Danylo Halytsky Lviv National Medical University
Faculty of medicine
Department of Propedeutics of Internal Medicine №1
Discipline: Care for Patients (Practice)
Methodological Guidelines for English-speaking Students of Medical Faculty
(2-d Year of Study)
“Care for Patients in Internal Medicine Department” – Module №1
Lviv-2014
CONTENTS
1. INTRODUCTION TO NURSING ASSISTING. INFECTION AND
INFECTION CONTROL ………………………………………………...…3
2. MEASURING AND RECORDING VITAL SIGNS, HEIGHT, AND
WEIGHT ……………………………………………………………………6
3. MANAGEMENT OF THE DRUGS………………………………………...9
4. PRINCIPLES OF NUTRITION, HYDRATION, AND ELIMINATION....12
5. PATIENT CARE AND COMFORT MEASURES. BODY SYSTEMS,
COMMON DISORDERS, AND RELATED CARE PROCEDURES…….15
6. CARING FOR PATIENTS WITH SPECIAL NEEDS. RESPONSE TO
BASIC EMERGENCIES ………………………………………………….19
7. THE FINAL MODULE CONTROL………………………………….…...22
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Topic 1
INTRODUCTION TO NURSING ASSISTING
INFECTION AND INFECTION CONTROL
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Who is nursing assistant?
2. How you understand the concept Quality-of-life?
3. What is the major nursing assistant function?
4. What includes (long-term and short-term) Health Care (HC)?
5. What types of Health Care (HC) you know?
6. Who is a Health Care consumer? How they identified by the type of care
that they need?
7. What types of Health Care facilities with short-term care you know?
8. What types of Health Care facilities with long-term care you know?
9. Please list job responsibilities of the nursing assistant?
10.What patients needs you know?
11.What rules of personal hygiene must comply nursing assistant?
12.What uniform must have nursing assistant?
13.Identify the members of the interdisciplinary health care team.
14.Identify the members of the nursing team.
15.What basic rules of ethics you know?
16.What basic legal issues nursing assistant must comply?
17.How you understand the concept of “Ethical standards”?
18.How you understand the concept of “Legal standards”?
19.Please identify difference between ethical and legal standards?
20.Explain the principles of medical asepsis.
21.Explain the components of standard precautions.
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22.Describe nursing assistant actions related to standard precautions.
23.Describe airborne, droplet, and contact precautions.
24.List the types of personal protective equipment and discuss the use of
each item.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
1. Procedure 1 – Handwashing
2. Procedure 2— Putting on a Mask
3. Procedure 3— Putting on a Gown
4. Procedure 4— Putting on Gloves
5. Procedure 5— Removing Contaminated Gloves
6. Procedure 6— Removing Contaminated Gloves, Eye Protection, Gown, and
Mask
7. Procedure 7— Transferring Nondisposable Equipment Outside of the Isolation
Unit
8. Procedure 8— Specimen Collection from a Patient in an Isolation Unit
9. Procedure 9— Transporting a Patient to and from the Isolation Unit
III.
Test Control of theoretical knowledge.
1. The general term for a person who needs health care is:
a) patient;
b) resident;
c) health care consumer;
d) health care provider.
2. Health care facilities:
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a) treat most patients on an outpatient basis;
b) must get the insurer’s approval before providing emergency care;
c) provide a variety of services to ill and injured persons;
d) allow patients to stay as long as they want.
3. Nursing care is:
a) occupationally oriented;
b) patient-focused;
c) cross-trained;
d) physician directed.
4. The most important nursing assistant measure to prevent the spread of
infection is:
a) using isolation technique;
b) good handwashing;
c) wearing gloves;
d) using standard precautions.
5. If there is an exposure incident, you should:
a) ignore the situation;
b) report it at once to the supervisor;
c) call the doctor;
d) tell other nursing assistants.
