Table of Contents

• Free Topics
  • Administering Intramuscular Injections by the Z-Track Method
  • Administering Subcutaneous Injections
  • Assessing Blood Pressure
  • Assessing Heart Rate
  • Assessing the Abdomen
  • Assessing the Nose and Sinuses
  • Blood Transfusion Therapy
  • Calculator - Norton Scale for Assessing Risk of Pressure Ulcers (Calculator)
  • Calculator - The Braden Scale for Predicting Pressure Sore Risk (Calculator)
  • Figure - Correct Position to Drain Right and Left Back
  • Figure - Egg-Crate Mattress
  • Inserting a Short-Term Peripheral Intravenous Catheter
  • Instilling Medications into the Ear
  • Managing Mechanical Ventilation (MV)
  • Oxygen Therapy
  • Parenteral Nutrition
  • Performing Nasopharyngeal and Nasotracheal Suctioning
  • References
  • Table - Medication Chart
  • Table - Support Groups for People with Ostomies
• 1. Basic Care
  • 1. Hygiene
    • 1-1. Giving a Complete Bed Bath
    • 1-2. Providing Mouth Care
    • 1-3. Performing Foot Care
    • 1-4. Making an Occupied Bed
    • Hygiene
  • 2. Infection Control
    • 2-1. Handwashing
    • 2-2. Donning Isolation Gown and Gloves
    • 2-3. Droplet Precautions
    • 2-4. Contact Precautions
    • 2-5. Airborne Precautions
    • Infection Control
• 2. Assessment
  • 3. Vital Signs
    • 3-1. Assessing Body Temperature
    • 3-2. Assessing Heart Rate
    • 3-3. Assessing Respiratory Rate
    • 3-4. Assessing Blood Pressure
    • F - 3-1. Types of Thermometers
    • F - 3-2 - A. Sites Commonly Used for Assessing Radial Pulse
    • F - 3-2 - B. Location of Apical Pulses for Adults and Children
    • F - 3-4. Site for Blood Pressure Cuff Placement
    • T - 3-1. Comparing Fahrenheit and Centigrade Temperatures
    • T - 3-3. Respiratory Rates and Rhythms
    • Vital Signs
  • 4. Physical Assessment
    • 4-1. Assessing the Eyes
    • 4-10. Assessing the Neurologic System
    • 4-11. Assessing the Skin, Hair and Scalp, and Nails
    • 4-2. Assessing the Ears
    • 4-3. Assessing the Nose and Sinuses
    • 4-4. Assessing the Mouth and Pharynx
    • 4-5. Assessing the Neck
    • 4-6. Assessing the Thorax and Lungs
    • 4-7. Assessing the Heart and Vascular System
    • 4-8. Assessing the Musculoskeletal System
    • 4-9. Assessing the Abdomen
    • F - 4-1. Ophthalmoscope
    • F - 4-10. Decorticate (A) and Decerebrate (B) Posturing
    • F - 4-2 - A. Otoscope
    • F - 4-2 - B. Tuning Fork
    • F - 4-2 - C. Otoscope in Sertion
    • F - 4-2 - D. Eardrum
    • F - 4-2 - E. Weber Test
    • F - 4-2 - F. Rinne Test
    • F - 4-3 - A. Inspect Nasal Cavity
    • F - 4-3 - B. Palpate Sinuses
    • F - 4-4. Inspecting the Pharynx
    • F - 4-5. Palpating the Thyroid
    • F - 4-6 - A. Example of Chest Palpation
    • F - 4-6 - B. Percussion Sequence
    • F - 4-6 - C. Auscultation Sequence
    • F - 4-7 - A. Sites for Cardiac Assessment; Palpating the Mitral Valve Area; Palpating the Pulmonic Area
    • F - 4-7 - B. Location of Jugular Veins
    • F - 4-9. Light Palpation
    • Physical Assessment
    • T - 4-6. Respiratory Rates for Children
• 3. Medication Administration
  • 5. Oral and Topical Medications
    • 5-1. Administering Oral Medications
    • 5-2. Helping Patients with Self-Medication
    • 5-3. Applying Medications to the Skin
    • 5-4. Administering Eye Drops and Ointments
    • 5-5. Instilling Medications into the Ear
