Sir Dennis Locsin

8/14/2019 Sir Dennis Locsin

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ADMINISTRATION OF MEDICATION

Routes of Drug Administration

a. Non-parenteral medication administrations

-Oral administration

(a) Advantages

1) Convenience

2) Economy

3) The drug need not be absolutely pure or sterile

4) A wide variety of dosage forms are available

(b) Oral medications include tablets, capsules, liquids, and suspensions

(c) Disadvantages include

1) Inability of some patients to swallow

2) Slow absorption

3) Partial or complete destruction by the digestive system

(d) Other routes associated closely with oral administration


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Sublingual

a) The drug is placed under the tongue and rapidly absorbed directly into the blood stream

b) Example - Nitroglycerin sublingual tablets

Buccal - The drug is placed between the cheek and gum and is quickly absorbed directly into the blood stream

-Inhalation

(a) The introduction of medications through the respiratory system in the form of a gas, vapor, or powder

(b) Divided into three major types

1) Vaporization - the drug is changed from a liquid or solid to a gas or vapor by the use of heat, such as steaminhalation

2) Gas inhalation- almost entirely restricted to anesthesia

3) Nebulization - the drug is nebulized into minute droplets by the use of compressed gas or oxygen

-Topical ointments

(a) Examples of topical preparations

1) Creams

2) Lotions

3) Shampoos


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(b) Topical application serves two purposes

1) Local effect-the drug is intended to relieve itching, burning, or other skin conditions without being absorbed into

the bloodstream and

2) Systemic effect-the drug is absorbed through the skin into the bloodstream.

3) Example - Nitroglycerin paste

-Suppositories

(a) Rectal is preferred to the oral route when patient is

1) Nauseated or vomiting

2) Unconscious, uncooperative, or mentally incapable

(b) Vaginal suppositories, creams, or tablets are examples of vaginal preparations that are inserted into thevagina to produce a local effect

b. Parenteral medications are those introduced by injection

(1) All drugs used by this route must be

(a) Pure

(b) Sterile

(c) Pyrogen-free (pyrogens are products of the growth of microorganisms)

(d) Liquid state


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(2) Several types of parenteral administration

(a) Subcutaneous

1) The agent is injected just below the skin's cutaneous layers

Example - Insulin

(b) Intradermal

1) The drug is injected within the dermis

Example - Purified Protein Derivative (PPD)

(c) Intramuscular

1) The drug is injected into the muscle

Example - Procaine penicillin G

(d) Intravenous

1) The drug is introduced directly into the vein

Example - Intravenous fluids/antibiotics

(e) Intrathecal/intraspinal

1) The drug is introduced into the subarachnoid space of the spinal column.


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Purpose

The administration of medication is often a chief responsibility of the nurse. The practice of administering medication involves

providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or

condition.

Special Considerations

1. Bulk drugs

-Once individual dosage is removed, it can NEVER be returned to bulk container

2. Unit dose

-If still in original wrapper/unused condition, can be returned to medication cart/storage

-Internal and topical (external) medications must be stored separately to prevent accidental use of the inappropriatemedication. Example - injectable, ointments, and tablets are stored on separate shelves

3. Specific medications kept in secured (limited access) area

-All narcotics

-All medications with abuse potential, e.g., diazepam (Valium)

-All pre-filled hypodermic needles and syringes

4. Check medical records, allergy bands, medic-alert tags and ask patient for medication allergies

5. Only administer medication that you have prepared or received from the pharmacy as unit dose


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6. Be familiar with all potential medication effects, both therapeutic and non-therapeutic.

7. If there is any doubt about administering a medication, check with supervisor, nurse, physician, PA, or

pharmacist.

8. NEVER alter medication dosage ordered by physician

9. Check all medications label 3 times to ensure that the correct medication is being prepared for administration

(a) When removing the medication or container from the storage area

(b) When preparing the medication dose

(c) When returning the container to the storage area

10. Check the expiration date of the medication

11. Handle only one medication at a time

12. While administering medication, do not perform other duties (i.e., obtain vital signs, dressing changes)

13. Never directly touch oral medications. Some medications can be absorbed through the skin, also themedication will become contaminated.

14. DO NOT administer oral medications to patients with a decreased level of consciousness. Check with supervisorfor instructions.

http://www.medtrng.com/blackboard/medication_administration.htm


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Preparations

Administering oral medications


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changes position several times in order for the fluid to flow up into the bowel. A low enema, intended to cleanse onlythe lower bowel, is administered at lower pressure, using about 500 cc of fluid.

Oil retention enemas serve to lubricate the rectum and lower bowel, and soften the stool. For adults, about150200 cc of oil is instilled, while in small children, 75150 cc of oil is considered adequate. Salad oil or liquidpetrolatum are commonly used at a temperature of 91F (32.8C). There are also commercially prepared oilretention enemas. The oil is usually retained for one to three hours before it is expelled.

The rectal tube used for infusion of the solution, usually made of rubber or plastic, has two or more openings at theend through which the solution can flow into the bowel. The distance to which the tube must be inserted isdependent upon the age and size of the patient. For adult, insertion is usually 34 in (7.510 cm); for children,approximately 23 in (57.5 cm); and for infants, only 11.5 in (2.53.75 cm). The rectal tube is lubricated beforeinsertion with a water soluble lubricant to ease insertion and decrease irritation to the rectal tissues.

The higher the container of solution is placed, the greater the force in which the fluid flows into the patient.Routinely, the container should be no higher than 12 in (30 cm) above the level of the bed; for a high cleansingenema, the container may be 1218 in (3045 cm) above the bed level, because the fluid is to be instilled higherinto the bowel.

Special Consideration

1. The occasional use of an enema is a temporary solution for relief of symptoms associated with constipation. Repeated

frequent use of enemas can cause damage.

2. Your colon does absorb some of the fluid from an enema so repeated enemas can cause an imbalance of electrolytes and acardiovascular overload. If you experience symptoms of vomiting, dizziness, and sweating after doing multiple enemas that could be asign of an imbalance.

3. The insertion of anything into a rectum always comes with risks. To limit the risks of getting any perforations or tears whenusing an enema it is important to make sure that the tip or tube being inserted is smooth and flexible.


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4. Lastly, repeated uses of enemas to combat constipation can make the problem worse in the long run. Enemas only

temporarily stimulate the colon walls and do not strengthen the colon. If used over long periods of time enemas can actually weakenthe colon muscles. When those muscles are weak they lack the contractions necessary to keep fecal matter through your digestive

system. Therefore using an enema for relief of constipation should be a last resort and doctor recommended.

Preparations


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BLOOD TRANSFUSION

Definition

A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line inone of your blood vessels.

Blood transfusions are done to replace blood lost during surgery or due to a serious injury. A transfusion also may bedone if your body can't make blood properly because of an illness.

During a blood transfusion, a small needle is used to insert an IV line into one of your blood vessels. Through thisline, you receive healthy blood. The procedure usually takes 1 to 4 hours, depending on how much blood you need.

Blood transfusions are very common. Each year, almost 5 million Americans need a blood transfusion. Most bloodtransfusions go well. Mild complications can occur. Very rarely, serious problems develop.

Types of Blood Transfusions

Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of bloodtransfusion you need depends on your situation.

For example, if you have an illness that stops your body from properly making a part of your blood, you may needonly that part to treat the illness.

Red Blood Cell Transfusions

Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to yourbody's organs and tissues. They also help your body get rid of carbon dioxide and other waste products.


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You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery. You also may need thistype of transfusion if you have severe anemia due to disease or blood loss.

Anemia is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occurif your red blood cells don't have enough hemoglobin.