Suggested Reading:
Nursing Assistant: A Nursing Process Approach—BASICS / Barbara R. Hegner,
Barbara Acello, Esther Caldwell – United States of America: Delmar, Cengage
Learning, 2010. – 701 p.
(SECTION 1: Unit 1, Unit 2, Unit 3) (SECTION 4: Unit 12. Unit 13)
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Topic 2
MEASURING AND RECORDING VITAL SIGNS, HEIGHT AND WEIGHT
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Name and identify the types of clinical thermometers and describe their
uses.
2. Read a thermometer.
3. What five body areas you know where is usually measured Temperature ?
4. Identify the range of normal temperature values for adults.
5. Define basic concepts: Pulse, Bradycardia, Tachycardi .
6. Explain the importance of monitoring a pulse rate.
7. Locate the pulse sites of the body.
8. Identify the range of normal pulse and respiratory rates.
9. Measure the pulse at different locations.
10.List the characteristics of the pulse and respiration.
11.List eight guidelines for using a stethoscope.
12.Identify the range of normal blood pressure values.
13.Identify the causes of inaccurate blood pressure readings.
14.Select the proper size blood pressure cuff.
15.List precautions associated with use of the sphygmomanometer.
16.Describe the use of a pulse oximeter.
17.Describe the proper use of an overbed scale.
18.Identify at least four types of scales and give an example of when each type
is used.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
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1. Procedure 25 – Measuring an Oral Temperature
2. Procedure 26 – Measuring a Rectal Temperature
3. Procedure 27 – Measuring an Axillary Temperature
4. Procedure 28 – Measuring a Tympanic Temperature
5. Procedure 29 – Measuring a Temporal Artery Temperature
6. Procedure 30 – Counting the Radial Pulse
7. Procedure 31 – Counting the Apical-Radial Pulse
8. Procedure 32 – Counting Respirations
9. Procedure 33 – Taking Blood Pressure
10.Procedure 34 – Taking Blood Pressure with an Electronic Blood Pressure
Apparatus
11.Procedure 35 – Measuring Weight and Height
III.
Test Control of theoretical knowledge.
1. Measuring the function of vital organs of the body is called taking:
a) vital statistics;
b) vital signs;
c) blood pressure;
d) pulse.
2. The rhythmic expansion and contraction of an artery is called the:
a) rate;
b) pulse;
c) volume;
d) blood pressure.
3. Difficulty breathing and shortness of breath is:
a) dyspnea;
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b) apnea;
c) expiration;
d) aspiration.
4. Hypertension is:
a) high blood pressure;
b) low blood pressure;
c) nervousness;
d) rapid pulse.
5. The instrument used to take a blood pressure reading is the:
a) thermometer;
b) aneroid dial;
c) mercury probe;
d) sphygmomanometer.
Suggested Reading:
Nursing Assistant: A Nursing Process Approach—BASICS / Barbara R. Hegner,
Barbara Acello, Esther Caldwell – United States of America: Delmar, Cengage
Learning, 2010. – 701 p.
(SECTION 6: Unit 18, Unit 19, Unit 20, Unit 21)
8
Topic 3
MANAGEMENT OF THE DRUGS
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Equipment Needed for Administering Oral, Sublingual, and Buccal
Medications (please note).
2. Please indicate client education that necessary for Administering Oral,
Sublingual, and Buccal Medications.
3. List all you have to assess for Administering Oral, Sublingual, and Buccal
Medications.
4. Equipment Needed for Administering an Intradermal Injection (please note).
5. Please indicate client education that necessary for Administering an
Intradermal Injection.
6. List all you have to assess for Administering an Intradermal Injection.
7. Equipment Needed for Administering Medication via Z-track Injection
(please note).
8. Please indicate client education that necessary for Administering Medication
via Z-track Injection.
9. List all you have to assess for Administering Medication via Z-track
Injection.
10.Equipment Needed for Administering Eye and Ear Medications (please
note).
11.Please indicate client education that necessary for Administering Eye and
Ear Medications.
