*

Lecture in patient care for 2 course students

Eugenia Golubkina, assistant of professor
Department of Internal Medicine
V.N. Karazin Kharkiv National University
 *

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Admission – entering a health care institution for nursing
care and medical and/or surgical treatment.

Hospital admission involves staying at a hospital for at

least one night or more.

An individual may be admitted to the hospital for a

positive experience, such as having a baby, or because
they are undergoing an elective surgery or procedure, or
because they are being admitted through the emergency
department.
 *
• Put on the patient an identification band
• Apply allergy band (if necessary)
• Initial patient assessment/nursing history
• Allergy History and Allergy Record
• Medication History/Medication Reconciliation
• Braden scale
• ARO screening
• Pediculosis and scabies screening
• Sanitary-hygienic procedures (bathing, changing
clothes)
Patient admission process, Central nursing orientation 2012, London
 *
 At the time of admission, the registered Nurse (RN)
performs complete assessment of the patient.
 Enter patient’s name, medical record number and age at
the upper left corner of the form.
 Enter also: patient’s adress, house and office phone
number, date of birth, place of employment, occupation.
 Enter date and time of admission, medical diagnosis and
chief complaint in the appropriate spaces in the form.
 Document the source of information (patient, family,
caregiver or health care person or significant person).
 Check and document if patient has previous
hospitalization and write patient history including past
major illnesses.
Patient admission process, Central nursing orientation 2012, London
 *
 Indicate if patient was admitted from ER (emergency
room), home, clinic, or other and accompanied by whom.
 Take patients vital signs (temperature, pulse, respiration),
height, weight .
 Evaluate and document the location and the severity of
the pain using the pain scale.
 Document if patient has history of allergy, if yes, check,
whether its due to medication, food or others.
 Document patient brought medicine to the hospital. If yes,
check whether it was send to pharmacy.
 Document if patient and family has valuables brought to
the hospital . If yes , check it was sent to admission office.

Patient admission process, Central nursing orientation 2012, London

 *
 At the time of arrival to the room, patient and family will
be given orientation to the unit, an explanation to the
patient’s rights and responsibilities.
 Check the activities of daily living and need of mobility
aid.
 Document emergency contact information, or the names
and telephone numbers of those individuals (family
members or others) the hospital should contact if the
person being admitted needs emergency care or their
condition worsens significantly

Patient admission process, Central nursing orientation 2012, London

 *
• Admission physical assessment shall be done within 24
hours of admission. (One nurse can start it (e.g. middle of
the night admissions) and nurse on next shift can complete)
• Must be completed before transferring patient from one unit
to another
• All data collected are entered on the Nursing Admission
Assessment Sheet and available to all those involved in the
care of the patient.
• The RN assigned to the patient is responsible to ensure that
the form is completed within the time frame specified.
• Documentation should be in permanent ink (blue or black).
• The nurse should write her/his name, RN and signature.
Patient admission process, Central nursing orientation 2012, London
 *

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Patient admission process, Central nursing orientation 2012, London

 *
Abbreviations:
• Temperature – T;
• Pulse – P;
• Respirations – R;
• Blood Pressure – BP;
• Vital signs - TPR and BP.

Purpose:
• Measured to detect any changes in normal body function
• Used to determine response to treatment

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 *
Ask about…
• all allergies, side effects and intolerances
• as well as reaction symptoms

Pay your attention on:

•Drug
•Environmental
•Food

Patient admission process, Central nursing orientation 2012, London

*

Patient admission process, Central nursing orientation 2012, London

 *
• A clinically validated tool that
allows nurses and other
medical staff to evaluate a
patient's level of risk for
developing pressure ulcers.
• Also determines if patient is on
correct therapeutic mattress.
• Completed on admission, once
a week and with any changes
in patient condition.

Patient admission process, Central nursing orientation 2012, London

 *
ARO – antibiotic resistant
organisms.

• All new admissions are

screened for MRSA
• MRSA sites - nasal, perianal,
wound (open or draining)
• Then screened every 14 days
while an inpatient

Patient admission process, Central nursing orientation 2012, London

*
Pediculosis - Infestation with blood-sucking lice.
Scabies - Human scabies is caused by an infestation of the
skin by the human itch mite (Sarcoptes scabiei var. hominis).