Hemoglobin is an iron-rich protein that gives blood its red color. This protein carries oxygen from the lungs to therest of the body.

Platelets and Clotting Factor Transfusions

Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses maycause your body to not make enough platelets or clotting factors. You may need regular transfusions of these partsof your blood to stay healthy.

For example, if you have hemophilia you may need a special clotting factor to replace the clotting factor you'relacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally.

If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleedinternally, especially in the joints (knees, ankles, and elbows).

Plasma Transfusions

Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones,

vitamins, cholesterol, sugar, sodium, potassium, calcium, and more.

If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion.

Purpose

A severe infection or liver disease that stops your body from properly making blood or some parts of blood.
http://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.htmlhttp://www.nhlbi.nih.gov/health/dci/Diseases/hemophilia/hemophilia_what.htmlhttp://www.nhlbi.nih.gov/health/dci/Diseases/anemia/anemia_whatis.htmlhttp://www.nhlbi.nih.gov/health/dci/Diseases/hemophilia/hemophilia_what.html


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An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medicalcondition also can cause anemia. There are many types of anemia, including aplastic, Fanconi, hemolytic, iron-deficiency, and sickle cell anemias and thalassemia

A bleeding disorder, such as hemophilia or thrombocytopenia.

Severe blood loss due to surgery or injury.


Before a blood transfusion, a technician tests your blood to find out what blood type you have (that is, A, B, AB, or Oand Rh-positive or Rh-negative). He or she pricks your finger with a needle to get a few drops of blood or draws

blood from one of your veins.

The blood type used in your transfusion must work with your blood type. If it doesn't, antibodies (proteins) in yourblood attack the new blood and make you sick.

Some people have allergic reactions even when the blood given does work with their own blood type. To preventthis, your doctor may prescribe a medicine to stop allergic reactions. (For more information, see "What Are the Risksof a Blood Transfusion?")

If you have allergies or have had an allergic reaction during a past transfusion, your doctor will make every effort to

make sure you're safe.

Most people don't need to change their diets or activities before or after a blood transfusion. Your doctor will let youknow whether you need to make any lifestyle changes prior to the procedure.

After a blood transfusion, your vital signs are checked (such as your temperature, blood pressure, and heart rate).The intravenous (IV) line is taken out. You may have some bruising or soreness for a few days at the site where theIV was inserted.
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You may need blood tests that show how your body is reacting to the transfusion. Your doctor will let you knowabout signs and symptoms to watch for and report.

If the patient has a preexisting fever the need for transfusion must be balanced with the risk of transfusion. Contactthe patients physician to determine if pretransfusion medications should be administered.

If a patient is being transported with blood hanging patients should not be transported with blood componentsinfusing unless accompanied by a clinician who can monitor and respond to a potential reaction. Additionally, thereceiving clinic/area must have a clinician who can manage a patient while they are receiving blood components.

Medications

o Do not add medications directly to a unit of blood during transfusion.o Medications that can be administered "IV Push" may be administered by stopping the transfusion,

clearing the line at the medication injection site with 5-10 mL of normal saline, administering themedication, reflushing the line with saline and restarting the transfusion.

Preparation

Patient Instructions and PreparationBlood Bank personnel will notify patient unit personnel by telephone when ordered blood is ready for transfusion.

Informed Consent

o Informed consent for blood transfusion is a process in which the patient is informed of the medicalindications for the transfusion, the possible risks, the possible benefits, the alternatives, and thepossible consequences of not receiving the transfusion.

o Informed consent may be obtained by a physician, a nurse, or a physician extender who isknowledgeable about blood transfusion and the patients condition so as to be able to explain theelements of informed consent above.
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o The risks of transfusion, including adverse symptoms and alternatives to homologous (allogeneic)transfusion, must be discussed with the patient well before the transfusion. The booklet, "BloodTransfusion, Your Options" describing transfusion options are available from Moore. This booklet should

be provided to patients as early as possible before transfusion.o The patient is then given a choice to accept or decline transfusion. Consent should be obtainedsufficiently in advance of the transfusion that the patient can truly understand what is said and havesufficient time to make a choice.

o Consent should be documented in the medical chart using the form "Consent to Receive BloodTransfusion" (available on-line or from Moore).

o A single informed consent may cover many transfusions if they are part of a single course of treatment.o It may be advisable, though, to obtain a new consent when there is a significant change in the patient's

care status, such as a transfer for care to another service, an inpatient admission, or an outpatienttransfusion.

o In emergency situations the physician ordering the transfusion must make a reasonable judgement that

the patient would accept the transfusion. Transfusion should not be delayed in a life-threateningsituation if it is likely that the patient would agree to transfusion. After the event, the circumstances ofthe transfusion decision should be

o documented in the medical chart.

Refusal of Blood Transfusion

o The form "Patients Release Form for Refusal of Blood or Treatment" should be used to document thepatients refusal of transfusion. The form is available on the Blood Bank web site.

Special Labels

o When blood is released for transfusion under unusual circumstances a special notation will be indicatedon the Transfusion Record Form.

o This information will often suggest to physicians and nurses that particular caution must be exercisedduring transfusion, and that the blood transfusion should be terminated at the first sign of an untowardreaction.

o Personnel initiating the transfusion who have questions concerning the significance of this informationshould contact the Blood Bank.


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IMMEDIATELY PRIOR TO BLOOD TRANSFUSIONPretransfusion Vital Sign Documentation

o

To provide a baseline, record the patient's blood pressure, pulse, respirations and temperature in thechart or on the transfusion record form

If a patient is febrile, consideration should be given to postponement of blood transfusion, since the fever may maskthe development of a febrile reaction to the blood component itself.

Verify physician's orders for transfusion and any that any pretransfusion medications have been administered Perform bedside verification of patient and component Using the labels on the bag, the Transfusion Record Form and the patients attached positive patient identifier.

Two qualified individuals mustThese steps must never be bypassed.

1 Ask the patient to state his or her name. Verify patient andcomponent identification information.

2 Verify the blood type, donor number, component name

3 Verify compatibility: a compatibility chart is on the back insidecover of this booklet.

4. Verify the product is not outdated

5. Sign the Transfusion Record Form before blood transfusion isinitiated.

6. The person who hangs the blood must record the date and


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time the transfusion was started

7. Record the date, time, component and unit number on the

appropriate sheet on the patient's chart. Refer to unit policyand procedures.

DO NOT START the transfusion if there is any discrepancy.Contact the Blood Bank.

Initiating the Transfusion

o Immediately before transfusion, mix the unit of blood thoroughly by gentle inversion.o Follow the manufacturer's instruction for the use of special filters and ancillary devices. Additional

administration instructions for selected components are printed at the end of this chapter and are

available upon request from the Blood Bank.o If any part of the unit is transfused, the unit is considered transfused.

Flow Rates

Initial Flow Rate Slowly at no more 1 mL/minute to allowfor recognition of an acute adversereaction. Proportionately smallervolume for pediatric patients.

Standard Flow Rate - Adults If no reaction occurs in the first 15minutes, the rate may be increased to 4mL/minute

Pediatrics 10-20 mL/kg over 30-60 minutes


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Usual Infusion time Red Blood Cells: two hours unless thepatient can tolerate only gradualexpansion of the intravascular volume

Platelets, plasma and cryoprecipitate:10 mL per minute. The transfusion maybe administered as rapidly as thepatient can tolerate, usually 30 minutes.

Maximum Infusion Time Infusion time should not exceed 4 hoursfor any component.

