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She wrote that these district nurses needed additional education because they would be working more independently than the hospital staff members generic geriforte syrup 100caps on-line. Nightingale’s strong statements about the role of nurses and their need for lifelong education are still quoted widely today discount 100 caps geriforte syrup fast delivery. Perhaps 6 Basic Clinical Nursing Skills she order geriforte syrup 100 caps overnight delivery, more than anyone else, can be credited with establishing nursing as a profession. Before the development of modern nursing, women of nomadic tribes performed nursing duties, such as helping the very young, the old, and the sick, care-dwelling mothers practiced the nursing of their time. As human needs expanded, nursing development broadened; its interest and functions through the social climates created by religious ideologies, economic development, industrial revolutions, wars, crusades, and education. The dynamic change in economic and political situations also influenced every corner of human development including nursing. She also contributed to the definition of nursing “to put the patient in best possible way for nature to act. Around 1866 missionaries came to Eritrea, (one of the former provinces of Ethiopia) and started to provide medical care for very few members of the society. In 1949 the Ethiopian Red Cross, School of Nursing was established at Hailesellasie I hospital in Addis Ababa. In 1954 HailesellasieI Public Health College was established in Gondar to train health officer, community health nurses and sanitarians to address the health problem of most of the rural population. In line with this, the Centralized school of Nursing formerly under Ministry of health and recently under Addis Ababa University Medical Faculty and Nekemit School of nursing are among the senior nurse’s training institutions. An additional higher health professional training institution was also established in Jimma(1983) to train health professionals using educational philosophy of community based and team approach. Additional public health professional training institutions were opened in Alamaya University and Dilla College of Teacher Education and Health Sciences (1996). Following further expansion of higher learning, Mekele University has started medical education and the former diploma offering university have upgraded to degree program in which nursing education is a part. In this line Hawassa University, College of Health Sciences also opened new medical education to the former existing health sciences programs. The Federal Ministry of Defense, established a University College under which the college of health sciences offering training for health professionals including nursing. The outputs of these training institutions are providing services all over the country not only to improve the health status of our society but also to ensure the attainment of millennium health development goals. It is a series of planned steps and actions directed toward meeting the need and solving problems of people and their significant others; it is systematic, scientific problem solving in action (Sorensen and Luckman, 1986) Purpose of Nursing Process: 1. Assessment – the systematic collection of data to determine the patient’s health status and to identify any actual or potential 10 Basic Clinical Nursing Skills health problems. Data collected about a client generally fall into one of the two categories: objective or subjective Objective data include all the measurable and observable pieces of information about the client and his or her overall state of health. Some times the client can communicate through body language: gesture, facial expressions and body posture. Methods of data collection Observation is an assessment tool that relies on the use of the five senses (sight, touch, hearing, smell and taste) to discover information about client. For those who wish to emphasize its importance analysis may be identified as a separate step of the nursing process. Diagnosis – identification of the following two types of patient problems: a) Nursing diagnosis – actual or potential health problems that can be managed by independent nursing interventions. Purposes of the Nursing Diagnosis- the nursing diagnosis serves the following purposes: • Identifies nursing priorities • Directs nursing interventions to meet the client’s high priority needs • Provides a common language and forms a basis for communication and understanding between nursing professionals and health care team. The three-part statement consists of the following components: • Problem • Etiology • Signs and symptoms, a two-part diagnostic statement consists of the problem, and signs and symptoms. Problem The problem portion of a statement describes- clearly and concisely- a health problem a client is having. For instance, the client with pneumonia had cough with thick sputum, abnormal breath sounds, increased respiration, and difficulty breathing. Ineffective Airway Clearance related to physiologic effects of pneumonia as evidenced by increased sputum, coughing, abnormal breath sounds, tachypnea, and dyspnea. Nurses manage collaborative problems using physician – prescribed and nursing prescribed interventions to minimize the complications of the events.