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 *
The three species of human lice are found on different parts
of the body:
• the head louse occurs on the scalp and is most common
in children on the back of the head and behind the ears;
• the pubic louse or crab louse is mainly found on hair in
the pubic region but it may spread to other hairy areas of
the body and, rarely, the head;
• the body louse occurs in clothing where it makes direct
contact with the body; it is similar to the head louse but
slightly bigger.

Body lice are known to transmit disease (epidemic typhus,

trench fever, and epidemic relapsing fever).

Secondary bacterial infection of the skin resulting from

scratching can occur with any lice infestation.
*
• Presence of live
louse or nit
• The person
habitually scratches
• There are scratches
on the skin, and
• There are
hemorrhagic spots in
the skin where the
lice have sucked
blood

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 *
Common sites for scabies
rash are:

• between fingers
• wrists
• auxiliary areas
• chest area
• the umbilical area
• genitalia
• buttocks
• ankles

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• Skin lesions: papules,
vesicles, pustules,
nodules
• burrows
• scratching, secondary
infection, eczema

Definite diagnosis - a
definite diagnosis is made
by taking skin scrapings
from burrows and
identifying the mites,
their eggs or faeces by
microscopy
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 *
Diagnosis is based on clinical findings such as mite attached
to the hair base and the presence of nits.
If a patient is positively identified as being infected with
pediculosis or scabies, the following steps need to be
instituted:

• Isolate confirmed and suspected cases under contact

precautions and exclude from social activities until 24
hours after treatment .
• Patient should be placed in a clean room with a clean
bedding and dressed in clean clothes.
• Cohort staff so only one group cares/attends the ill
residents.
• Do not transfer patients without notifying the accepting
facility of the diagnosis of pediculosis/scabies
 *
Environmental measures:
• Machine wash and dry bedding and clothing of patients using
the hot water and hot dryer cycles.
• Items that cannot be laundered or dry cleaned should be
placed in sealed plastic bags for 7 days.
• Routine cleaning and vacuuming should provide adequate
environmental control.
Non-drug treatment of pediculosis:
• Nits can be removed manually with fine-toothed combs or
forceps.
• All contaminated clothes and linens should be
decontaminated or removed from body contact.
• Shaving the hairs of the pubis removes the nits & the
ectoparasites.
Hairclipper after shaving should be treated with 70% ethanol.
 *
Drug Usage Dosage forms Notes
Permethrin applied to the affected area, lotion, 1% First line therapy
(Nix) and rinsed after 10 minutes

Lindane applied to the affected area, shampoo, 1% C/I: pregnant and

and washed after 4 minutes lactating women,
children <2 years of
age

Malathion applied to the scalp and left Lotion, 0,5% C/I: pregnant and
for 8-12 hours before rinsing lactating women,
children <2 years of
age

It’s flammable!
Benzyl applied to the infected area lotion, 25% for children: 12.5%
benzoate
 *
• Day 1 (p.m.) clip nails bathe or shower apply 5%
Permethrin cream to all skin areas from the neck down and
under nails
• Day 2 (a.m.) bathe or shower to remove the cream and note
that itching may continue for weeks
• Day 14 and Day 28: reexamine and retreat if there are
persistent or recurrent lesions
Lindane (lotion, 1%) – second line therapy
The lotion is left for 12 to 24 hours, followed by a thorough
washing.
C/I: pregnant and lactating women, children <2 years of age
Combined therapy:
esdepalletrin (esbiol)+piperonyl butoxide=Spregal-spray
applied on skin for 12 hours (C/I in lactation, caution in
pregnancy)
 *
Indications: admission of patients to the hospital in
satisfactory condition.
Contraindications: severe conditions of the patient –
• hypertensive crisis,
• acute myocardial infarction,
• acute ischemic stroke,
• active tuberculosis,
• all types of bleeding,
• burns,
• fever,
• psycosis
• acute abdomen.
 *
Equipment:
• Disinfectant for cleansing the tub
• Clean gloves;
• Soap and washcloth or sponge
• Hospital towel
• Clean gown or pajama
• Suitable bathtub/shower
• Disposable floor mat
• Thermometer