If rate slows appreciably investigate immediately

Consider measures that may enhanceblood flow

repositioning the patient's arm, changing to a larger gauge

needle, changing the filter and tubing,

and elevating the IV pole, ifgravity rather than a pump is

being used.During the Transfusion Document

What temperature, blood pressure,respirations and pulse, and examinethe skin for urticaria.


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Assess flow rate

When before initiating the transfusion after the first 15 minutes after 30 minutes

hourly until one hour after completionof the transfusion

Outpatient Post Transfusion VitalSigns

For outpatient transfusions, the vital signsmay be taken at 30 minutes posttransfusion.

Units entered and not transfusedIf a unit of blood or a blood component has been entered for any reason by personnel not working in the Blood Bank,and the unit has not been transfused

Record on the transfusion Record Form the volume transfused as "NONE" Indicate the disposition of the unit "Discarded on patient unit" and sign and date the notation. Return the Transfusion Record Form to the Blood Bank

If Components Are No Longer NeededTo avoid unnecessary waste of blood resources, notify the Blood Bank staff immediately if components are no longerneeded for a patient, as the component may be suitable for transfusion to another patient. Return any unneededunits to the blood bank.At the Termination of an Uncomplicated TransfusionAfter the completion of each uncomplicated transfusion, the responsible physician or nurse should verify that the"Transfusers Must Complete" section of the Transfusion Record Formis complete, including


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date and time transfusion was stopped volume of blood infused Check the box documenting the presence/absence of a transfusion reaction.

Discontinue the isotonic saline solution used to initiate the transfusion after the completion of the transfusion unlessspecifically ordered.Document the patient's response to the transfusion in the patient's medical record.If a Transfusion Reaction is Suspected

o Stop the transfusiono Maintain the IV.o Save the bag and attached tubing and refer to Chapter 7 for additional instructions.

http://www.medicinenet.com/blood_transfusion/article.htm

RECTAL AND VAGINAL SUPPOSITORY

Definition

A suppository is a drug delivery system that is inserted into the rectum (rectal suppository), vagina (vaginal suppository), orurethra(urethral suppository), where it dissolves.

They are used to deliver both systemically-acting and locally-acting medications.

The alternative term for delivery ofmedicine via such routes is pharmaceutical pessary.

The general principle is that the suppository is inserted as a solid, and will dissolve inside the body to deliver the medicine

Purpose

Rectal suppositories
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Rectal suppositories are commonly used for:

laxative purposes, with chemicals such as glycerin or bisacodyl

treatment ofhemorrhoids by delivering a moisturizer or vasoconstrictor delivery of many other systemically-acting medications, such as promethazine or aspirin general medical administration purposes: the substance crosses the rectal mucosa into the bloodstream;

examples include paracetamol (acetaminophen), diclofenac, opiates, and eucalyptol suppositories

Vaginal suppositories

Vaginal suppositories are commonly used to treat gynecological ailments, including vaginal infections such ascandidiasis.

Nursing Consideration

-While the patient may sit down and insert the suppository, for best results assist the patient that they lie on theirleft side. Because the colon leads to the rectum from the left, it also allows gravity to help with the bowelmovement.

-If the patient does not use a lubricated suppository, lubricate it with water- based lubricant. Some people find iteasier to insert suppository base side first. If it is more comfortable for you, it will not change the effect of thesuppository.

- Inform the patient to consult a doctor before using any type of medication.
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COLOSTOMY

Definition

A colostomy is an opening in the belly (abdominal wall) that is made during surgery. The end of the colon is broughtthrough this opening to form a stoma. Where the stoma will be on the abdomen depends on which part of the colonis used to make it. The enterostomal therapy nurse (ET nurse) or the surgeon will figure out the best location foryour stoma.

Colostomy surgery is done for many different diseases and problems. Some colostomies are done because ofmalignancy (cancer), others are not. A child, may need one because of a birth defect. Sometimes a colostomy is onlyneeded for a short time, sometimes it is life-long. Some colostomies are large, some small; some are on the left sideof the abdomen, some are on the right side, others may be in the middle.

When you look at a stoma, you are actually looking at the lining (the mucosa) of the intestine, which looks a lot likethe lining of your cheek. The stoma will look pink to red. It is warm and moist and secretes small amounts of mucus.


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Unlike the anus, the stoma has no valve or shut-off muscle. This means you will not be able to control of the passageof stool from the stoma, although bowel movements can sometimes be managed in other ways.

The way the stoma looks depends on the type of colostomy the surgeon makes and on individual body differences. Itmay look quite large at first, but it will shrink to its final size about 6 to 8 weeks after surgery. The shape will beround to oval. Some stomas may stick out a little, while others are flush with the skin.

A colostomy is not a disease, but a change in the way your body works. It surgically changes normal body functionto allow stool to pass after a disease or injury. Although a colostomy is a big change for the patient, the operationitself is rather simple. The body's chemistry and digestive function are not changed by having a colostomy.

Types of colostomies

A colostomy can be short-term (temporary) or life-long (permanent) and can be made in any part of the colon.

Transverse colostomies

The transverse colostomy is in the upper abdomen, either in the middle or toward the right side of the body. Colonproblems like diverticulitis, inflammatory bowel disease, cancer, obstruction (blockage), injury, or birth defects canlead to a transverse colostomy. This type of colostomy allows the stool to leave the colon before it reaches thedescending colon.

When the problems are in the lower bowel, the affected part of the bowel might need time to rest and heal. Atransverse colostomy may be used to keep stool out of the area of the colon that is inflamed, infected, diseased, ornewly operated on this allows healing to take place. This type of colostomy is usually temporary. Depending on thehealing process, the colostomy may be needed for a few weeks, months, or even years. If you heal over time, thecolostomy is likely to be reversed (closed) and you will go back to having normal bowel function.


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A permanent transverse colostomy is made when the lower portion of the colon must be removed or permanentlyrested. This type may also be needed if other health problems make the patient unable to have further surgery. Thiscolostomy is a permanent exit for stool and will not be closed in the future.

Types of transverse colostomies

There are 2 types of transverse colostomies: loop transverse colostomy and double-barrel transverse colostomy.

Loop transverse colostomy -The loop colostomy may look like one very large stoma, but it in fact has 2 openings.One opening puts out stool, the other only puts out mucus. A colon normally makes small amounts of mucus toprotect itself from the bowel contents. The mucus passes with the bowel movements and is usually not noticed.Despite the colostomy, the resting part of the colon keeps making mucus that will come out either through thestoma or through the rectum and anus. This is normal and expected.

Double-barrel transverse colostomy- When creating a double-barrel colostomy, the surgeon divides the bowelcompletely. Each opening is brought to the surface as a separate stoma. The 2 stomas may or may not be separatedby skin. Here, too, one opening puts out stool and the other puts out only mucus (this smaller stoma is called amucus fistula). Sometimes the mucus fistula is sewn closed at the time of surgery and left inside the abdomen. Thenthere is only one stoma and mucus from the resting portion of the bowel comes out through the rectum.

Ascending colostomy

The ascending colostomy is placed on the right side of the abdomen. Only a short portion of colon remains active.This means that the output is very liquid. A drainable pouch is worn at all times for colostomies like this. This type ofcolostomy is rare because an ileostomy is better if the discharge is liquid. (For more information, please contact usfor a copy ofIleostomy: A Guide.)

Stool in the right half of the colon is liquid and contains many digestive enzymes. The discharge from an ascendingcolostomy will usually be loose or semi-solid and the enzymes in it can irritate the skin. This type of colostomydrains all of the time and cannot be controlled. It must be covered with a lightweight, drainable pouch that protects
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the skin from contact with the output. Caring for an ascending colostomy is much like caring for a transversecolostomy (discussed above).

