syringe (5-10ml) and needles
50ml syringe with aspiratory needle size, 16,18 and 20
2 or 3 way stop cork with extensive tube
Chest drainage set
Dressing mackintosh and towel
Specimen bottles
Local anaesthetic agent
TPR tray with a blood pressure apparatus
A pair of scissors
Receptacle for used instrument and swabs
Adhesive strapping
1. Establish rapport , explain procedure to patient and ensures consent form is signed
2. Washes and prepares the trolley with the following requirement
a. Two plain dissecting forceps
b. 1 artery forceps
c. Sterile syringe (5-10ml) and needles
d. 50ml syringe with aspiratory needle size, 16,18 and 20
e. 2 or 3 way stop cork with extensive tube
f. Sterile gloves and marks
g. Sterile towel and dressing
3. Dressing mackintosh
a. Receptacle and specimen bottles
b. Local anaesthetic agent
c. TPR tray with a blood pressure apparatus
d. A pair of scissors
e. Receptacle for used instrument and swabs
f. Adhesive strapping
4. Sends trolley to bedside and provides privacy
40
5. Ensure chest x-rays are ready
6. Check vital signs ad records
7. Sits patient on the edge of the bed with his legs supported and his head and folded
arms resting on th over bed tables or have him embraced on a chair backward and rest
his head and folds arm on the back of the chair. Or if not able to sit positon patient by
turning him on the unaffected side with the arm on the affected side raised above his
head, elevates the head of the bed 30-45 degrees.
Assisting with the procedure
8. Maintains patient position throughout procedure
9. Protects bed linen with mackintosh and towel or paper
10. Reminds patient not to cough or breathe deeply or more suddenly during the
procedure
11. Exposes the whole area and shaves (when necessary) and cleans the area with an
antiseptic solution.
12. Assist the doctor throughout the procedure
13. Checks vital signs, general condition and level of pain throughout the procedure
14. Secures tube in position with a firm dressing and strapping.
15. Makes patient comfortable and thanks him
16. Discards trolley and decontaminates used instruments
17. Labelsspecimens and ensures specimen is taken to the laboratory
18. Washeshand and documents procedure and findings
TASK: CARE OF A PATIENT IN SKIN TRACTION
Requirement
Vital signs tray
Rope
Pulley
Traction kits
Prescribed weight
41
1. Explain procedure to patient and ensure patient understands activity restriction
2. Check vital signs and records, assesses patients neuromuscular status of affected
extremity ( peripheral pulse, colour, amount of movement, oedema, numbness
temperature and sensation)
3. Assess patient regularly for signs of thrombi and emboli i.e. pulse, blood pressure,
respiration, breath sounds for evidence of emboli inspect extremity involved for
redness, swelling and pain and patients mental status
4. Assess pressure areas for signs of irritation on breakdown of the continuity of the
skin especially bonny prominences ( heels, ankles ,sacrum ,elbow, chin and
shoulders)
5. Assess skin for allergies or signs of infection or injuries
6. Inspect traction apparatus regularly for level of elevation of the foot end knee
flexion on bed 20 -30 degrees
7. Ensure free play of ropes on the pulley
8. Ensure weights are hanging freely and not resting on the bed or the floor when
bed is in the lowest position
9. Ensure ropes are straight without knots kinks between points of attachment and in
the same plane as the ling axis of the bone
10. Ensures ropes are securely attached with slip knot and the short ends of the ropes
are attached with a tape.
11. Ensure bed clothes and other objects do not impinge on the traction and spreaderbar wide enough to prevent the traction tape from rubbing on the bony
prominences
12. Ensure patient is in the supine position and maintain body alignment when turning
him
13. Ensure trapezes is padded to assist patient in lifting his body for back care and
provide slipper bedpan to minimise movement on bed
14. Provide protective devices and measures to safeguard the skin for example watr
bags to the heels sacrum, shoulders and other pressure areas.
15. Treat pressure areas four hourly
16. Changes adhesive skin traction when ordered provides skin care and re-wraps into
position.
17. Encourage patient to do deep breathing, coughing and range of motion and flexion
and extension exercise
42
18. Remove gloves, washes hands, dries and document findings
TASK: LAST OFFICES
REQUIREMENTS ON TROLLEY
Gallipot containing cotton
A receiver to collect urine
Shroud kits
1. Prepares trolley and provides privacy
2. Turns body to lateral position with a receiver to collect oral secretion
3. Turns body to the supine position and applies gentle pressure over the lower abdomen
to empty the bladder into a receiver.