12.List all you have to assess for Administering Eye and Ear Medications.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
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1. 5-1 Administering Oral, Sublingual, and Buccal Medications your actions)
2. 5-2 Administering Eye and Ear Medications
3. 5-3 Administering Skin/Topical Medications
4. 5-4 Administering Nasal Medications
5. 5-5 Administering Rectal Medications
6. 5-7 Administering Nebulized Medications
7. 5-8 Administering an Intradermal Injection
8. 5-9 Administering a Subcutaneous Injection
9. 5-10 Administering an Intramuscular Injection
10.5-11 Administering Medication via Z-track Injection
III.
Test Control of theoretical knowledge.
1. The correct way to administer eardrops to an adult client is to:
a) Pull the pinna straight back;
b) Pull the pinna down and back;
c) Pull the pinna upward and outward;
d) Pull the pinna straight down.
2. What is the appropriate method to administer medications through a
nasogastric tube?
a) Mix all medications together that are compatible, and flush with 20 to 30
mL warm water at the end.
b) Administer those medications that are compatible, and flush with 60 mL
warm water at the end.
c) Administer each medication individually, and flush with 100 mL warm
water at the end.
d) Administer each medication individually, flush with 15 to 30 mL warm
water between each medication, and flush with 30 to 60 mL at the end.
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3. The prescribing practitioner has order 2 teaspoonsful of Milk of Magnesia.
The nurse converts this dose to the metric system and administers:
a) 5 mL;
b) 10 mL;
c) 15 mL;
d) 30 mL.
4. What information should be obtained from the drug history?
a) Prescription drugs;
b) Allergies;
c) Herbal supplements;
d) Over-the-counter drugs;
e) Client’s sensory and cognitive status;
f) Lifestyles and beliefs.
5. What is the usual dosage range for intradermal injections?
a) 0.01 to 0.1 mL;
b) 0.1 to 0.15 mL;
c) 1.15 to 0.2 mL;
d) 0.2 to 0.25 mL.
Suggested Reading:
1. Nursing Assistant: A Nursing Process Approach—BASICS / Barbara R.
Hegner, Barbara Acello, Esther Caldwell – United States of America: Delmar,
Cengage Learning, 2010. – 701 p.
2. Fundamentals of Nursing: Standards and Practice Fourth Edition / Sue C.
DeLaune, Patricia K. Ladner – United States of America: Delmar, Cengage
Learning, 2011. – 1438 p.;
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Topic 4
PRINCIPLES OF NUTRITION, HYDRATION, AND ELIMINATION
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Spell and define terms: intake and output, push fluids or force fluids, fluid
balance, edema, urinary incontinence, urinalysis.
2. Identify aging changes of the urinary system.
3. List some common diseases of the urinary system.
4. Identify signs and symptoms of the urinary system that the nursing assistant
must observe and report.
5. Describe nursing assistant actions related to the care of patients with urinary
system diseases and conditions.
6. Spell and define terms: cholecystitis, constipation, diarrhea, enema, fecal
impaction, hernia, peristalsis, stool, suppository, ulcer, urgency.
7. Describe aging changes of the gastrointestinal system.
8. Describe some common disorders of the gastrointestinal system.
9. Describe nursing assistant actions related to the care of patients with
disorders of the gastrointestinal system.
10.List signs and symptoms the nursing assistant should observe for and report.
11.Indicate the main types of enemas, their function and purpose.
12.Spell and define terms: dysphagia, enteral feeding, full liquid diet,
gastrostomy feeding, nasogastric (NG) feeding, nutrition, pureed diet, soft
diet, therapeutic diets.
13.Define normal nutrition.
14.List the essential nutrients.
15.Name the six groups listed on the food pyramid.
16.Identify the basic facility diets and describe each.
17.State the purpose of calorie counts and food intake studies.
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18.Describe general care for the patient with dysphagia and swallowing
problems.