Descending and sigmoid colostomies

Located at the end of the descending colon, the descending colostomy (Figure 6) is placed on the lower left side ofthe abdomen. Most often, the output is firm and can be controlled.

A sigmoid colostomy (Figure 7), is made just a few inches lower than a descending colostomy, in the sigmoid colon.Because there is more working colon, it may produce more solid stool more regularly. The sigmoid colostomy is themost common type of colostomy.

Both the descending and the sigmoid colostomies can have a double-barrel or single-barrel opening. The single-barrel, or end colostomy, is more common. The stoma of the end colostomy is either sewn flush with the skin or it is

turned back on itself (like the turned-down top of a sock).

The stool of a descending or sigmoid colostomy is firmer than that of the transverse colostomy. It does not have asmuch of the irritating digestive enzymes in it. Output from these types of colostomies may happen as a reflex atregular, expected times. The bowel movement will take place after a certain amount of stool has collected in thebowel above the colostomy. Two or 3 days may go between movements. Spilling may happen between movementsbecause there is no anus to hold the stool back. Many people use a lightweight, disposable pouch to preventaccidents. A reflex to empty the bowel will set up quite naturally in some people. Others may need mild stimulation,such as juice, coffee, a meal, a mild laxative, or irrigation.

While many descending and sigmoid colostomies can be trained to move regularly, some cannot. Training, with or

without stimulation, is likely to happen only in those people who had regular bowel movements before they becameill. If bowel movements were irregular in earlier years, it may be hard, or impossible, to have regular, predictablecolostomy function. Spastic colon, irritable bowel, and some types of indigestion are some conditions that causepeople with colostomies to continue to have bouts of constipation or loose stool.

Many people think that a person must have a bowel movement every day. In truth, this varies from person toperson. Some people have 2 or 3 movements a day, while others have a bowel movement every 2 or 3 days or evenless often. Figure out what is normal for you.


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Purpose

After a colostomy has been created, the intestines will work just like they did before except:

The colon and rectum beyond the colostomy is disconnected or removed.

The anus is no longer the exit for stool.

Since nutrients are absorbed in the small intestine, a colostomy does not change how the body uses food. The mainfunctions of the colon are to absorb water, to move the stool toward the anus, and to store it in the rectum until it ispassed out of the body. When a colostomy changes the stool's route, the storage area is no longer available.

The higher up in the colon the colostomy is made, the shorter the bowel is. The less time the bowel has to absorbwater, the softer or more liquid the stool is likely to be. A colostomy further down in the colon, near the rectum, will

discharge stool that has been in the intestine a longer time. Depending on the effects of illness, medicines, or otherforms of treatment, the longer bowel can put out a more solid or formed stool. Some people with colostomies findthat they are able to pass this stool at certain times of the day with or without the help of irrigation. (Irrigation isdiscussed later in this document)

After surgery, some people still may feel urges and even have some discharge from the anal area. This discharge ismucus, blood, and at times stool, left from the operation. If the rectum is left alone during surgery, it will keepputting out mucus that can be harmlessly passed whenever you have the urge.


Choose a time in the day when you know you will have the bathroom to yourself.

Irrigation may work better if it is done after a meal or a hot or warm drink. Also, consider irrigating atabout the same time of day you usually moved your bowels before you had the colostomy.

Put 1,000 cc (1 quart) of lukewarm (not hot) water in your irrigating container. You may need a little less.NEVER connect the tube directly to the faucet.


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Hang the container at a height that makes the bottom of it level with your shoulder when you are seated.

Sit on the toilet or on a chair next to it. Sit up straight.

Put on the plastic irrigation sleeve and place the bottom end in the toilet bowl.

Wet or lubricate the end of the cone with water-soluble lubricant.

To remove air bubbles from the tubing, open the clamp on the tubing and let a small amount of water runinto the sleeve. Re-clamp the tubing and put the cone into the stoma as far as it will go, but not beyond itswidest point. Slowly open the clamp on the tubing and allow the water to flow into your bowel.

The water must go in slowly. You may shut the clamp or squeeze the tube to slow or stop the water flow. Ittakes about 5 minutes to drip in 1,000 cc (1 quart) of water. Hold the cone in place for 10 more seconds.

The amount of water you need depends on your own body. You may need less, but do not use more than1,000 cc (1 quart). The purpose of irrigating is to remove stool, not to be strict about the amount of waterused.

You should not have cramps or nausea while the water flows in. These are signs that the water is runningin too fast, you are using too much water, or the water is too cold. After the water has been put in, a bowelmovement-type cramp may happen as the stool comes out.

After the water has run in, remove the cone. Output or "returns" will come in spurts over the next 45minutes or so. As soon as the major portion has come, you may clip the bottom of the irrigating sleeve tothe top with a clasp. This allows you to move around, bathe, or do anything you wish to pass the time.

In time you will know when all the water and stool have all come out. A squirt of gas may be a sign thatthe process is done, or the stoma may look quiet or inactive.

If the complete irrigation process always takes much more than an hour, talk to your doctor or ostomynurse.


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Which one, or which combination of the above methods you use depends on many factors, such as:

Colostomy management

Learning to take care of your colostomy may seem hard at first, but with practice and time it will become secondnature, just like shaving or bathing.

Think of your colostomy's function as you did your natural bowel movements. You still have the same bowel, just alittle less of it. The real change is having the stool come out of an opening made on your belly (abdomen). Learninghow to care for your colostomy will help you adjust.

There is no one way to take care of a colostomy. As colostomies differ, so does taking care of them. This guide offersyou suggestions and ideas for managing your colostomy. Discuss the ideas with your doctor or ostomy nurse andadapt them to your needs. Give new things a fair trial but do not keep doing them if they do not make you more

comfortable. What is good for someone else may not be good for you. Use your recovery time to learn and trydifferent things so that you can find what works best for you.

In our society, bathroom needs are kept private. This is the same for a person with a colostomy. While you learn thenew procedures, you may need help. But before long you again will be in control. A good sense of humor andcommon sense are needed when changes in body function take place. Be confident. You can learn the new system.

In the beginning, it will be hard to tell what your stools will be like or when they will come out. The doctor andostomy nurse will work with you to find the best way to contain the stool so you will not be surprised orembarrassed. There are many ways that this can be done. The choice depends on your type of colostomy, yourusual bowel function, and your personal preference.

Caring for a transverse colostomy

Care of any colostomy is really not very hard to do, but getting to the point where you feel comfortable takes a lot oflearning, a lot of practice, the right supplies, and a positive attitude. Keep in mind the following points:

An appliance that will keep you from soiling your clothing is the right one for you.


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The colostomy will put out stool no matter what you do, but the firmness of your stool is affected by what you eatand drink.

Gas and odor are part of the digestive process and cannot be prevented. Still, they can be controlled so that youwill not feel embarrassed.

Empty the appliance often during the day to keep it from leaking or bulging under your clothes.

Change the pouch system before there is a leak. It is best to change it no more than once a day and not less thanonce every 3 or 4 days.

The ostomy should not irritate your skin. You can prevent skin problems by having a correctly fitted pouchsystem and by using special materials for ostomy care.

For more information on care, see the section "Helpful hints."

Bowel movements with a descending or sigmoid colostomy

You can treat the bowel movement through a colostomy like a normal movement through the anus, just let ithappen naturally. But, unlike the anal opening, the colostomy does not have a sphincter muscle that can stop thepassage of stool. This means you must wear a pouch to collect anything that might come through, whether it isexpected or not. There are many lightweight pouches you can buy that are hard to see under clothes. They stick tothe skin around the colostomy and may be worn all the time, or only as needed.