    • 5-6. Administering Medications via Metered-Dose Inhaler (MDI)
    • 5-7. Administrating Medications via Rectal Suppository
    • F - 5-4 - A. Instilling Eye Drops
    • F - 5-4 - B. Instilling Eye Ointment
    • F - 5-5 - A. Method for Instilling Ear Medications
    • F - 5-6. Metered-Dose Inhaler
    • F - 5-7. Inserting a Rectal Suppository
    • Oral and Topical Medications
    • T - 5-2. Medication Chart
  • 6. Parenteral Medications
    • 6-1. Administering Subcutaneous Injections
    • 6-2. Administering Intramuscular Injections
    • 6-3. Administering Intramuscular Injections by the Z-Track Method
    • 6-4. Administering Intradermal Injections
    • 6-5. Administering Intravenous Medications by Intermittent Infusion Sets or Mini-Infusion Pumps
    • 6-6. Administering Medication by Intravenous Bolus
    • 6-7. Teaching Patients How to Administer Self-Injections
    • 6-8. Mixing Two Types of Insulin
    • 6-9. Using Patient-Controlled Analgesia (PCA) Infusion Devices
    • F - 6-1 - A. Subcutaneous Injection Sites
    • F - 6-1 - B. Pinch Tissue Between Thumb and Forefinger
    • F - 6-1 - C. Insert Needle at a 45-Degree or 90-Degree Angle
    • F - 6-2 - A. Locating the Ventrogluteal Site
    • F - 6-2 - B. Locating the Vastus Lateralis Injection Site
    • F - 6-2 - C. Locating the Dorsogluteal Injection Site
    • F - 6-2 - D. Locating the Deltoid Injection Site
    • F - 6-3 - A. Applying Traction
    • F - 6-3 - B. Medication is Sealed in the Muscle
    • F - 6-4 - A. Locations for Intradermal Injections
    • F - 6-4 - B. Angle of Needle for Insertion
    • F - 6-4 - C. Bleb Formation
    • F - 6-5 - A. Needleless Adapter Connection with Saline Flush
    • F - 6-5 - B. Insertion of Needle/Needleless Adapter into Heparin Lock
    • F - 6-5 - C. Use Port Closer to Insertion Site
    • F - 6-5 - D. Intravenous Medication Administration Using a Buretrol-Type Setup
    • F - 6-5 - E. For IVPB, Use Extender So Primary IV Bag Hangs Lower Than Secondary Bag
    • F - 6-6 - A. Clamp or Pinch IV Tubing Just above Port
    • F - 6-6 - B. Administer Medication in Increments According to Rate of Infusion
    • F - 6-8 - A. Mixing Two Kinds of Insulin in One Syringe
    • Parenteral Medications
• 4. Respiratory
  • 10. Airway Suctioning
    • 10-1. Inserting an Oral or Nasal Airway
    • 10-2. Performing Oropharyngeal (Yankauer) Suctioning
    • 10-3. Performing Nasopharyngeal and Nasotracheal Suctioning
    • 10-4. Performing Endotracheal or Tracheostomy Tube Suctioning
    • Airway Suctioning
    • F - 10-1 - A. Oropharyngeal Airway in Place
    • F - 10-1 - B. A Nasopharyngeal Airway in Proper Position
    • F - 10-1 - C. Taping the Airway
    • F - 10-2 - A. Yankauer Suction Tube
    • F - 10-4 - A. Ambu Bag Connected to 100% Oxygen
    • F - 10-4 - B. Hold Suction Catheter with Dominant (Sterile) Hand
    • F - 10-4 - C. Collection of a Specimen from the Suction Pathway
    • F - 10-4 - D. Seal the Specimen Cup
    • T - 10-1A. Oral Airway Size in Children and Adults
    • T - 10-2A. Vacuum and Suction Settings
    • T - 10-3A. Suction Catheter Sizes
  • 11. Lung Re-Expansion or Chest Drainage
    • 11-1. Managing Chest Tube and Drainage Systems
    • 11-2. Assisting with Chest Tube Removal
    • F - 11-1 - A. Bottle and Disposable Chest Drainage Systems
    • F - 11-1 - B. Dressing Application
    • F - 11-1 - C. Ensure Tubing is Free of Kinks