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 *
• Take supplies to bath or shower area, put on gloves;
• Bathtubs should be cleaned before an after use with
disinfectants (ex: 2% solution of chloramine B);
• Put the rubber mat in the tub or shower;
• Rinse the tub with cold water to prevent development of
steam;
• Fill the ½ of the bathtub with warm water;
• Measure the water temperature in tub: it should be 35-
37*C or adjust shower temperature;
• Ensure patient understands and consents to procedure;
• Caution patients about the possible discomfort
(palpitations, shortness of breath, etc.) and ask the
patient to inform about it.
 *
• Assist the patient to undress and to seat in tub if necessary
(water should reach the level of the xiphoid process) or to
get in the shower area.
• Assist the patient if needed: first wash the head, then the
trunk, upper and lower limbs, groin and perineum.
• The duration of the bath is 20-25 minutes.
• Help the patient to get out of the bathtub or shower area.
• Dry the patient with towel and assist to dress if needed.
• Empty and clean the tub;
The presence of a nurse during bathing procedure is required,
with a deterioration in health condition of the patient (the
appearance of chest pain, palpitations, dizziness, pale skin
and other symptoms) nurse should stop procedure, provide
first aid and inform the doctor on charge.
*

If the patient has

contraindications for hygienic
bath nurse can use technique of
sponge bath.
The method lies in washing the
patient with wet sponge or
washcloth without immersing the
body of a patient in the water.

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*
The patient’s weight, compared with the height, gives
information about his/her nutritional status and changes in
the medical condition.
It is also used by doctor to prescribe medications.
Height measurements
• Feet
• Inches
• Centimeters
Weight measurements
• Pounds
• Ounces
• Kilograms
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Equipment:
• Balance beam scale (for patients who are able to stand
without assistance)
• Bed scale (for patients who are confined to bed or who
are unable to stand) or Bed scale (built into the bed)
• Floor scale (for patients in wheelchairs)
 *
Balance beam scale
• Balance scale so that
weight is accurate
• Place a clean paper towel
on scale and ask patient
to remove shoes.
• Assist patient to stand on
scale.
• Move weights until the
weight bar is level or
balanced.
• Record weight on
appropriate record.

Clinical nursing skills, basic to advanced skills 7 th ed by Smith, Duel, and Martin
 *
Floor scale
Scales accommodate
wheelchairs for weighing
patients.

Clinical nursing skills, basic to advanced skills 7 th ed by Smith, Duel, and Martin
 *
Bed scale is used to
weigh patients who
are on complete bed
rest.

Clinical nursing skills, basic to advanced skills 7 th ed by Smith, Duel, and Martin
*
 Check patient ID and perform hand hygiene.
 Weigh patient in the morning before breakfast. Ask
patient to void before weighing.
 Use the same scale each time you weigh the patient.
 Make sure the patient wears the same type of clothing
(e.g., gown or robe) for each weighing.
 If bed scale is used, account for weight of linens, etc.
 (Extraneous variables, such as linens, extra pillows, etc.,
result in inaccurate patient measurements.)
 Change wet gowns or heavily saturated dressings before
weighing the patient.
*
• Ask patient to face front so
back is toward scale's balancing
bar.
• Instruct patient to stand erect.
• Place L-shaped sliding height
bar on top of patient's head.
• Read patient's height as
measured.
• Record height on appropriate
record.
• Discard paper towel (if used)
and assist patient back to
room.
• Perform hand hygiene.

Clinical nursing skills, basic to advanced skills 7 th ed by Smith, Duel, and Martin
*Functions of inpatient
services
Hospital inpatient services basically covers 1/3 rd of the
total hospital complex.

The functions of inpatient services are:

•To render nursing care to all patients
•To provide necessary equipment, essential drugs and all
other stores requirements for patients care in an organized
manner in the wards
•It provides opportunity for training medical, nursing and
paramedical, nursing and medical staffs besides conducting
research work.
 *
Hospital ward
- block forming a division of a hospital (or a suite of rooms)
shared by patients who need a similar kind of care

Types of wards:
• General wards
• Specialized wards (maternity, pediatrics, psychiatric,
geriatrics, oncology, and detoxification wards)

Constituents:
• Patient space
• Nursing space
• Corridors
*Important design factors for the
ward:

• Movement space
• Number of beds in a room
• Bed spacing
• Position of nursing station
• Category of the ward
• Ancillary rooms
• Ratio of toilet accommodation
 *
There are different types of ward design:

