DOCUMENT RESUME ED 082 063 CE 000 378 TITLE Nursing Procedures. NAVMED P-5066. INSTITUTION Bureau of Medicine and Surgery (Navy), Washington, D.C. REPORT NO NAVMED-P-5066 PUL DATE 73 NOTE 514p. EDRS PRICE MF-$0.65 HC-$19.74 DESCRIPTORS Equipment; Equipment Maintenance; Health Occupations Education; *Instructional Materials; *Manuals; *Medical Education; Nurses; *Nursing ABSTRACT The revised manual of nursing procedures covers fundamental nursing care, admission and discharge of the patient, assisting with therapeutic measures, pre- and postoperative care, diagnostic tests and procedures, and isolation technique. Each of the over 300 topics includes the purpose, equIpmente and procedure to be used and, where relevant, such items as pointii, to emphasize, care of equipment, and diagrams. The document is indexed. (MS) 4:0' 0 r. 9 _....e-. ' 0 .oct. Copy '57a DT_TT 1 GATE NURSING PROUDURES U.S DEPARTMENT OF HEALTH. EDUCATION & WELFARE NATIONAL INSTITUTE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO DIKED EXACTLY AS RECEIVED FROM PERSON OR ORGANIZATION ORIGIN ATING IT POINTS OF VIEW OR OPINIONS ST ATVO DO NOT NECESSARILY REPRE SENT OFFICIAL NATIONAL INSTITUTE OF EDUCATION POSITION OR POLICY NAVMEDP-5066 2 Nursing Division Bureau of Medicine and Surgery Department of the Navy Washington, D. C. 20390 1973 FILMED FROM BEST AVAILABLE COPY FORWARD This manual is intended to be utilized as a guide for nonprofessional personnel. So many changes have taken p!ace since this manual was last published in 1967 that a complete revision was necessary.This was accomplished through the ef- forts of a. committee which spent many we'aks bringing it up-to-date.The pro- fessional judgment of medical officers and Nurse Corps officers at local klommands will determine any changes in the outlined procedures. D. L. CUSTIS Vice Admiral, MC, USN Chief, Bureau of Medicine and Surgery PREFACE This is the second revision of NURSING PROCEDURES which was first pub- lished in 1960.Because of the many advances in medicine and changes in nursing techniques, it became necessary to update this manual. A committee composed of the following members CAPT Dolores Cornelius NC USN CAPT Norma H. Gardill NC USN LCDR Mary L. Young NC USN LCDR Jean Rollins NC USN LCDR Sheila E. Muffler) NC USN LTJG David H. Minzes NC USNR met at the Naval Medical Training Institute, Beth trde, Maryland to review the nursing procedures and determine what changes, additions, or deletions should be made.They found that many of the procedures were still basically sound, but the equipment used to carry them out had changed.For this reason, it was necessary to update the majority of procedures included in the manual. We are indebted to the Nurse Corps officers at the Hospital Corps Schools San Diego and Great Lakes for their extensive reviews and suggestions for revi- sion of this manual.Additionally, the fine revised illustrations are the work of Michael Willhoite, HM3, of the Naval Medical Training Institute. Special recognition is given to Vivian Ann Brown of the Nursing Division who typed the entire revision of the manual. ALENE B. DUERK Rear Admiral, NC, USN Director, Navy Nurse Corps TABLE OF CONTENTS Page LIST OF ILLUSTRATIONS SECTION I. FUNDAMENTAL NURSING CARE OF PATIErT 1 Morning Care 2 Oral Hygiene 3 Special Mouth Care 5 Care of Dentures 7 Be.. Bath 9 Making an Unoccupied Bed 12 Making an Occupied Bed 16 Serving Diets from Food Cart 20 Central Tray Service 22 Care of Ice Machine and Handling of Ice, Bedside Pitchers, and Glasses 22A Feeding the Helpless Patient 23 Evening Care (p.m. Care) 24 Taking Oral Temperature 25. Taking Axillary Temperature 29 Taking Rectal Temperature 30 Taking Pulse and Respiration 34 Taking Apical-Radial Pulse 35 Taking Blood Pressure 36 Recording on TPR Form. 38 Recording on Plotting Chart 41 Care of the Seriously Ill Patient 43 Prevention and Care of Decubiti 45 Alternating Pressure Pad (Air Mat- tress) 47 Turning Frames, Orthopedic Bed - Stryker and Fostiv:. Frame 50 Circ-o-matic (Circ-o-lectric) Bed 57 Orthopedic Traction ;Skeletal Trac- tion) 60A Orthopedic Traction (Skin Traction) 60C. Bed or Heat Cradle 61 Posture and Body MIchanics 63 Body Positions of the Bed Patient 68 Recording Nursing Notes 73 TABLE OF CONTENTS (Continued) Page Transcription of Doctor`:; Orders 79 Recording Intake and Output 86 Visible File (Kardex) 89 Nursing Assessment 91 Nursing Care Plan I 93 Nursing Care Plan II 94 Ward Report 95 Nursing Service 24-Hour Report 98 II. ADMISSION AND DISCHARGE OF THE PATIENT 100 Admission of Patient 101 Assisting With Physical Examination 104 AOW 106 TOW 107 Discharge of Patient 108 Care of the Dead 110 Care of Unit Upon Discharge of Patient 112 III. ASSISTING WITH THERAPEUTIC MEASURES 114 Table of Equivalents 115 Administration of