    • Lung Re-Expansion or Chest Drainage
  • 7. Noninvasive Pulmonary Hygiene
    • 7-1. Performing Postural Drainage
    • 7-2. Teaching Controlled Coughing Techniques
    • F - 7-1 - A. Correct Position to Drain Right Posterior Segment
    • F - 7-1 - B. Correct Position to Drain Right Middle Lobe
    • F - 7-1 - C. Correct Position to Drain Lower Right and Left Lobes
    • F - 7-1 - D. Correct Position to Drain Right and Left Back
    • Noninvasive Pulmonary Hygiene
  • 8. Oxygen Therapy
    • 8-1. Administering Oxygen Therapy
    • 8-2. Administering Oxygen Therapy to the Patient with an Artificial Airway
    • F - 8-1 - A. Oxygen-Delivery Systems
    • F - 8-1 - B. Oxygen Percentage Regular
    • F - 8-2 - A. Trach Collar
    • F - 8-2 - B. T-Piece
    • Oxygen Therapy
  • 9. Ventilation Support
    • 9-1. Managing Continuous Positive Airway Pressure (CPAP)
    • 9-2. Managing Intermittent Positive Pressure Ventilation
    • 9-3. Managing Mechanical Ventilation (MV)
    • 9-4. Using an Ambu Manual Ventilator
    • 9-5. Performing Endotracheal Tube Care
    • 9-6. Performing Tracheostomy Care
    • 9-7. Managing a Cuffed Endotracheal or Tracheostomy Tube
    • F - 9-1 - A. CPAP Mask
    • F - 9-2 - A. Pressure-Controlled Noninvasive Ventilator
    • F - 9-3 - A. Ambu Bags, Infant to Adult Sizes
    • F - 9-4 - A. Create a Good Seal
    • F - 9-6 - A. Clean Inner Cannula with Hydrogen Peroxide and Small Brush
    • F - 9-6 - B. Clean Stoma with Cotton-Tipped Swab
    • F - 9-6 - C. Securing Face Plate with Ties
    • F - 9-6 - D. Insert Clean Dressing Under Ties and Face Plate
    • Ventilation Support
• 5. Cardiovascular
  • 12. Intravenous Fluid Therapy
    • 12-1. Inserting a Short-Term Peripheral Intravenous Catheter
    • 12-2. Inserting Peripheral Midline and Central Catheters (PICC)
    • 12-3. Calculating and Regulating Intravenous Flow Rate
    • 12-4. Changing Intravenous Site Dressings (Peripheral and Central)
    • 12-5. Assisting with Percutaneous Central Line Placement
    • F - 12-1 - A. Pulling Skin Taut
    • F - 12-1 - B. Insert Needle at Correct Angle
    • F - 12-1 - C. Advance the Catheter
    • F - 12-1 - D. Removing the Needle
    • F - 12-1 - E. U Method
    • F - 12-1 - F. Chevron Method
    • F - 12-1 - G. Cover Site with Transparent Film
    • F - 12-2 - A. Midline Catheter
    • F - 12-2 - B. Peripheral Intravenous Central Catheters (PICCs)
    • F - 12-5 - A. Injection Ports of a Triple Lumen Catheter
    • F - 12-5 - B. Tunneled Catheter
    • F - 12-5 - C. Ports
    • Intravenous Fluid Therapy
    • T - 12-1A. Catheter Sizes and Uses
    • T - 12-5A. Types, Use, Advantages and Disadvantages of Central Catheters
  • 13. Circulatory Maintenance
    • 13-1. Caring for Vascular Access Devices
    • 13-2. Applying Sequential Compression Devices
    • 13-3. Applying Antiembolic Hose
    • 13-4. Teaching Postoperative Leg Exercises
    • Circulatory Maintenance
  • 14. Blood Transfusion Therapy
    • 14-1. Transfusing Blood Products
    • 14-2. Assisting with Autotransfusion
    • Blood Transfusion Therapy
• 6. Nutritional and Digestive
  • 15. Oral and Enteric Nutrition
    • 15-1. Administering Nasogastric, Nasoenteric, and Enteric Tube Feedings
    • 15-2. Administering Medications Through a Feeding Tube
    • F - 15-1 - A. Continuous Tube Feeding Administered by Enteral Pump
    • F - 15-1 - B. Intermittent Feeding by Gravity