Some people with a descending or sigmoid colostomy find that by eating certain foods at certain times, they canmake the bowel move at a time that works best for them. With time and practice, they may feel so certain of thisschedule, they will wear a pouch only when a movement is expected. Some people use only this method to keepbowel movements on a regular schedule, while other use it along with irrigation.

More information on diet and eating is covered later in this guide.

Choosing a pouching system
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Deciding what pouching system or appliance is best for you is a very personal matter. When you are trying out yourfirst pouching system, it is best to talk with an ostomy nurse or someone who has experience in this area. Thereshould be someone in the hospital that is experienced and will get you started with equipment and instructions aftersurgery. As you are getting ready to leave the hospital, be sure you are referred to an ostomy nurse, a clinic, or achapter of the United Ostomy Associations of America. Even if you must go out of town to get such help, it isworthwhile, as you want to get a good start and avoid making mistakes. Even with help, you may have to trydifferent types or brands to find the system that best suits you. (See the section "Getting help, information, andsupport.")

There are many things to think about when trying to find the pouching system that will work best for you. The lengthof the stoma, abdominal firmness and shape, the location of the stoma, scars and folds near the stoma, and yourheight and weight all must be considered. Special changes may have to be made for stomas near the hipbone,waistline, groin, or scars. Some companies have custom-made products to fit unusual situations.

You may not need to wear a pouch, but many people with colostomies do. For example, those who have atransverse colostomy, those who do not want to irrigate, and those who have some return between irrigations maywear pouches. (More information on irrigation is coming up.)

A good pouching system should be:

secure, with a good leak-proof seal that lasts for up to 3 days

odor-resistant

protective of the skin around the stoma

nearly invisible when covered with clothing

be easy to put on and take off

Disposable pouches
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Pouches come in many styles and sizes, but they all do the same job they collect stool drainage that comes out ofthe stoma. Some can be opened at the bottom for easy emptying. Others are closed and taken off when they arefull. Still others allow the adhesive skin barrier, also called the face plate or flange, to stay on the body while thepouch may be taken off, washed out, and reused.

Figures 8 through 15 show you some available ostomy supplies. Along with the different kinds of pouches, othersupplies such as flanges, clips, and belts are shown. Some types of pouching systems need these supplies. Pouchesare made from odor-resistant materials and vary in cost. Pouches are either clear or opaque and come in differentlengths.

There are 2 main types of systems available. Both kinds include a part that sticks to your skin, called a faceplate,flange, skin barrier, or wafer, and a collection pouch.

one-piece pouches are attached to the skin barrier

two-piece systems are made up of a skin barrier and a pouch that can be removed from the barrier

The face plate or flange of the pouch may need a hole cut out for the stoma, or it may be sized and pre-cut. It isdesigned to protect the skin from the stoma output and to be as gentle to the skin as possible.

Stoma covers

A gauze or tissue can be folded neatly, touched with a small amount of water-soluble lubricant, placed over thestoma, and covered with a piece of plastic wrap. Such a dressing may be held on with medical tape, underclothing,or an elastic garment. Plastic, ready-made stoma caps (Figure 16) are also available. Stoma covers may be used for

colostomies that put out stool at regular, expected times.

Changing the pouching system

There may be less bowel activity at certain times in the day. It is easiest to change the pouching system duringthese times. You may find that early morning before you eat or drink is best.


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Sterility

You don't have to use sterile supplies. For instance, facial tissue or cotton balls can be used in place of gauze pads.The stoma and nearby skin are clean but not sterile.

Factors that affect the pouching system seal

The length of time a pouch will stay sealed to the skin depends on many things, such as the weather, skin condition,scars, weight changes, diet, activity, body shape near the stoma, and the nature of the colostomy output.

Sweating during the summer months in warm humid climates will shorten the number of days you can wear thepouching system. Body heat, added to outside temperature, will cause skin barriers to loosen more quicklythan usual.

Moist, oily skin may reduce wearing time.

Weight changes will also affect how long you can wear a pouch. Weight gained or lost after colostomy surgerycan change the shape of your abdomen. You may need an entirely different system.

Diet may affect your seal. Foods that cause a watery output are more likely to break a seal than a thickerdischarge.

Physical activities may affect wearing time. Swimming, very strenuous sports, or anything that makes you sweatmay shorten wearing time.

Irrigation (for descending and sigmoid colostomies only)

Irrigating to have regular, controlled bowel movements is up to each person, but you should fully discuss it with yourdoctor or ostomy nurse before a decision is made. The irrigation procedure is taught and may be done a littledifferently depending on the experience of the doctor or nurse teaching you.


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Needed equipment includes a plastic irrigating container with a long tube and a cone or tip to put water into thecolostomy. An irrigation sleeve is worn to take the irrigation output into the toilet. You can use a tail closure or clipand a belt for extra irrigation sleeve support, too.

Try to find a method, or combination of methods, that most closely matches your body's normal bowel habit orpattern. At first, you may need to try different things under a doctor or nurse's guidance. Just remember, it will taketime to set up a new system. Having regular daily habits will help. If you find certain foods or irrigation procedureslet you regulate your bowel movements, keep doing those things at the same time every day. Regular habits willpromote regular bowel functions. On the other hand, it is never wise to be locked into habits. Occasional changes inroutine will not harm you.

Ordering and storing supplies

Keep all your supplies together on a shelf, in a drawer, or in a box in a dry area away from hot or cold temperatures.

Order supplies a few weeks before you expect them to run out to allow enough time for delivery. But don't stockpilesupplies because they may be ruined by moisture and changes in temperature.

To order more pouches, skin barriers, and other ostomy products, you will need the manufacturer's name andproduct numbers. Supplies may be ordered from a mail order company, from a medical supply store, or from a localpharmacy. If you want to order supplies online, talk with your nurse about reputable dealers who can supply youwith what you need. You will also want to check with your insurance to be sure that they work with the company inquestion. You may also want to compare prices when using mail order and the Internet to include how much you will

pay for shipping. For information and help ordering, you may contact a local ostomy nurse, the productmanufacturer, telephone directory business pages, or the Internet (try the search words "ostomy supplies").

Protecting the skin around the stoma

The skin around your stoma should always look the same as skin anywhere else on your abdomen. A colostomy thatputs out firm stool usually causes few, if any skin problems. If the stool is loose, as is often the case with transverse


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colostomies, it can make the nearby skin tender and sore. As you get stronger and get better at handling yourequipment, skin irritation will become less of a problem. Here are some ways to keep your skin healthy:

Use the right size pouch and skin barrier opening. An opening that is too small can cut or injure the stoma andmay cause it to swell. If the opening is too large, output could get to and possibly irritate the skin. In bothcases, change the pouch or skin barrier and replace it with one that fits well.

Change the pouching system regularly to avoid leakage and skin irritation. Itching and burning are signs thatthe skin needs to be cleaned and the pouching system should be changed.

Do not rip the pouching system away from the abdomen or remove it more than once a day unless there is aproblem. Remove the face plate gently by pushing your skin away from the sticky barrier rather than pullingthe barrier from the skin..

Clean the skin around the stoma with water. If needed, you can use a mild soap and rinse very well. Pat drybefore putting on the cover or pouch. You can clean your stoma in the shower or tub.

Watch for sensitivities and allergies to adhesive, skin barrier, paste, tape, or pouch material. They candevelop after weeks, months, or even years of using a product because you can become sensitized over time.If your skin is irritated only where the plastic pouch touches it, you might try a pouch cover. These areavailable from supply manufacturers, or you can make your own.