19.List types of alternative nutrition.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
1. Procedure 58 – Assisting with the Bedpan
2. Procedure 59 – Assisting with the Urinal
3. Procedure 60 – Assisting with Use of the Bedside Commode
4. Procedure 61 – Collecting a Routine Urine Specimen
5. Procedure 62 – Collecting a Clean-Catch Urine Specimen
6. Procedure 63 – Collecting a 24-Hour Urine Specimen
7. Procedure 73 – Testing Stool for Occult Blood
8. Procedure 74 – Giving a Soap-Solution Enema
9. Procedure 75 – Giving a Commercially Prepared Enema
10.Procedure 76 – Inserting a Rectal Suppository
11.Procedure 78 – Serving Meal Trays
12.Procedure 79 – Feeding the Dependent Patient
III.
Test Control of theoretical knowledge.
1. Enemas are given:
a) after the patient showers;
b) at bedtime;
c) before diagnostic testing;
d) after surgery.
2. Occult blood is:
a) easily seen in the patient’s stools;
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b) hidden blood that you cannot see;
c) always black, tarry, and pasty;
d) seen only when a person vomits.
3. Fecal impaction:
a) is the most serious form of constipation;
b) results from rapid movement of stool;
c) is a complication of persistent diarrhea;
d) has no identifiable signs and symptoms.
4. A condition that makes swallowing food and fluids difficult is:
a) dysphagia;
b) aphasia;
c) dysplasia;
d) aplasia.
5. The diet that is most difficult for patients to adhere to is the:
a) low-sodium diet;
b) full liquid diet;
c) selective diet;
d) house diet.
Suggested Reading:
Nursing Assistant: A Nursing Process Approach—BASICS / Barbara R. Hegner,
Barbara Acello, Esther Caldwell – United States of America: Delmar, Cengage
Learning, 2010. – 701 p.
(SECTION 8: Unit 26, Unit 2 7, Unit 28)
14
Topic 5
PATIENT CARE AND COMFORT MEASURES
BODY SYSTEMS, COMMON DISORDERS, AND RELATED CARE
PROCEDURES
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. List the ways the nursing assistant can help in the processes of admission,
transfer, and discharge.
2. List ways in which the nursing assistant can develop positive relationships
with a patient’s family members.
3. Operate each closed bed.
4. Operate each occupied bed.
5. Operate each surgical bed.
6. Properly handle clean and soiled linens.
7. Describe the safety precautions for patient bathing.
8. List the purposes of bathing patients.
9. Review the location and function of the skin.
10.List common problems related to the integumentary system.
11.Identify observations of signs and symptoms that the nursing assistant
should make and report.
12.Identify patients at risk for the formation of pressure ulcers.
13.Describe the stages of pressure ulcer formation.
14.Describe measures and identify appropriate nursing assistant actions to
prevent pressure ulcers.
15.Describe electrical, thermal, and chemical burns.
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II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
1. Procedure 36 – Admitting the Patient
2. Procedure 37 – Transferring the Patient
3. Procedure 38 – Discharging the Patient
4. Procedure 39 – Making a Closed Bed
5. Procedure 40 – Opening the Closed Bed
6. Procedure 41 – Making an Occupied Bed
7. Procedure 42 – Making the Surgical Bed
8. Procedure 43 – Assisting with the Tub Bath or Shower
9. Procedure 44 – Bed Bath or Waterless Bed Bath (Bag Bath)
10.Procedure 45 – Changing the Patient’s Gown
11.Procedure 46 – Partial Bath
12.Procedure 47 – Female Perineal Care
13.Procedure 48 – Male Perineal Care
14.Procedure 49 – Hand and Fingernail Care
15.Procedure 50 – Bed Shampoo
16.Procedure 51 – Dressing and Undressing the Patient
17.Procedure 52 – Assisting the Patient to Floss and Brush Teeth
18.Procedure 53 – Providing Mouth Care for an Unresponsive Patient
19.Procedure 54 – Caring for Dentures
20.Procedure 55 – Backrub
21.Procedure 56 – Shaving a Male Patient
22.Procedure 57 – Daily Hair Care
23.Procedure 86 – Changing a Clean Dressing
III.