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Assist the patient with grooming • Apply powder lotion or deodorants (of pt uses) • Help patient to care for hair buy discount geriforte syrup 100caps online, mouth and nails trusted geriforte syrup 100 caps. Recomfort the patient • Change linen if soiled • Arrange the bed • Put pt in comfortable position • Remove the screen 130 Basic Clinical Nursing Skills i order 100caps geriforte syrup otc. Give proper care of materials used for bathing • Document and report pertinent data • Observation of the skin condition • General appearance or reaction of the pt • Type of bath give Report any abnormal findings to the nurse in charge B. Saline: 4 ml (1Tsp) NaCl to 500 ml (1 pt) water • Has a cooling effect • Cleans 131 Basic Clinical Nursing Skills • Decrease skin irritation 2. Potassium permanganate (Kmno4): available in tablets, which are crushed, dissolved in a little water, and added to the bath • Cleans and disinfects • Treats infected skin areas 4. Oatmeal (Aveeino) and cornstarch can also be used Tub Bath Typically, bathtubs are low in height to ease the process of getting in and out of the tub. Equipment • Bath blanket • Bath mat • Bath towel • Soap • Clean gown or pajama 132 Basic Clinical Nursing Skills • Clean bed linen • Bath thermometer if available • Disinfectant for cleansing the tub Procedure ™ Check the bath room temperature, which should be warmer than the normal room temperature. After dressing assist the client back to the room ™ Inform the cleaner to carefully clean the tub after the bath ™ Dispose of the glove and wash your hands ™ Document the procedure, describing any unusual client reactions Back Care (massage): includes the area from the back and shoulder to the lower buttocks Purpose • To relieve muscle tension • To promote physical and mental relaxation • To improve muscle and skin functioning • To relieve insomnia • To relax patient • To provide a relieve from pain • To prevent pressure sores (decubitus) • To enhance circulation Equipment Basin of warm water Washcloth Towel Soap 134 Basic Clinical Nursing Skills Skin care lotion Procedure 1. Massaging the back • Pour small amount of lotion (oil) on your palm and rub your palms together to warm the lotion (oil) before massaging. Petrissape: kneading and making large quick pinches of the skin, tissue, and muscle • Clean the back first • Warm the massage lotion or oil before use by pouring over your hands: cold lotion may startle the client and increase discomfort 1. Effleurage the entire back: has a relaxing sedative effect if slow movement and light pressure are used 2. Petrissape first up the vertebral column and them over the entire back: is stimulating if done quickly with firm p 137 Basic Clinical Nursing Skills • Assess: signs of relaxation and /or decreased pain (relaxed breathing, decreased muscles tension, drowsiness, and peaceful affect) ⇒ Verbalizations of freedom from pain and tension ⇒ Areas or redness, broken skin, bruises, or other sings of skin breakdown Note • The duration of a massage ranges from 5-20 minutes • Remember the location of bony prominence to avoid direct pressure over this areas • Frequent positioning is preferable to back massage as massaging the back could possibly lead to subcutaneous tissue degeneration. Backrub requires special skills as it might cause subcutaneous tissue degeneration; mainly in elderly. Offering and Removing Bed Pan • If the individual is weak or helpless, two peoples are needed to place and remove bed pans • If a person needs the bed pan for a longer time periodically remove and replace the pan to ease pressure and prevent tissue damage • Metal bed pans should be warmed before use by: o Running warm water inside the rim of the pan or over the pan o Covering with cloth 138 Basic Clinical Nursing Skills • Semi-Fowler’s position relieves strain on the client’s back and permits a more normal position for elimination Improper placement of the bedpan can cause skin abrasion to the sacral area and spillage o Place a regular bed pan under the buttocks with the narrow end towards the foot of the bed and the buttocks resting on the smooth, rounded rim o Place a slipper (fracture) pan with the flat, low end under the client’s buttocks o Covering the bed pan after use reduces offensive odors and the clients embarrassment If the client is unable to achieve regular defecation help by attending to: 1. Timing – do not ignore the urge to defecate • A patient should be encouraged to defecate when the urge to defecate is recognized • The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day) 3. Nutrition and fluids For a constipated client: increase daily fluid intake, drink hot liquids and fruit juices etc For the client with diarrhea – encourage oral intake of foods and fluids 139 Basic Clinical Nursing Skills For the client who has flatulence: limit carbonated beverages; avoid gas-forming foods 