4. Ensures eyes are closed and cleans thebody
5. Cleans nostrils and ears and mouth and replaces dentures if any and removes all tubes.
6. Trims the nails, shave males beard and saves for the relatives
7. Remove all jewellery. ( including wedding rings and beads records and hands over to
the next of kin or ward in charge).
8. Redresses wounds if any secures dressings with a loss tape or bandage
9. Pack orifice- nostrils ears, rectum and vagina with cotton wool using forceps to
prevent leakage
10. Puts a label on the arm and body the following
a. Age
b. Sex
c. Ward
d. Diagnosis
e. Date and time of admission
f. Date and time of date
11. Wraps body in a sheet ensuring patient that the face and feet are covered and all limbs
held securely in position.
12. Makes and arrangement to transfer the body to the mortuary
13. Checks property with a second nurse
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a. a list of property in a value or property book , locks the property in a safe place
b. hands them over to the nest of kin if available and asks this person to sign the
book
14. Clears away any equipment used and observes infection prevention protocol
15. Clears the bed locker and all appliances.
16. Documents in the admission and discharge book and daily ward state.
17. Takes patients folder to the revenue office for assessment of hospital bill.
TASK: SKIN PREPARATION FOR SURGERY
REQUIREMENT ON TRAY
Soap in a soap dish
Water
Antiseptic lotion e.g. savlon, bethadine lotion
Disposable gloves
Sterile towel
Mackintosh and a towel
Receiver
1. Establish rapport and explains procedure to patient
2. Sends prepared tray to bed side, provides privacy and puts patient into the desired
position
3. Washes hands and exposes the area to be prepared only and protects the bed clothes
4. Washes a wide area around the operated side with soap and water
44
5. Washes and dries hands and put on gloves
6. Cleans the area with antiseptic lotion
7. Applies sterile dressing towel or paper towel and secures into position
8. Thanks the patient removes and discard tray
9. Decontaminate the items used, removes gloves washes hands and dries hands
10. Documents procedure and reports finding
TASK: RECTAL WASHOUT
Requirement
A trolley containing
Mackintosh and towel
Enema syringe
Lubricant e.g. KY jelly
Disposable Gloves
Jug of cold and hot water/ prescribed solution
Gallipot containing swabs
Bedpan
1. Establishes rapport and explains procedure to the patient
2. Sets trolley and sends to the patient’s bed side and provides privacy
3. Put patient into a left lateral position at the edge of the bed
4. Put mackintosh and towel under patient’s buttocks
5. Covers upper part of patient with top bed sheet and lower part with bath blanket to the hip
level.
6. Involves patient in checking the temperature of the solution
7. Flex patients hip and knees
8. Puts on gloves, cleans anal region with swabs and lubricates
9. Introduces enema syringe into rectum
10. Encourages patient to hold solution for some few minutes
11. Offers bedpan or commode for patient to empty bowel
12. Repeats till the returning fluid is clear or patients cannot tolerate any more.
13. Discards tray and decontaminates enema syringe by soaking in 0.5% chlorine solution for
10 minutes
45
14. Removes and observes the content of the bed pan and discards
15. Removes gloves washes and dries hands
16. Give patient soap and water to wash hands and makes him comfortable in bed
17. Thank patient, records procedure and finding.
18. Decontaminates, cleans and stores articles used.
TASK : CONTINUOUS BLADDER IRRIGATION
REQUIREMENT
Mackintosh and towel
Sterile towel
Irrigating apparatus
Prescribed Irrigating fluid (Normal saline)
Gloves
Intake and output chart and nurses notes
1. Establishes rapport and explain procedure to the patient and ensures privacy.
2. Assembles necessary items for irrigation.
3. Assist patient into a desired position.
4. Turns back the top bed cloth to expose the retention catheter.
5. Protects bed with mackintosh and dressing towel.
6. Washes and dries hands, wears sterile gloves.
7. Puts sterile towel under the end of catheter.
8. Cleans the lumen of the catheter and connects the irrigating apparatus
9. Infuses 40-60 drops of irrigation fluid per minute or as prescribed
10. Continues the process until purpose of the irrigation is accomplished
11. Observes patient for any discomfort during the process
12. Empties the receptacle and record the output and observation made
13. Removes gloves washes and dries hands
14. Makes patient comfortable in bed
15. Decontaminate and sterilise used equipment if not disposable
46
16. Washes and dries hands and document procedure
TASK: CARING FOR A PATIENT WITH UNDER WATER-SEALED
DRAINAGE
REQUIREMENT

Vital signs tray

Tray for serving oral medication

Dressing trolley if necessary

Sterile gloves
1. Reassure patient and puts patient in the fowlers or semi fowlers position
2. Checks vital signs and records( baseline data)
3. Washes hands and puts on gloves
4. Place the bottle below he chest level in a receptacle
5. Checks the rate and depth of respiration, chest movement and auscultates his lungs
6. Observes dressing site for bleeding and dislodgement of tube and inspect air vent in
the system
7. Checks fluid level fluctuation and bubbling in the drainage system
8. Checks tube for kinking an perforations
9. Encourage patient to cough frequently an breathe deeply
10. Assess patency of drainage system
11. Tell patient to report any breathing difficulty immediately
12. Checks and changes the chest tube dressing when necessary and palpates the area
surrounding the dressing for crepitus.