Test Control of theoretical knowledge.
1. When a patient takes a bath, the bathroom door should:
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a) not be locked;
b) be left wide open;
c) be locked for privacy;
d) be left partially open.
2. You must dress Mr. Luna, a patient whose right side is paralyzed as a result
of a stroke. You will:
a) dress the patient’s right arm first;
b) select pullover clothing;
c) dress the patient’s left arm first;
d) remove pants on the right side first.
3. An ulcer that extends to the subcutaneous fat is a:
a) stage III pressure ulcer;
b) stage II pressure ulcer;
c) stage IV pressure ulcer;
d) stage I pressure ulcer.
4. Which of the following should be done when giving a partial bath to Mrs. De
Palma?
a) Take her to the shower room to give the partial bath.
b) Let her do as much of the bath as possible.
c) Wash the hands and feet as part of the procedure.
d) Avoid giving peri care, as this is not part of the procedure.
5. To help ensure adequate circulation to prevent skin breakdown, you could:
a) change the patient’s position frequently;
b) position the patient on bony prominences;
c) rub red areas well;
d) apply rubbing alcohol to the skin after bathing.
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Suggested Reading:
Nursing Assistant: A Nursing Process Approach—BASICS / Barbara R. Hegner,
Barbara Acello, Esther Caldwell – United States of America: Delmar, Cengage
Learning, 2010. – 701 p.
(SECTION 7: Unit 22, Unit 23, Unit 24)
(SECTION 11: Unit 35)
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Topic 6
CARING FOR THE PATIENT WHO IS DYING
RESPONSE TO BASIC EMERGENCIES
Type of a lesson – theoretical consideration, practical.
I.
Please answer the following questions (Theoretical knowledge).
1. Spell and define terms: cardiac arrest, cardiopulmonary resuscitation (CPR),
DNR (do not resuscitate), hospice care, living will, postmortem care.
2. Recognize the need for CPR.
3. List the benefits of early defibrillation.
4. Identify the signs, symptoms, and treatment of common emergency
situation: Choking.
5. Describe the grieving process and list the steps.
6. Spell and define terms: cardiac arrest, emergency care, chin-lift maneuver,
jaw-thrust maneuver, respiratory failure, strain.
7. Recognize the need for CPR.
8. Identify the signs, symptoms, and treatment of common emergency
situation: Head Injury.
9. List the signs of approaching death.
10.Spell and define terms: defibrillation, first aid, Heimlich maneuver,
hemorrhage, shock, ventilation.
11.Describe how to maintain the patient’s airway and breathing.
12.Identify the signs, symptoms, and treatment of common emergency
situation: Cardiac arrest.
13.Describe the hospice philosophy and method of care.
14.Spell and define terms: cardiopulmonary resuscitation (CPR), head-tilt,
recovery position, respiratory arrest, sprain, victim.
15.Recognize the need for CPR.
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16.Identify the signs, symptoms, and treatment of common emergency
situation: Heart Attack.
17.Evaluate situations and determine the actions to be taken.
II.
Please describe the following methods for patients care, that are
included in the duties of nurses assistant (Рractical skills).
1. Procedure 85 – Giving Postmortem Care
2. Procedure 107 – Head-Tilt, Chin-Lift Maneuver
3. Procedure 108 – Jaw-Thrust Maneuver
4. Procedure 109 – Mask-to-Mouth Ventilation
5. Procedure 110 – Positioning the Patient in the Recovery Position
6. Procedure 111 – Heimlich Maneuver— Abdominal Thrusts
7. Procedure 112 – Assisting the Adult Who Has an Obstructed Airway and
Becomes Unconscious
III.
Test Control of theoretical knowledge.