• Open ward or Nightingale Ward

• Modified Nightingale Ward
• Rig’s Pattern Ward (Unilateral or Bilateral)
• T-Shaped Ward
• L-Shaped Ward
• Cruciform type of ward
 *
This type of ward was designed in 1770 by Frenchman,
Later it was adopted by Florence Nightingale and is
known by her name.
The characteristics of Nightingale ward are :
• This is an open-plan ward containing 25-30 beds.
• Patients’ beds are located in two row in a long,
rectangular ward.
• It may have side rooms for utilities and perhaps one or
two side rooms, that can be used for patient occupancy
when patient isolation or patient privacy is important.
• Nursing Station, Doctor’s room and others facility at
one end. Bathroom and WC at the other end.
*

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Advantages:
• Good visibility;
• Economical benefits (easy to construct);
• Good possibilities for ventilation.

Disadvantages:
• This is the noisiest type of ward;
• No privacy for the patients;
• High risk of cross-infections.
 *
Main features of the modified Nightingale ward:
• This type of ward has a nursing station in centre of ward;
• Ancillary and Auxiliary service are located at one end and
utility service at other end of the ward;
• The nurse travel time has been reduced and the
supervision over patients condition also improved in
modified pattern of ward.
 *

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It was first made in Rigg hospital in 1910 in Copenhagen.

Main features of Rigg’s ward:

• Ward unit is divided into small compartments separated
from each other.
• Each compartment having 4-6 or more beds arranged
parallel to the longitudinal wall.
• Bed may be on one side or both sides of nursing station.
• Isolation room (1 or 2) can be kept in ward.
 *

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Advantages:
• Patient beds not visible to outside visitors except for
visiting hours
• Gives a more clean and tidy look
• It provides as a barrier against psychological shock for other
patients during emergency situations.
• More privacy

Disadvantages:
• Communication between nurses and patient becomes more
difficult
• Patients deprived of direct observation from nurses
• Wards become longer, consequently nurses have to run
more
• More nurses are required
• Expensive to build and maintain
*

Ancillary Auxiliary
accommodation accommodation

Ward
unit

Sanitary Primary
accommodation accommodation
 *
Primary Accommodation.
Consists of single bedroom or multiple bedroom for patients
and a nursing station.
Ancillary accommodation.
Service for direct support of treatment (portable x-ray,
Pantry, Dietician service in ward, mobile pharmacy).
Auxiliary accommodation.
Service for indirect support of treatment (Store,
housekeeping, doctor’s room, nurse’s room, seminar –
teaching room).
Sanitary accommodation.
Consists of WC, Bathroom, sluice room.
 *
What should be considered in designing different types of
wards:
• General ward :Healthy Environment
• Pediatric/ psychiatric ward- Safety
• Geriatric ward- Safety/ comfort
• Obstetrics/Gynecology ward – Privacy
• ICU- Nursing Care
• OT-Infection control
*
Sanitary-hygienic and anti-epidemic regimen is the extensive
complex of actions which are carried out by medical staff, and
also by patients to maintain safety and cleanliness in the
medical institution and prevention of developing or/and
spreading of nosocomial infections.

Hygienic requirements in wards are:

• Optimal temperature in the ward should be 18-20C;
• Wiping(the floor, windows, furniture) at least 2 times a day
– in the morning and evening.
• In some departments — more often, for example, in the
infectious departments — 4 times a day.
• Morning wiping should be finished till 9 a.m.
• Ventilation of wards not less than four times a day.
*
• White coat;
• Tidy appearance;
• Short nails;
• Special hospital footwear which can be easily disinfected
(for example, leather).
• Hands well washed up with soap.
• To medical sisters engaged in surgical manipulations,
watches, rings, varnish on nails are forbidden.
• According to indications (the maternity, infectious
department, epidemic of influenza, etc.) a mask is put on;
it is necessary to change a gauze mask every 4 hours; at
an opportunity, it is better to use disposable sterile masks.
*
There are several psyco-emotional types of nurses:

• Mother-like type;
• Sergeant-like type;
• Nervous type;
• Expert type;
• Routine type.
*

Working with patients

nurse is caring, shows
empathy, ability to feel
needs and emotions of a
patient.