You may have to test different products to see how your skin will react to them. If you feel comfortable testingyourself, follow the directions under "Patch testing" that follow. If you are not comfortable doing this on your ownand the problem continues, talk to your doctor or ostomy nurse.

Patch testing

Place a small piece of the material to be tested on the skin of your belly, far away from the colostomy. If thematerial is not self-sticking attach it with an adhesive tape that you know you are not allergic to (Figures 21 and 22).Leave it on for 48 hours.


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Gently remove the patch at the end of 48 hours and look for redness or spots under the patch. If there is no rednessafter 48 hours, it is generally safe to use the product. But, in a few cases, reactions that took longer than 48 hours toshow up have been reported Itching or burning before 48 hours pass is a sign of sensitivity. Remove the materialright away and wash your skin well with soap and water.

A reaction to the tape is also possible. If this is the case, the redness or other irritation will only be in the areaoutlined by the tape

If you seem to be allergic to a certain product, try one made by another company and patch test it, too. You willprobably find one that works for you. Allergies are not as common as is irritation caused by using a product thewrong way. For this reason, always read the directions that come with the product. When in doubt, check with yourostomy nurse or doctor.

Spots of blood on the stoma

Spots of blood are not a cause for alarm. Cleaning around the stoma as you change the pouch or skin barrier maycause slight bleeding. The blood vessels in the tissues of the stoma are very delicate at the surface and are easilydisturbed. The bleeding will usually stop quickly. If it does not, call your ostomy nurse or your doctor.

Shaving hair under the pouch

Having a lot of hair around the stoma can make it hard to get the skin barrier to stick well and may cause pain whenyou remove it. Shaving with a razor or trimming hair with scissors is helpful. Extreme care should always be taken

when using a straight edge or razor. A mild soap or shaving cream may be used. Rinse well.

Flatulence (gas)

Right after surgery it may seem that you have a lot of gas almost all the time. Most abdominal surgery is followed bythis uncomfortable, embarrassing, yet harmless symptom. As the tissue swelling goes down, you will have less gas.But certain foods, such as eggs, cabbage, broccoli, onions, fish, beans, milk, cheese, and alcohol may cause gas..


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Eating regularly will help prevent gas. Skipping meals to avoid gas or output is not smart. Some people find it best toeat smaller amounts of food 4 to 5 times a day.

You may be worried about how others will respond to the gassy noises. You will find that these noises sound louderto you than to others. They often only sound like stomach rumblings to those around you. If you are embarrassed bythese rumblings when others are nearby you can say, "Excuse me, my stomachs growling." If you feel as thoughyou are about to release gas when you are with people, casually fold your arms across your abdomen so that yourforearm rests over your stoma. This will muffle most sounds. Check with your ostomy nurse about products you cantake to help lessen gas, such as Beano.

Odor

Many factors, such as foods, normal bacterial action in your intestine, illness, different medicines, and vitamins cancause odor. Some foods can produce odor: eggs, cabbage, cheese, cucumber, onion, garlic, fish, dairy foods, and

coffee are among them. If you find that certain foods bother you, avoid them. Some people with colostomies havemore trouble with odors than others. Learning by experience is the only solution to this problem. Odors may beworse with transverse colostomies. Here are some hints for odor control:

Use an odor-resistant pouch.

Check to see that the skin barrier is stuck securely to your skin.

Empty the pouch often.

Place special deodorant liquids and/or tablets in the pouch.

There are some medicines you can take that may help. Check with your doctor or ostomy nurse about theseproducts and how to use them. Some things that many people have found to help with odor are chlorophylltablets, Devrom (bismuth subgallate), and bismuth subcarbonate.

There are air deodorizers that control odor very well when you are emptying the pouch.


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Care of the posterior wound

In some patients the rectum and anus are removed. This will leave a surgical wound in that area called a posteriorwound. Care of the posterior wound is based on good hygiene and the use of dressings or pads to collect andcontain any drainage. Infections or drainage that lasts may be treated by antibiotics, irrigations, or sitz baths (sittingin a tub or pan of warm water). Your doctor or nurse should tell you how to care for this wound and what problemsneed to be reported right away.

Blockage (obstruction)

If you have cramps, vomiting and/or nausea, belly swelling, stoma swelling, and little to no output or gas from yourstoma the intestine could be blocked (obstructed). Call your doctor or ostomy nurse right away if this happens.

There are some things you can do to help move things through your colostomy.

Drink enough fluids. Talk to your doctor or nurse about how much is enough for you.

Watch for swelling of the stoma and adjust the opening of the pouch as needed until the problem swellinggoes down.

Take a warm bath to relax your abdominal muscles.

Sometimes changing your position, such as drawing your knees up to your chest, may help move along thefood in your gut.

Do NOT take a laxative.

High-residue foods (foods high in fiber) such as Chinese vegetables, pineapple, nuts, coconut, and corn can causeobstruction. It can also be caused by internal changes such as adhesions (scar tissue that forms inside yourabdomen after surgery).


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Phantom rectum

Phantom rectum is much like the "phantom limb" of amputees who feel as if their removed limb is still there. It isnormal for you to have the urge to move your bowels the way you did before surgery. This can happen for years

after surgery. If the rectum has not been removed, you may have this feeling and also may pass mucus when sittingon the toilet. Some who have had their rectum removed say that the feeling is helped by sitting on the toilet andacting as if a bowel movement is taking place.

When you should call the doctor

You should call the doctor or ostomy nurse if you have:

cramps lasting more than 2 or 3 hours

continuous nausea or vomiting

bad or unusual odor lasting more than a week (This may be a sign of infection.)

unusual change in your stoma size or color

blockage at the stoma (obstruction) and/or the inner part of the stoma coming out (prolapse)

a lot of bleeding from the stoma opening (or a moderate amount in the pouch that you notice several timeswhen emptying it) (NOTE: Eating beets will lead to some red discoloration.)

injury to the stoma

a cut in the stoma

continuous bleeding where the stoma meets the skin

bad skin irritation or deep ulcers (sores)


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severe watery output lasting more than 5 or 6 hours

anything unusual going on with your ostomy

A stoma can become narrowed (stenotic) with time, usually over many years. Stenosis may also be caused by injuryfrom irrigation or a short-term poor blood supply right after surgery. It can usually be corrected with a minoroperation if it becomes a problem.

Now that we use irrigation cones, rupture or perforation of the colon is rarely seen. They can still happen, though, ifthe irrigation cone is not carefully put into the stoma.

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OXYGEN ADMINISTRATION

Oxygen therapy is the administration ofoxygen as a medical intervention, which can be for a variety of purposesin both chronic and acute patient care. Oxygen is essential for cell metabolism, and in turn, tissue oxygenation isessential for all normal physiological functions.[1]

Room air only contains 21% oxygen, and increasing the fraction of oxygen in the breathing gas increases theamount of oxygen in the blood. It is often only required to raise the fraction of oxygen delivered to 3035% and thisis done by use of a nasal cannula. When 100% oxygen is needed, it may be delivered via a tight-fitting face mask, orby supplying 100% oxygen to an incubator in the case of infants. Oxygen can be administered in other ways,including specific treatments at raised air pressure, such as hyperbaric oxygen therapy.

High blood and tissue levels of oxygen can be helpful or damaging, depending on circumstances and oxygentherapy should be used to benefit the patient by increasing the supply of oxygen to the lungs and therebyincreasing the availability of oxygen to the body tissues, especially when the patient is suffering from hypoxia and/orhypoxaemia.