    • Oral and Enteric Nutrition
  • 16. Parenteral Nutrition
    • 16-1. Administering Total Parenteral Nutrition (TPN)
    • 16-2. Administering Peripheral Partial Nutrition
    • 16-3. Administering a Fat Emulsion (Lipids)
    • Parenteral Nutrition
  • 17. Gastrointestinal Intubation
    • 17-1. Inserting a Nasogastric Tube
    • 17-2. Advancing a Nasoenteric Decompression Tube
    • F - 17-1 - A. Measuring Tube for Placement
    • F - 17-1 - B. Inserting Tube into a Patent Nostril
    • F - 17-1 - C. Secure Tube with Tape
    • Gastrointestinal Intubation
  • 18. Bowel Elimination
    • 18-1. Administering an Enema
    • 18-2. Managing a Rectal Tube
    • 18-3. Managing Ostomy Care
    • Bowel Elimination
    • F - 18-1 - A. Inserting the Enema Tube into the Rectum
    • F - 18-1 - B. Inserting Commercially Prepared Enema Tip into the Rectum
    • F - 18-3 - A. Remove Old Wafer from the Skin
    • F - 18-3 - B. Use of Stoma Measuring Guide
    • F - 18-3 - C. Center the Wafer over the Stoma
    • T - 18-3A. Support Groups for People with Ostomies
• 7. Renal and Urinary
  • 19. Urinary Elimination
    • 19-1. Inserting a Straight or Indwelling Catheter (Male and Female)
    • 19-2. Performing Catheter Care
    • 19-3. Applying a Urinary Incontinence Collection Device
    • 19-4. Teaching Clean Intermittent Self-Catheterization
    • F - 19-1 - A. Draping the Patient
    • F - 19-1 - B. Cleansing the Urinary Meatus, Male Patient
    • F - 19-1 - C. Inserting a Catheter into the Urinary Meatus, Male Patient
    • F - 19-1 - D. Cleansing the Urinary Meatus, Female Patient
    • F - 19-1 - E. Inserting a Catheter into the Urinary Meatus, Female Patient
    • F - 19-3 - A. Placing the Penis Inside Urinary Incontinence Collection Device
    • Urinary Elimination
  • 20. Bladder Irrigation and Function
    • 20-1. Performing and Managing Bladder Irrigation Through a Three-Way Foley Catheter
    • 20-2. Obtaining a Post-Void Residual Urine Volume
    • Bladder Irrigation and Function
    • F - 20-1 - A. Triple Lumen Catheter
    • F - 20-1 - B. Setup for Continuous Bladder Irrigation
• 8. Musculoskeletal
  • 21. Body Alignment and Mechanics
    • 21-1. Maintaining Proper Body Alignment
    • 21-2. Performing Correct Lifting Techniques
    • Body Alignment and Mechanics
    • F - 21-1 - A. A Footboard is Placed at the End of the Bed to Prevent Foot Drop
    • F - 21-1 - B. Trochanter Roll Prevents External Rotation
    • F - 21-1 - C. The Oblique Position
    • F - 21-1 - D. Assisting Patient to Chair Using a Transfer Belt
    • F - 21-2. Wide Stance Lowers the Center of Gravity and is More Stable
  • 22. Exercise and Ambulation
    • 22-1. Performing Passive Range-of-Motion (ROM) Exercises
    • 22-2. Teaching Isometric Exercises
    • 22-3. Teaching the Patient to Crutch Walk or Use a Walker
    • Exercise and Ambulation
    • F - 22-1. Passive Range-of-motion Exercises
    • F - 22-3. Gait Patterns
    • T - 22-3A. Different Types of Gait Patterns
  • 23. Transfer and Positioning
    • 23-1. Moving and Positioning the Patient in Bed
    • 23-2. Transferring a Patient from Bed to Wheelchair
    • 23-3. Teaching Hip Precautions
    • F - 23-1 - A. Moving Patient Up in Bed (Two Nurses)
    • F - 23-1 - B. Turning a Patient in Bed
    • F - 23-3 - A. Abductor Pillow Prevents Hip Adduction
    • F - 23-3 - B. Hip Precautions, Hip Flexion