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Working with patients

nurse shows resoluteness,
uncompromising attitude,
instantaneously reacts on
slightest infringements of
discipline.
Patients feel themselves
nervous when she
approaches and try to put
their beds and bedside
tables in order.
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*

Such type of nurse is

emotionally labile, quick-
tempered, easily irritable,
constantly shows
hyperactive reactions on
different situations, tries
to draw your special
attention on her problems.

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While working with

patients nurse shows
extreme attention in the
field of professional
activity, she is proud of
her importance as a
nurse, sometimes she
tries to act like a doctor.
*

While working nurse shows

high level of qualification,
accurate and mechanically
performs her duties, but
her relationships with the
patient are deprived of
emotion, compassion and
empathy.
*

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*
• Endorse patients and give attention to patients’ comfort
and safety; maintains safe environment for patients.
• Maintains nursing care of a patients, especially seriously ill
(transfer, measurement of body temperature, BP,
collecting analysis data, feeding, cleaning, moving
seriously ill patients etc.)
• Carries out the doctors instructions
• Maintains proper ward management with house keeping
and sanitation
• Delivers clean medical supplies to patient care units and
collect used supplies, instrument sets, rubber goods, etc.
• Makes general assessment of patients in the recovery room
and confers with head nurse nursing management of each
patient
*
• Accompanies physician on rounds to answer questions,
receives instructions and notes patients’ care
requirements.
• May render professional nursing care and instruct patients
and members of their families in techniques and methods
of home care after discharge
• Observes nursing care and visits patients to insure that
nursing care is carried out as directed and treatment is
administered in accordance with physician’s instructions
and to ascertain needs for additional or modified services.
• Cooperates with individual/group in other departments or
services in carrying forward the work of the hospital as a
whole.
*
• Determines and makes recommendations concerning
hospital wards’ facilities, equipment and surgical supplies
affecting nursing care, and plans for allocation and
utilization of space and equipment to ensure safe
environment for patients and working personnel
 *
A transfer is the safe movement of the patient from one
place to another, like from bed to wheelchair, from one unit
to another within the one medical institution or from one
medical institution to another.

Types of transfer:
Intrahospital – Within the same facility

Interhospital – Within two different facilities

From hospital to home– Post Discharge/ After Referral to

other type of Healthcare delivery Setups
 *
• From Admitting office to Wards
• From Emergency to Wards
• From Emergency to OT/ ICUs
• From Wards to OT/ ICUs
• From Wards to Radiology for Imaging
• From Wards to Wards
• From One ICU to other ICU
*

Clinical nursing skills, basic to advanced skills 7 th ed by Smith, Duel, and Martin
 *
• From one facility to other in same city
• From one facility to other in different city
• From Hospital to other healthcare delivery centre,
Government Hospitals, Geriatric care, End of life care
facilities, Nursing homes etc
*

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 *
Equipment:

• Wheelchair or gurney
• Covering for client
• Patient's records, chart patient care plan, and valuables
receipt
• Patient's MAR (medication administration record)
• Patient's personal hygiene equipment
• Special equipment (e.g., walker)
• Personal belongings
 *Equipment for Patient’s Transfer

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 *
Slider sheets

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 *
Slide/transfer boards

Transfer belts

Smaller
slide/transfer
boards:
banana
board Turning or pivot discs
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 *

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Supine — lying on the back
(ex – MI, head traumas, etc.)

Fowler’s position — lying on

the back with the head of the
bed raised 30 to 90 degrees,
most commonly about 45
degrees (obesity, pulmonary
disease (ex. - bronchial
asthma), heart disease (ex. -
left heart failure))

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Prone position, the patient
lies on the abdomen with the
head turned to one side. (
ex.–injury of the back, burn
of the back)
Side-lying position- the
patient lies on one side of the
body with the top leg in front
of the bottom leg and the hip
and knee flexed.(ex –
patients with vomiting,
patients with dry pleurisy on
affected side to decrease
pain)