Oral Medications 116 Administration of Subcutaneous Injections 119 Administration of Intramuscular Injections 122' Administration of Rectal Medications 126 Medication Administration Record 128 Moisturized Oxygen Therapy to Patient with Tracheostomy Tube 132 Steam Inhalation 135 Administration of Intravenous (I.V.) Fluids 136 Hypodermoclysis 140 IVAC I.V. Pump 142A Assisting with Blood Transfusions 143 Assisting with the Administration of Mustargen 149 Hot Water Bottle 151 ii TABLE OF CONTENTS (Continued) 1.14,2t Hot Wet Compresses, Clean 152 Hot Wet Compresses, Sterile 154 Soaks, Extremities 156 Sitz Bath 158 Treatment Pad, Hot-Cold, Cir- culating Aquamatic (K-Pak) 161 Heat Treatment Pad/Hydrocollator 165 Hypo/Hyperthermia Unit 168 Ice Bag 172 Cold Wet Compresses, Clean 174 Cold Wet Compresses, Sterile 175 Sponge Bath 177 Instillation of Eye Ointment 179 Instillation of Eye Drops 180 I Instillation of Ear Drops 181 Instillation of Nose Drops 182 Throat Irrigation 183 Catheterization of Male Patient 185 Catheterization of Female Patient 188 Indwelling Catheter (Foley) 190 Urinary Catheter Irrigation 193 External Catheter, Dunbar Drain 196 Bladder Irrigation 197 Bladder Instillation 200 Cleansing Enema 201 Retention Enema 204 Commonly Ordered Enemas 206 Gastrostomy Feedings 209 Murphy Drip 212 Gastric Lavage 214 Gastric Gavage 216 Gastric Intestinal Tubes 218 Esophageal Balloon Intubation (Sengstaken/Blakemore) 220 Intestinal Intubation (Miller- Abbott Tube) 223 Phelan Hand Pump Suction Siphonage 227 Gastric Tube Irrigation 230 Peritoneal Lavage/Dialysis 231 Oxygen by Tent 235 Oxygen by Mask 237 Oxygen by Catheter 239 Oxygen by Nasal Cannula 241 Oxygen Piping Equipment 244 Oxygen by Face Tent (Puritan Face Mask) 247 iii TABLE OF CONTENTS (Continued) Page AMBU-Resuscitator 249 Mouth to Mouth-Mouth to Nose Resuscitation 251 Closed Cardiac Massage 254 Suction Units and Vacuum Pressure 258 Intermittent Positive Pressure Breathing Unit (Bennett) 261 Bird Respirator 265 Chest Physical Therapy 268A Placing Patient in Emerson Respirator 270 Instructions for Operating the Emerson Respirator 274 Cough Procedure for Patient in Respirator 281 Replacing Plastic Collar on Respirator 283 Portable Respirator (Monaghan) 285 Oscillating (Rocking) Bed (Emerson) 289 Central. Venous Pressure 290A Tourniquets in Pulmonary Edema 291 Breast Care 294 Perineal Care 295 Perineal. Light 297 Infant Incubator (Armstrong) 298 Infant Incubator (Isolette) 301 Vaporizer Incubator (Vapojet- Isolette) 305 Isolette Rocker 307 Humidity and Oxygen Therapy (Croupette) 310 IV. PRE and POSTOPERATIVE CARE 314 Preoperative Preparation 315 Skin Preparation 318 Recovery Unit :330 Postoperative Care - Immediate 332 Scultetus Binder 334 Straight Abdominal Binder 336 T Binder 337 Breast Binder 338 Restraints (Safety Devices for the Patient) . 339 iv TABLE OF CONTENTS (Continued) Page Surgical Dressing Technique 342 Wound Irrigation 345 Tracheotomy Care and Care of Tracheotomy Tube 346 Periodic Deep Lung Inflations for Patients with an Artificial Airway (Sighing) 349A Ventilator Sighing 349B Changing Tracheostomy Dressing 349C Water-sealed Chest Drainage 350 Colostomy Irrigation 353 V. DIAGNOSTIC TESTS AND PROCEDURES 355 Technique of Venipuncture with Needle and Syringe 356 Technique of Venipuncture with Vacutainer 359 Collection of Specimens Blood Blood Culture Using Vacutainer 361 BSP - Bromsulphalein 363 Glucose Tolerance Test 365 Urine Clean Single Specimen 367 Sterile Specimen 367 Midstream or Clean Catch Specimen 368 24 Houi Collection 370 Clinitest (Reagent Test for Sugar) 371 Clinistix (Reagent Test for Sugar) 372 Tes-Tape (Reagent Test for Sugar) 372 Acetest (Reagent Test for Acetone) 374 Urobilinogen 375 Addis Sediment Count 376 Fishberg Concentration Test 377 24 Hour Collection for Vanlmandelu Acid (VMA) 378 PSP - Phenolsulfonphthalcin 380 TABLE OF' CONTENTS' (Continued) Page Sputum 381 Gastric Analysis 383 Feces 385 Ova and Parasites 385 Occult Blood 385 Amoeba 385 Guiac Test 387 Rectal Swab 388 Discharges f_ rom Wounds 389 Smear 389 Culture 390 Preparation for Radiological Studies Angiocardiography 391 Aortography and Arteriography 391 Arteriography (cerebral) 393 Bronchogram 394 Cholecystography 395 Gastrointestinal Series 396 Barium Enema 397 Pyelogram - Intravenous and Retrograde 398 Myelogram 399 Pneumoencephalogram 400 Bronchoscopy 401 T-3, T-4 Test 402 Cold Pressor Test 403 Abdominal Paracentesis 404 Lumbar Puncture 406 Thorocentesis 408 VI. ISOLATION TECHNIQUE 410 Preparation of a Unit 411 Handwashing Technique 414 Mask Technique 416 Gown Technique .418 Care of Linen 421 Serving Food Using Disposable Dishes 422 Medications for the Isolated Patient 424 Care of Body Discharges and Excreta 425 vi TABLE OF CONTENTS (Continued) Page Terminal Disinfection