    • Transfer and Positioning
  • 24. Orthopedic Interventions
    • 24-1. Providing Cast Care
    • 24-2. Managing Skin Traction
    • 24-3. Managing Skeletal Traction
    • 24-4. Applying a Moist Compress
    • 24-5. Applying an Ice Bag, Ice Pack, or Collar
    • F - 24-1. Handle Wet Cast with Palms Only
    • F - 24-2 - A. Buck's Traction
    • F - 24-2 - B. Russell's Traction
    • F - 24-3 - A. Balanced Suspension and Skeletal Traction for Femur
    • Orthopedic Interventions
  • 25. Beds, Frames, and Mattresses
    • 25-1. Placing the Patient on a Specialty Surface
    • 25-2. Placing the Patient on an Air-Suspension or Air-Fluidized Bed
    • Beds, Frames, and Mattresses
    • F - 25-1. Egg-Crate Mattress
• 9. Integumentary System and Wound Care
  • 26. Pressure Ulcers
    • 26-1. Assessing Pressure Ulcer Risk
    • 26-2. Implementing Pressure-Ulcer Prevention Strategies
    • 26-3. Assessing Wounds and Staging Pressure Ulcers
    • F - 26-1 - A. Norton Scale for Assessing Risk of Pressure Ulcers
    • F - 26-1 - B. The Braden Scale for Predicting Pressure Sore Risk
    • F - 26-3. Pressure Sore Stages
    • Pressure Ulcers
  • 27. Wound Care
    • 27-1. Applying a Pressure Bandage
    • 27-2. Administering a Sitz Bath
    • 27-3. Performing Wound Irrigation
    • 27-4. Managing Wound Drainage
    • 27-5. Teaching Self-Management of Wound-Drainage Devices
    • 27-6. Applying Wound Dressings
    • 27-7. Applying and Managing a V.A.C. ATS(TM) System
    • F - 27-3. Direct Stream of Irrigant to All Areas of the Wound
    • F - 27-5. Teach Patient to Carefully Dry Periwound Edges
    • F - 27-6 - A. Place Moistened Gauze in Wound Cavity While Avoiding Wound Edges
    • F - 27-6 - B. Take Care to Avoid Creasing Film
    • F - 27-6 - C. Apply Hydrocolloid Dressing
    • F - 27-7 - A. Foam Sponge, Drapes, and Suction Wafer
    • F - 27-7 - B. Cut Foam to Fit into the Wound Bed
    • F - 27-7 - C. Cut Hole in Drape Film over the Foam Sponge
    • F - 27-7 - D. Apply T.R.A.C. over the Cutout, Opening in the Drape
    • F - 27-7 - E. Observe “Pruning” of the Foam, and Drape Dressing after Suction is Applied
    • Wound Care
• 10. Specimen Collection
  • 28. Collecting Blood Samples
    • 28-1. Performing Venipuncture
    • 28-2. Obtaining a Blood Glucose Level by Finger Stick
    • 28-3. Obtaining a Specimen for Arterial Blood Gas Analysis
    • Collecting Blood Samples
    • F - 28-2 - A. Proper Position of Lancet
    • F - 28-2 - B. Apply Blood Drop to Reagent
  • 29. Collecting Urine Samples
    • 29-1. Collecting a Midstream Urine Specimen
    • 29-2. Collecting a Timed (24-Hour) Urine Specimen
    • 29-3. Collecting a Sterile Urine Specimen from an Indwelling Catheter
    • 29-4. Measuring Specific Gravity of Urine
    • Collecting Urine Samples
    • F - 29-3. Obtaining a Sterile Urine Specimen from an Indwelling Catheter
  • 30. Collecting Other Specimens
    • 30-1. Collecting a Nose or Throat Specimen for Culture
    • 30-2. Collecting a Sputum Specimen
    • 30-3. Obtaining a Wound Drainage Specimen
    • Collecting Other Specimens
    • F - 30-2 - A. Attach Suction Tube to Specimen Container
    • F - 30-2 - B. Obtaining a Sterile Urine Specimen from an Indwelling Catheter
    • F - 30-3. Rotate Cotton Swab in Wound Drainage
• References
  • References
• Front Matter
  • Contributors
  • Standard Practice for All Procedures