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• Verify physician's order if needed.
• Contact admitting office to arrange for transfer.
• Communicate with transfer unit to determine the best
time for transferring client.
• Identify patient and inform patient of impending transfer.
• Gather equipment, belongings, and records.
• Obtain necessary staff assistance for transfer.
• Transfer patient to wheelchair or gurney unless patient is
remaining in bed for the transfer. Use protective belts and
rails as indicated.
• Cover patient to provide warmth and to avoid exposure
during transfer.
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• Notify charge nurse when you arrive on the receiving unit.
• Introduce patient to new staff, who will be caring for the
patient that day.
• Give complete report to staff, using the patient care plan.
Give information concerning individualized care needs,
patient problems, progress, when next medications or
treatments are due. If necessary, give phone report to
receiving nurse.
• Notify physician, admitting office, and dietary department
when transfer is completed. A transfer notification must be
sent to the appropriate departments.
• Notify x-ray and the laboratory if tests were scheduled or
results pending.
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Independent transfers
◦The patient consistently performs all aspects of the
transfer, including setup, in a safe manner and without
assistance.

Assisted transfers
◦The patient actively participates, but also requires
assistance by a clinician(s).

Dependent transfers
◦The patient does not participate actively, or only very
minimally and the clinician(s) perform all aspects of the
transfer
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•Place and lock the wheelchair close to the bed. Remove
armrest nearest to the bed and swing away both leg rests.

•Help the patient turn over.

•Put an arm under the patient’s neck with your hand

supporting the shoulder blade; put your other hand under
the knees.

•Swing legs over the edge of the bed, helping the patient to
sit up.

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• Have the patient scoot to the
edge of the bed.

• Put your arms around the

patient’s chest and clasp your
hands behind his or her back.
Or, you may also use a
transfer belt to provide a firm
handhold.
• Supporting the leg farthest
from the wheelchair between
your legs, lean back, shift
your weight, and lift.

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•Have the patient pivot
toward the chair, as you
continue to clasp your hands
around the patient.

•A helper can support the

wheelchair or patient from
behind.
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•As the patient bends toward you, bend your knees and
lower the patient into the back of the wheelchair.

•A helper may position the patient’s buttocks and support

the chair.

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Cross Arms of a
patient

•Put the bed rail

and head of the
bed down; adjust
the top of the bed
to waist- or hip-
level.

•Cross the
patient’s arms on
his or her chest;
bend the leg
farther away from
you.
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Turn the Patient

• Put one hand behind the

patient’s far shoulder.
• Put your other hand
behind the patient’s hip.
• Turn the patient,
supporting the patient’s
leg with your knee.

• Remember: Putting one

knee on the bed gets you
closer to the patient, so
you pull more with you
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The leader should have one foot forward with knees bent.

Prepare to move.
•Put the head of the bed down and adjust the bed height.
•Put a garbage bag or plastic slide board between the sheet
and draw-sheet, beneath one edge of the patient’s torso.
•Move the patient’s legs closer to the edge of the bed.
•Instruct patient to cross arms across chest and explain move
to patient.

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Pull to Edge of Bed

Grasp the draw-sheet on both
sides of the bed.

•On the count of three, lean

back and shift your weight,
sliding the patient to the edge of
the bed. The helper holds the
sheet, keeping it from slipping.

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Position Stretcher
•Have the helper ―cradle‖ the patient in the draw-sheet
while you retrieve a stretcher.
•Adjust the bed to be slightly higher than the stretcher.
Then, position the stretcher, locking it in place.
•Move the patient’s legs onto the stretcher.

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Slide onto Stretcher

•Have the helper kneel on the
bed, holding on to the draw-
sheet.

•On the count of three, grasp

the draw-sheet and slide the
patient onto the stretcher. You
may need to repeat this step.

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Once the momentum has started, it’s almost impossible to
stop a patient from falling. By trying to do so, you can
injure your back. Instead, guide the patient to the ground;
then get help to move the patient back to a bed or
stretcher.
Guiding the Fall
Help falling patients to the floor with
as little impact as possible. If you’re
near a wall, gently push the patient
against it to slow the fall. If you can,
move close enough to ―hug‖ the
patient. Focus on protecting the
patient’s head as you move down to
the floor. Then call for help.
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Roll onto Blanket
•Roll the patient onto his or
her side.
•Put a blanket under the
patient and roll the patient
onto it.
•Position two or more people
on each side of the patient.

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Lift from Floor
•Kneel on one knee and grasp
the blanket.
•On a count of three, lift the
patient and stand up.
•Move the patient onto a bed
or stretcher.
Remember: Be proactive;
assess and identify a patient
as a fall risk and start
intervention to prevent a fall.

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