1. For one-person CPR, the ratio of chest compressions to ventilations is:
a) 30 compressions to 2 ventilations;
b) 5 compressions to 1 ventilation;
c) 15 compressions to 2 ventilations;
d) 30 compressions to 1 ventilation.
2. Moribund changes include:
a) permanent pupil constriction;
b) increased body heat;
c) increase in pulse and respiration;
d) blood pooling in the lower body.
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3. Hospice:
a) is a philosophy of care;
b) is available only at home;
c) cannot care for children;
d) is not available everywhere.
4. First aid is care given:
a) for nausea and vomiting;
b) only upon a physician’s order;
c) if medical help is delayed;
d) for cough, cold, or sore throat.
5. You suspect that a patient is in shock because the:
a) blood pressure is elevated;
b) face is flushed;
c) skin is cold and clammy;
d) pulse is full and bounding.
Suggested Reading: Nursing Assistant: A Nursing Process Approach—BASICS /
Barbara R. Hegner, Barbara Acello, Esther Caldwell – United States of America:
Delmar, Cengage Learning, 2010. – 701 p.
(SECTION 9: Unit 33) (SECTION 13: Unit 42)
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Topic 7
EVALUATION OF STUDENT KNOWLEDGE
ON FINAL MODULE
The final module control includes two situational tasks, practical skills and
control test of theoretical knowledge that are added.
Maximum points that can be earned for the module is 100 points:
- control test of theoretical knowledge – 50 points;
- 2 situational tasks – each task is rated at 20 points;
- practical skill – 10 points.
Minimum points that can be earned for the module is 50 points:
Module consists of two parts:
- First part of the module involves writing control test of theoretical
knowledge. Maximum – 50 points, minimum – 25 points. *
- Second part of the module consists of two situational tasks (each task is
rated at 20 points) and practical skill (10 points). Maximum – 50 points,
minimum – 25 points.
The final score of the module
Evaluation of a four-system
100……….85
"Excellent" – 5
84…….…70
"Good" – 4
69…….…50
"Satisfactory" – 3
49…….….0
"Unsatisfactory" – 2
* If student received less than 25 points on first part of the module this involves
re-writing of the first part (control test of theoretical knowledge). In this situation
student not permitted to the second part of the module and in convenient for
teacher and for student time again writes test control of theoretical knowledge. In
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case of receiving 25 or more points for test control student is admitted to the
second part of the module.
EXAMPLE:
Form № Н-5.04
Danylo Halytsky Lviv National Medical University
Educational and qualification level
specialist __
Direction of preparation 1201 medicine
Specialty ________________”Medicine” _________ semester ___III___________
Educational discipline __Care for the patients (Practice)______ Module №__1___
TEST PAPER №___
1. Control test of theoretical knowledge (appendix).
2. Situational task number 1. Susanna Hernandez is a 34-year-old patient who
was in an accident in which she fractured her pelvis, left femur (thigh bone), and
right forearm. She formerly lived alone in an apartment and looked in on her
elderly mother at the assisted living facility daily. After a long hospitalization, the
doctor plans to discharge Susanna. She cannot ambulate (walk) and has difficulty
feeding herself with her left hand. Consider how Ms. Hernandez will move through
the health care system to regain her self-care ability.
a) Ms. Hernandez cannot feed herself or ambulate. What kind of assistance will
she need after discharge?
b) Can she be discharged to her apartment, living alone? Explain your answer.
c) List the locations in which her continuing care could be provided.
3. Situational task number 2. Read clinical situation and answer the
questions. Enrique is given his assignment and has questions.
a) He must check his assignment with.
b) One of his assignments is to bathe patients. Is this appropriate?
c) One of his assignments is to give medications. Is this appropriate?
4. Practical skills. Procedure 30 – Counting the Radial Pulse.
Approved at the department meeting Propaedeutics of Internal Medicine №1
“
“ of ____________ 20___ year
Head of the chair ______________ Prof. MD Dutka R.J.
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