13. Observe the volume colour and consistency and odour of the drainage
14. Washes hands and administers pain medication
15. Assist patient with range of motion (R.O.M) exercises
16. Thanks patient for cooperation
17. Washes hands again and documents procedure
47
REMOVAL OF AN INDWELLING CATHETER
Tray containing
Gloves
Mackintosh and towel
Syringe(10-20ml)
Receiver
Gallipot containing swabs
Towel
Measuring jug
Small towel( for cleaning the genital area)
1. Establishes rapport and explains the procedure to patient
2. Prepares and takes tray to bedside and provides privacy
3. Positions patient as for catheterization
4. Places mackintosh and dressing towel beneath the patient and around genital area
5. Washes and dries hands
6. Wears gloves and places towel between legs of the female patient/on the thighs of the
male patient
7. Inserts the syringe into the injection part of catheter and withdraws water from the
balloon
8. Gently withdraws the catheter and places in the waste receptacle
9. Dries the genital area with towel
10. Measures urine in the drainage bag and removes gloves
11. Thanks patient and discards used items
12. Washes and dries hands and documents findings
CATHETER CARE FOR FEMALE PATIENTS
Mackintosh and towel
Gloves
K Y jelly
Gallipot with lid containing cotton wool
Gallipot with containing antiseptic lotion
48
1. Establishes rapport and explains procedure to patient
2. Assembles necessary equipment and supplies
3. Ensures privacy
4. Washes hands and put patient in the supine position
5. Places mackintosh and towel under patient
6. Covers patient up so that only vulva area is exposed washes hands and wears gloves
7. Removes anchor device to free catheter tubing
8. Cleans vulva using cotton wool swab and antiseptic solution towards anus,
cleans urethral meatus, moving down the catheter
9. Reassess urethral meatus for discharge
10. Uses cotton wool swab soaked in antiseptic lotion, wipes in a circular motion along
length of catheter and anchors back into position
11. Applies antibiotics ointment at urethral meatus and along 2.5cm of catheter if ordered by
Physician/Surgeon
12. Places patient in a safe and comfortable position
13. Disposes all contaminated items, removes gloves and wash hands
14. Records and reports findings
CARE OF A PATIENT IN SKIN TRACTION
1. Explains procedure to patient and ensures patient understands activity restrictions
Checks vital signs and records, assesses patient's neurovascular status of affected
extremely (peripheral pulses, colour, amount of movement, oedema, numbness,
temperature and sensation)
49
2. Assesses patient regularly for signs of thrombi and emboli i.e. pulse, blood pressure
respirations, breath sounds for evidence of emboli, inspects extremity involved fore
redness swelling and pain and patient's mental status
3. Assesses pressure areas for signs of irritation or breakdown in the continuity of the
skin
especially bony prominences (heels, ankles, sacrum, elbow, chin and shoulders).