4. Positioning • Sitting position is preferred Measures to assist the person to void include: • Running water in the sink so that the client can hear it • Warming the bed pan before use • Pouring warm water over the perineum slowly • Having the person assume a comfortable position by raising the head of the bed (men often prefer to stand) • Providing sufficient analgesia for pain • Having the person blow through a straw into a glass of water – relaxes the urinary sphincter Perineal Care (Perineal – Genital Care) Perineal Area: • Is located between the thighs and extends from the symphysis pubis of the pelvic bone (anterior) to the anus (posterior). Perineal Care (Hygiene) • Is cleaning of the external genitalia and surrounding area • Always done in conjunction with general bathing Patients in special needs of perineal care • Post partum and surgical patients (surgery of the perineal area) • Non surgical patients who unable to care for themselves • Patients with catheter (particularly indwelling catheter) Other indications for perineal care are: 1. Excessive secretions or concentrated urine, causing skin irritation or excoriation Purpose • To remove normal perineal secretions and odors • To prevent infection (e. Patient preparation • Give adequate explanation • Provide privacy • Fold the top bedding and pajamas (given to expose perineal area and drape using the top linen. Cleaning the genital area • Put on gloves 142 Basic Clinical Nursing Skills For Female • Remove dressing or pad used • Inspect the perineal area for inflammation excoriation, swelling or any discharge. In case of post partum or surgical patient • Clean by cotton swabs, first the labia majora then the skin folds between the majora and minora by retracting the majora using gauze squares, clean from anterior to posterior direction using separate swab for each stroke. In case of non-surgical patients • Wash or clean the genital area with soapy water using the different quarters of the washcloth in the same manner. Female Perineum • Is made up of the vulva (external genitalia), including the mons pubis, prepuce, clitoris, urethral and vaginal orifices, and labia majora and minora • The skin of the vaginal orifice is normally moist • The secretion has a slight odor due to the cells and normal vaginal florae • The clitoris consists of erectile tissues and many nerves fibers. Sterile cotton balls • The operative site and perineal area may be washed with an antiseptic solution – apply by squirting them on the perineum from a squeeze bottle Male Perineum • The penis contains pathways for urination and ejaculation through the urethral orifice (meatus) • At the end of the penis is the glans covered by a skin flap (fore skin or prepuce) • The urethral orifice is located in the center of the penis and opens at the tip 144 Basic Clinical Nursing Skills • The shaft of the penis consists of erectile tissue bound by the foreskin’s dense fibrous tissue Care • Hold the shaft of the penis firmly with one hand and the wash cloth with the other – to prevent erection – embarrassment • Use a circular motion, cleaning from the center to the periphery • Use a separate section of the wash cloth Position • Lying in bed with knee flexed to clean the perineal part and side lying cleaning the perineal area N. Equipments • Comb (which is large with open and long toothed) • Hand mirror • Towel • Lubricant/oils (if required) Procedure 1. Comb the hair by dividing the hair 146 Basic Clinical Nursing Skills • Hold a section of hair 2-3 inches from the end and comb the end until it is free from tangles. Shampooing/Washing the Hair of Patient Confined to Bed Purpose • Stimulate blood circulation to the scalp through massaging • Clean the patients hair so it increase a sense of well-being to the pt • To treat hair disorders like dandruft Equipments • Comb and brush • Shampoo/soap in a dish 147 Basic Clinical Nursing Skills • Shampoo basin • Plastic sheet • Two wash towels • Cotton balls • Water in basin and pitcher • Receptacle (bucket) to receive the used water • Lubricants/oil as required Procedure 1. Prepare the patient • Assist patient to move to the working side of the bed • Remove any hair accessories (e. Documentation and reporting Pediculosis Treatment Definition Pediculosis: infestation with lice Purpose • To prevent transmission of some arthropod born diseases • To make patient comfortable Equipment Lindane 1% permethrine cream rinse Clean linen Fine-tooth “nit” comb Disinfectant for comb Clean gloves Towel Lice: • Are small, grayish white, parasitic insects that infest mammals • Are of three common kinds: 150 Basic Clinical Nursing Skills ¾ Pediculose capitis: is found on the scalp and tends to stay hidden in the hairs ¾ Pediculose pubis: stay in pubic hair ¾ Pediculose corporis: tends to cling to clothing, suck blood from the person and lay their eggs the clothing suspect their presence in the cloth and the body: a.