Purpose

Oxygen is used as a medical treatment in both chronic and acute cases, and can be used in hospital, pre-hospital orentirely out of hospital, dependant on the needs of the patient and the views of the medical professional advising.
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Use in chronic conditions

A common use of supplementary oxygen is in patients with chronic obstructive pulmonary disease (COPD), acommon long term effect ofsmoking, who may require additional oxygen to breathe either during a

temporary worsening of their condition, or throughout the day and night. It is indicated in COPD patients withPaO2 55mmHg or SaO2 88% and has been shown to increase

Use in acute conditions

Oxygen is widely used in emergency medicine, both in hospital and by emergency medical services or advancedfirst aiders.

In the pre-hospital environment, high flow oxygen is definitively indicated for use in resuscitation, major trauma,anaphylaxis, major haemorrhage, shock, active convulsions and hypothermia.

It may also be indicated for any other patient where their injury or illness has caused hypoxaemia, although in thiscase oxygen flow should be moderated to achieve target oxygen saturation levels, based on pulse oximetry (with atarget level of 94-98% in most patients, or 88-92% in COPD patients).

For personal use, high concentration oxygen is used as home therapy to abort cluster headache attacks, due to itsvaso-constrictive effects.


cylinders should be kept cool, dry and undercover

all cylinders should be kept in a secure but accessible area near the oxygen equipment cylinders should be contained or secured to prevent movement and precautions should be taken to prevent them falling over the storage area should be out of direct sunlight and away from heat

full and empty cylinders should be clearly marked and kept stored separately the storage area should have the regulation signage

there should be no naked flames or smoking allowed within 25 metres of stored oxygen cylinders

empty cylinders should be returned for filling without delay
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DO NOT store near grease or oil

Safety with oxygen

always check that the cylinder is clean ensure that the cylinder is black with white shoulders always use the correct yoke with pressure gauges

ensure that the bodock seal (O ring) and valve seat are clean and undamaged store cylinders upright and secure

adhere to Government regulations regarding the storage of oxygen cylinders store full and empty cylinders separately. Mark empty cylinders clearly

ensure that you are qualified prior to using oxygen equipment

DO NOT drop or roll cylinders DO NOT completely empty a cylinder leave pressure in the cylinder to prevent moisture entering

DO NOT expose cylinders to extreme heat or flame (oxygen is flammable and potentially explosive) DO NOT smoke near oxygen equipment

DO NOT use petroleum based oil or grease products near oxygen equipment

Preparation

Administering oxygenBY FACE MASK

reassure the casualty explain the need for oxygen therapy explain that the oxygen mask will assist with breathing turn on oxygen select mask (adult or child) connect oxygen tubing to mask connect oxygen tubing to flowmeter turn on flowmeter to appropriate rate (lpm) place mask comfortably over casualtys face covering the mouth and nose


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adjust straps adjust metal strip over nose continue to reassure the casualty continue to observe the casualty

BY NASAL PRONGS

reassure the casualty explain the need for oxygen therapy explain that the prongs will assist with breathing turn on oxygen select appropriate size nasal prongs connect oxygen tubing to flowmeter turn on flowmeter to appropriate rate (lpm)

place tips into casualtys nostrils place tubing over and then under casualtys ears adjust for comfort secure tubing to casualtys clothing continue to reassure the casualty continue to observe the casualty

BY BAG AND MASK

turn on oxygen select appropriate size resuscitation mask

connect oxygen tubing to resuscitation bag oxygen inlet connect oxygen tubing to flowmeter turn on flowmeter to appropriate rate (10 lpm) place mask over casualtys face covering the mouth and nose hold the mask firmly in place, ensuring a good seal maintain head tilt and jaw lift squeeze the resuscitation bag until the casualtys chest rises, then release (2 seconds) continue to observe the casualty for airway secretions and obstructions


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Resuscitation using a bag and mask is a two person procedure, with one person holding the mask and the secondperson squeezing the bag.

Manual suction

turn casualty on to side if possible prepare suction unit

o install an unused container into the suction deviceo remove the protective cap from the tip of the suction catheter

spread the victim's teeth using the cross-finger technique with the other hand insert the catheter into the victim's mouth towards the back of the throat

o insert the catheter only as far as the base of the tongue squeeze the suction handle and hold it until suction stops

o repeat the handle squeeze as needed return to ventilations as soon as possible suction only the mouth DO NOT suction for more than 15 seconds at a time DO NOT place the catheter tip any farther than the base of the tongue

http://www.parasolemt.com.au/manual.php?subpage=oxygenadmin


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WOUND CARE

Definition

A wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds are usually caused by cuts orscrapes. Different kinds of wounds may be treated differently from one another, depending upon how they

happened and how serious they are.

Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissuesheal with some scarring. The object of proper care is to minimize the possibility ofinfection and scarring.

There are basically 4 phases to the healing process:

Inflammatory phase: The inflammatory phase begins with the injury itself. Here you have bleeding, immediatenarrowing of the blood vessels, clot formation, and release of various chemical substances into the woundthat will begin the healing process. Specialized cells clear the wound of debris over the course of several days.

Proliferative phase: Next is the proliferative phase in which a matrix or latticework of cells forms. On thismatrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) thatgive a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuildingcells with oxygen and nutrients to sustain the growth of the new cells and support the production ofproteins(primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is thedominant substance in the final scar.
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Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized makingthe tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color.Over the course of 6 months, the area increases in strength, eventually reaching 70% of the strength ofuninjured skin.

Epithelialization: This is the process of laying down new skin, orepithelial, cells. The skin forms a protective barrier betweenthe outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria.

Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured

(stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes toscarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis)

Purpose

1) Prevention of infection: - comply with the rule of aseptic technique during wound dressing (seebelow).

2) Cleaning of wound: - always wipe from inside to outside and not vice versa.- change the dressing regularly and when there are discharge and oozingfrom the wound.

3) Minimize further damage: - secure the dressing with a bandage only tight enough to sustain thepressure but not to impair the circulation.- apply non-allergenic sterile gauze.

4) Promote healing: - maintain a well-balanced diet.
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Classification and management of wounds

1) Abrasion (Graze) - e.g. superficial abrasion result from a fall in the park.- If the wound is dirty, rinse it with soap and water.

- Cover the wound with swab and sterile gauze.- In case of large wound, seek medical treatment immediately.

2) Incision - e.g. a cut by a sharp object such as knife.- Firstly, remove any foreign bodies (e.g. glass) and rinse the wound with water.- Do not attempt to remove objects that are firmly embedded in the wound, this mayworsen bleeding.- Control bleeding by applying direct pressure over the wound for at least 5-15minutes by covering it with a gauze.- Seek medical treatment if bleeding continues.

3) Contusion - e.g. bruises from knocking against furniture- Contusion of skin by hard object with bruise appearing afterwards.- Minor injuries can be treated with heparinoid ointment.- Extensive contusion especially involving the head and limbs may be associated withsevere damage and fractures, medical attention is therefore advised.


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4) Burn and scald - e.g. scald wound from hot water in the bath.- rinse the wound under cold running water for at least 10 minutes.- Carefully remove any clothing or jewelleries before the affected area becomesinflamed and swollen.

- Remove any clothing that is soaked with hot water.- Cover the burn and the surrounding tissue with sterile dressing or cling film.- Do not rub the wound with ice, this may cause further damage to the skin.- Keep the wound clean, do not apply any lotion, ointment or butter to the scaldwound.- Leave all blisters intact to prevent infection.- Severe cases should be treated in hospital.

5) Pressure sores - e.g. back sores found in a bedridden patient.

- Change dressing every day if possible or whenever the dressing is soaked through.- Use aseptic techniques- Turn the patient regularly to promote healing of wound and to prevent contractures.