Areas
susceptible 0 pressure from the traction e.g. (the tibia for Buck's extension)
4. Assesses skin for allergies and signs for infection or injury
5. Inspects traction apparatus regularly for level of elevation of foot end knee flexion on
bed 20 to 30 degrees
6. Ensures free play of ropes on the pulley
7. Ensures weight are hanging freely and not resting on the bed or floor when bed is in
the lowest position
8. Ensures ropes are straight without knots or kinks between points of attachment and in
the same plane as the long axis of the bone
9. Ensures ropes are securely attached with slip knots and the short ends of ropes are
attached with a tape
10. Ensures bedclothes and other objects do not Impinge on the traction and spreader-bar
wide enough to prevent the traction tap on the bony prominences
11. Ensures patient is in the supine position body alignment when turning him
12. Ensures trapeze is padded to assist patient in lifting his body for back care and
provide slipper bedpan to minimize movement in bed
13. Provides protective devices and measures to safeguard the skin example, water bags
for the heels, sacrum, shoulders and other pressure areas
14. Treats pressure areas 4 hourly
50
15. Changes adhesive skin traction as ordered, provides skin care and re-wraps into
position
16. Encourages patient to do deep-breathing, coughing and range of motion and flexion
and extension exercises
17. Removes gloves, washes hands, dries and document findings
CATHETER CARE FOR MALE PATIENTS
1. Establishes rapport and explains procedure to patient
2. Assembles necessary equipment and supplies
3. Ensures privacy
4. Washes and dries hands and puts patient in the supine position
5. Places mackintosh and towel under patient
6. Covers patient up so that only genital area is exposed
7. Removes anchor device to free catheter tubing, washes hands and wears gloves
8. Retracts foreskin if present to expose urethral meatus, cleans around catheter first, and
then wipes in circular motion around meatus and glans
9. Reassess urethral meatus for discharge
10. Uses cotton swab soaked in antiseptic lotion, wipes in circular motion along the
length of catheter and anchors it back
11. Applies antibiotics ointment at urethral meatus and along 2.5cm of catheter if ordered
by Physician/Surgeon
12. Places patient in a safe and comfortable position
13. Disposes all contaminated items, removes gloves and washes hands
14. Records and reports finding
51
TASK: CHECKING VITAL SIGNS-TEMPERATURE, PUSLE,
RESPIRATION,BLOOD PRESSURE(USING THE INDIVIDUAL
ELECTRONIC THERMOMETRE AND ELECTRONIC
SPHYGMOMANOMETRE)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Explains procedures to patient
Presses knob to ensure thermometer is functioning and washes hands
Prepares and sends tray to patient’s bedside
Makes patient comfortable by lying or sitting up in bed
Presses knob again to show reading on the screen, exposes axilla, dries with clean
cotton wool and discards
Inserts thermometer into the axilla between two skin folds leaves it in places
until it beeps
Whiles thermometer is in axilla, checks and records pulse and respiration
Removes thermometer after beep, reads and records
Cleans from stem to the bulb and insert thermometer back into its cover
Records readings of pulse
Records respiration
Stretches patients arm and wounds cuff around arm above the elbow
Presses knob to inflates cuff and read after a beep
Removes cuff and reassemble apparatus
Thanks patient, washes hands
Notes reading
Makes patient comfortable
TASK: CHECKING VITAL SIGNS-TEMPERATURE, PUSLE, RESPIRATION,BLOOD
PRESSURE(USING THE INDIVIDUAL NON DIGITAL AND MERCURIAL
SPHYGMOMANOMETRE)
1.
2.
3.
4.
Explains procedures to patient
Prepares and sends tray to patient bedside
Makes patient comfortable by lying or sitting
Dip the bulb of the thermometer into a gallipot containing water.
5.
6.
Cleans thermometer from stem to the bulb
Read thermometer at eye level and ensure mercury is at 35ᵒ C
52
7.
8.
9.
10.
Wipe axilla with cotton swab (dry)
Inserts thermometer in to axilla between two skin folds
Leave thermometer in axilla for three full minutes
Whiles the thermometer is in position check pulse and respiration rate
11.
12.
13.
14.
Records pulse rate and respiration rate
Remove thermometer Cleans thermometer from stem to the bulb at eye-level
Reads thermometer at eye level
Washes, dries hands or uses alcohol to rub and records temperature
15
16.
17.
18.
Stretches patient arm and places sphygmomanometer at the shoulder level
Wounds cuff around arm above elbow
Palpates radial artery and inflates cuff
Checks, Wears and places stethoscope on brachial artery
19.
20.
21.
22.
23.
Releases cuff pressure slowly and listens to sound with stethoscope
Removes cuff and reassembles
Thanks and makes patient comfortable in bed
Washes and dries hands
Records Blood Pressure readings on nurse note and vital signs chart
TASK:
MAKING A CARDIAC BED
1.
2.
3.
Collects, arranges items on trolley and sends to bedside
Arranges items in order of use on a chair or heart table
Places bottom sheet evenly on the bed and tucks the sheet under
the mattress using enveloped corners
4. Pull sheet tight so that there are no creases. Tucks in at the sides under the mattress at the
bottom using enveloped corners.
5. Places draw mackintosh across bed and covers with draw sheet and tucks in
6. Places covered air rings in between the mackintosh and draw sheet
7. Places/elevates backs rest at top of bed and arranges pillows in an arm chair-like fashion
on it
8. Places top sheet on bed with the wrong side upper most and folds sheet
over at the bottom
9. Places foot rest in position
10. Places
heart
table
with
covered
pillows
in
position
11. Places sputum mug and bell within reach of patient
12. Provides pen and paper if patient literate
53
13. Clears chairs/tables, trolley, washes dries hand or use alcohol rub if applicable
BRO. EBEN Wishes You Best Of Luck
54
(GOD HAS DONE IT ALREADY)