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Infrequent cystocoeles was frst described by complications include buttock pain Kelly in 1913 generic geriforte syrup 100 caps amex, and in controlled or a sacral / pudendal nerve injury 100 caps geriforte syrup amex. Randomized trials favour abdominal paravaginal repair the robust abdominal approach having a success rate of up to 97% order geriforte syrup 100caps otc. Goldberg and co – present, and the results of studies workers demonstrated in a case are awaited with interest. The control study in women with use of mesh would be particularly anterior prolapse and stress useful where conventional incontinence, that the addition techniques have already failed, in of a pubovaginal sling to the large defects or in individuals with anterior colporrhaphy signifcantly obstructive pulmonary disease reduced the recurrence of a or other predisposing causes of anterior prolapse from 42% in prolapse. The surgeon should bear in Which begs the question – does mind that a certain percentage the addition of type 1 soft mesh of women develop stress to a vaginal repair make the incontinence following anterior procedure more robust, with an repair procedures. It 20% may need urinary continence has already been established that procedures, and all patients having the type 1 large pore prolene mesh anterior repairs must be councelled is extra – ordinarily well tolerated to this effect. Workers have proposed that a tension – free Posterior Prolapse mesh buttress may serve as a Procedures scaffold for collagen ingrowth and so reduce the incidence of repair Nowdays several approaches are failure. The ProliftR and PerigeeR systems have been developed for this The Abdominal Route purpose and allow minimally The abdominal approach is well invasive vaginal techniques described, and involves placement anchoring a mesh hammock in of a mesh buttress anterior to situ by means of mesh extensions the rectum behind the posterior emerging through the obturator vaginal wall fascia, commonly foramen. However a signifcant vaginal wall has been alluded to, number of failures are still and these prolene mesh hammocks reported, with 10% of women with supporting straps which pass needing surgery for complications through the sacrospinous ligament specifc to the surgery. A number of papers have appeared describing a novel The Vaginal Route procedure to deal with posterior Variations abound in transvaginal compartment prolapse and techniques. On the good anatomical outcome with basis of two randomized trials,8 acceptable sexual function, but with 3 series of transanal stapled midline fascial plication is superior resections published to date, it in correcting obstructed defecation seems that this novel procedure in 80% of cases. Site - specifc is of potential beneft but repair is less robust and durable needs careful evidence – based than midline fascial plication, evaluation. Level 1 evidence with less entrapment of faeces demonstrates that the vaginal on straining (grade A evidence). Part of the prosthesis and the optimal surgical problem arises from the paucity approach in women requiring of baseline data regarding the reconstructive pelvic foor surgery. As a not compensate for poor surgical result of this the effcacy of adding techniques or a poorly conceived prosthetic material for primary procedure. A host of “copy – cat” or recurrent prolapse affecting prostheses are available on the these compartments is diffcult market, riding the wave of more to assess. A prudent surgeon will theoretical advantage, this must evaluate published data on specifc be balanced against increased cost products before using “me – too” and potential morbidity. There is also a need for further long – term prospective studies, Conclusions ideally in the form of randomized controlled trials as well as from New insights classifcation systems structured personal series audits, have modifed previously held in order to determine the long beliefs in the feld of pelvic – term effcacy and potential organ prolapse. The of an interplay between complex mechanisms involved are complex multifactorial aetiologies which with multiple factors playing a vary between women. Because this is such a diverse not be wise to reduce the end feld, these aspects are addressed result to a specifc event and the by two authors in this chapter. This would eventually repetitive heavy lifting during become a problem even when they occupational duties or during were not pregnant. These would changes associated with pregnancy be considered to be promoting have an effect on the elasticity and causes. Decompensatory distension of the pelvic contents mechanisms include aging, by their effect on the muscle menopause, neuropathy, and collagen content as well as myopathy, debilitating diseases the changes in circulation of the and medication such as cortisone. In addition there A combination of factors each is the added stress of increased infuence the development of intra-abdominal pressures and this disease to a greater or lesser distension by the fetal presenting degree. Firstly, mechanical distension and tearing Pregnancy of muscle and connective tissue Although increasing parity is a invariably occur. Secondly, vascular risk factor for prolapse, nulliparity compression with the potential does not provide absolute for hypoxic damage to the same protection. There are (i) Myogenic damage: numerous studies that confrm We have histological confrmation these fndings. In contrast, correlation between prolapse and among postmenopausal women, the total volume of levator muscle pregnancy and childbirth seem and muscle strength. Co-morbidities, but pudendal nerve compression particularly aging, outweigh the certainly plays a signifcant role.

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