Anti-Tetanus Toxoid injection (ATT)

Patients who do not have immunization before or have immunization more than ten years ago should receiveTetanus immunization for any wound that is dirty and covered by soil or rust. A full course of ATT comprises of 3injections and offers 10 years of protection.

Proper techniques in Wound Management

Information for carers at home

Carers should follow advice from doctor and bring the elder to a nearby clinic for regular wound dressing. Frail eldersor elders with mobility problem could apply for the Community Nursing Services through doctors referral duringfollow up. Observe for signs and symptoms of infection (please refer to details on next page) and consult doctor ifnecessary.


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Information for carers in elderly home

Staff are advised to follow guidelines of aseptic technique when performing wound dressing. Details are as follow:

Signs and symptoms of wound infection

- Wound pain- Oozing- Redness, hot to touch- Foul smelling wound with blood stained discharge or pus- Change in general condition: fever, chills, increase in respiratory rate and pulse, headache, nausea and vomitingIf there are signs of wound infection or delayed healing , seek medical advice at once!

First aid box should contain the following items:

- Antiseptic lotion and alcohol- Cotton wool and gauze- Adhesive strapping and bandages- Triangular bandage and scissors- Disposable gloves

Preparation for wound dressing

1) Keep the area clean and tidy with good lighting.

2) Dressing materials: use disposable set for dressing ( usually include sterile towels, disposable forceps, gallipots,cotton wool balls and gauge), lotion ( according to doctors prescriptions ),mask and gloves ( if needed ), disposablebag for soiled dressing, bandages, adhesive strapping and scissors.3) Keep the patient warm and comfortable. Ensure adequate privacy during the procedure.4) Wash hands thoroughly with soap and water.


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Procedures of Aseptic Techniques

1) Open the package of sterile dressing. Lay the instruments on the sterile towel provided.2) Pour the antiseptic lotion into the gallipot. Remove the soiled dressing with a pair of forceps. If the dressing is

stuck to the wound, soak the dressing with normal saline. Dispose forceps and soiled dressing in a plastic bag.3) Reserve the other two pairs of forceps for handling the clean dressing and the wound.4) Use forceps to dip the cotton ball into antiseptic lotion and wipe the wound from inside to outside. Repeat theprocedure using a new cotton ball each time until the wound is clean.5) Dry the wound with sterile gauze.6) Cover the wound with clean dressing and apply adhesive strapping to secure it.

Aftercare

1) Put everything in a plastic bag and tie it up tightly before disposal.2) Wash hands again.

http://www.info.gov.hk/elderly/english/healthinfo/elderly/wound_care-e.htm
http://www.info.gov.hk/elderly/english/healthinfo/elderly/wound_care-e.htmhttp://www.info.gov.hk/elderly/english/healthinfo/elderly/wound_care-e.htm


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GASTRIC LAVAGE

Definition

Gastric lavage, also commonly called stomach pumping or Gastric irrigation, is the process of cleaning out thecontents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach.Such devices are normally used on a person who has ingested a poison or overdosed on a drug. They may also beused before surgery, to clear the contents of the digestive tract before it is opened.

The introduction of nourishment into the stomach by means of a tube passed through the nose or mouth.

Purpose

Gastric lavage is used infrequently in modern poisonings and some authorities have suggested that it not be used

routinely, if ever, in poisoning situations. Lavage should only be considered if the amount of poison ingested ispotentially life-threatening and the procedure can be performed within 60 minutes of ingestion.

To provide nourishment with food and/or medication.

Equipments

Nasogastric tube

Prescribed feeding formula

Calibrated drinking glass

Bowl with warm water

Asepto syringe

Medicine glass with tap water
http://en.wikipedia.org/wiki/Lavagehttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Poisonhttp://en.wikipedia.org/wiki/Drug_overdosehttp://en.wikipedia.org/wiki/Psychoactive_drughttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Digestive_tracthttp://en.wikipedia.org/wiki/Lavagehttp://en.wikipedia.org/wiki/Stomachhttp://en.wikipedia.org/wiki/Poisonhttp://en.wikipedia.org/wiki/Drug_overdosehttp://en.wikipedia.org/wiki/Psychoactive_drughttp://en.wikipedia.org/wiki/Surgeryhttp://en.wikipedia.org/wiki/Digestive_tract


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Syringe 50 cc for aspiration

Procedure

1.Pour specific amount & kind of formula into a calibrated glass.

2.Place the glass into a bowl of warm water & warm feeding to approx. body

B. Syringe or Funnel Method (by gravity flow)

1.Explain to the patient what and why is the procedure to be done.

2.Help the patient to assume a sitting position. If contraindicated, elevate slightly the head of the bed

3. Place towel on the chest or preferably on the side where feeding will be given.

4. Hold the end of the nasogastric tube & bend over itself or pinch it off.

5. Attach the syringe barrel to the free end of the tube.

6. Keeping the tube pinched

7. Release the pinch on the tube & allow the feeding to flow slowly by gravity.

8. Maintain the height of the gavage container at 8 12 inch ( 1 foot) above the patients level. a. if the formula isthick or fails to flow, raise the container a bit or apply slight

9. When the required amount of formula is consumed, follow with 30 60 cc of water.

10. Clamp & disconnect the tube as soon as the water has emptied into the tubing.

11. Cover the end of the nasogastric tube with a piece of gauze.


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12. Keep patient in a sitting position or in his right side for an hour or more.

13. Remove the towel; keep patient comfortable.

14. Clean and return used equipment Chart:

a.Time the feeding was given. b.Type and amount of feeding


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Urinary Catheterization

Definition

Urinary Catheterization- is the introduction of a catheter through the urethra into the urinary bladder. It is thepassage of a catheter into the bladder for the drainage of urine. It is the passage of a slender tubular device into thebladder or kidney for the drainage of urine or diagnostic purposes. A plastic tube known as a urinary catheter (suchas a Foley catheter inserted into a patient's bladder via their urethra.

Complications of catheter use may include: urinary tract or kidney infections, blood infections (sepsis), urethralinjury, skin breakdown, bladder stones, and blood in the urine (hematuria). After many years of catheter use,bladder cancer may also develop.

Purposes

To relieve discomfort due to bladder distention or to provide gradual decompression of a distended bladder. To assess the amount of residual urine if the bladder empties in completely. To obtain a urine specimen. To empty the bladder completely prior to surgery. To facilitate accurate measurement of urinary output for critically ill clients whose output needs to be monitoredhourly. To provide intermittent or continuous bladder irrigation. To prevent urine from contacting an incision after perineal surgery. To manage incontinence when other measures have failed.

Preparation

Equipments

sterile gloves

antiseptic cleansing solution


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cotton balls water-soluble lubricating jelly

forceps prefilled syringe

drape

indwelling catheter with drainage tubing and collecting bag

1. Explain to the client what you are going to do, why it is necessary, and how he or she can cooperate.

2. Wash hands and observe other appropriate infection control procedures.

3. Provide for client privacy.

4. Place the client in the appropriate position and drape all areas except the perineum (Male: supine, legs slightlyabducted)

5. Establish adequate lighting. Stand on the clients right if you are right-handed, on the clients left if you are left-handed.

6. If using a collecting bag not contained within the catheterization kit open the drainage package and place the endof the tubing within reach.

7. If agency policy permits, apply clean gloves and inject 10-15 ml Xylocaine gel into the urethra. In the male, wipethe underside of the shaft to distribute the gel up the urethra. Wait at least 5 minutes for the gel to take effect

before inserting the catheter.

8. Open the catheteriz

Sir Dennis Locsin

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