PRACTICAL GUIDE TO STUDENT

NURSES AND MIDWIVES

NB: This pamphlet is to only assist in understanding practicals not a
complete say to the practical exam

For more information contact Nelson Kawalya “The Professor” on

0783359928/0707040358(whatsapp)

GENERAL RULES CONSIDERED IN PRACTICAL EXAMINATION

ROOM

 Great the patient

 Introduce self
 Explain the procedure
 Screen the patient
 Position the patient
 Wash the hands
 Do the procedure
 Explain the findings to the patient
 Clear away
 Re-wash hands
 Document the findings

ORIENTATION OF NEW PATIENTS ON THE WARD

 Refer to the general rules

 Show the patient and relatives the bed
 The patient is introduced to other patients
 The patients belonging are recorded on the patients chart
 Tell the patient and relatives about the availability of catering
services e.g kitchen
 Tell the patient about ward routines like visiting hours
 48Inform the patient about treatment plan e.g schedule of
drug administration
  Inform the patient about keeping valuables with ward in
charge
 Ask the patient about specific religious rights
 Show the patient and relatives the bath room and toilets

TAKING PATIENTS PARTICULARS

 Refer to the general rules

 Full name of the patient
 Age
 In-patient number/ hospital number
 Sex
 Address of the patient
 Tribe
 Nationality
 Name and address of next of kin
 Provisional dx
 Date and time of admission

REFFERAL OF A PATIENT

 Refer to the general rules

 The patient is explained to the reason for referral
 Fill the referral form and include the following
 First aid rx or care given
 Observation of vital signs
 Drug rx
 Investigations carried out
 Patients dx
 Reason for referral

DISCHARGING A PATIENT

Under normal circumstances, the following should be considered on

discharge
  Teach the patient
 about the illness, its cause, its effect on the patient and how
it can be prevented
 Care at home
 Diet
 Drugs on discharge
 Counsel the patient on drug compliance
 The importance of attending follow up clinic
 Period of leave from work
 The property kept for patient should be returned and signed
for by the patient
 Check for hospital items
 Escort the patient to the gate

BED APPLIENCES/ACCESSORIES

These provides support, comfort and safety to the patient

1. Mackintosh
 Protect the bottom sheet
 Protect the pillow
 Protect the bed clothes during the procedure
2. Back rest
 Helps the patient sit upright on the bed
3. Fractured board
 Placed under the mattress to provide a firm support

4.Trapeze(lifting pole)

 This is fixed at the head of the bed and helps the patient
lift himself from the mattress.

5.Hot water bottle

 Gives warmth to the patient

 Helps in relieve of pain
  Helps to relieve retention of urine

6. Bed cradle

 Keep the weight of the bedclothes off the patients body

7.Bed-block/Elevator

 To elevate the top or the bottom of the bed

8.Air Ring

 To prevent friction

9.Foot rest

 To prevent foot drop

10.cardiac table

 To put pillows on for the patient to breathe more easily when

sitting forword
 To provide the patient with a meal or medications

Side rails

 These are protected barriers attached to the bed as asafety

measures

11.Sand bag

 Prevent movement of limb in the treatment of special condition

VITAL OBSERVATIONS TRAY

 BP machine
 Stethoscope
 Thermometer
 Toxopulsometer
 Watch
 Galipot with swabs
  Antiseptic solution
 Receiver for used swabs
 Vital observation charts

TAKING TEMPERATURE

Requirement

 Thermometer
 Swabs in galipot
 Receiver for used swabs
 Disposable gloves
 Temperature chart

Procedure

 Refer to general rules

 Position the patient
 Put on gloves
 Inspect the axilla for cleanness
 Dry the axilla
 Inspect the thermometer for cracks
 Shake the thermometer for the mercury level to go below 350c
 Clean the thermometer cotton swabs soaked in antiseptics
solution
 Insert the bulb of the thermometer in axilla
 Position the arm across the chest
 Leave it in position for 3minutes
 Read the findings and record on the temperature chart

TAKING BLOOD PRESSURE

 Requirements
 BP machine
 Stethoscope
 Vital observation chart
Procedure

 Refer to the general rules

 Position the patients arm
 Fix the cuff on the brachium, make sure its not too tight or too
lose
 Palpate and feel for the brachial artery
 Test the stethoscope whether it’s in good working condition
 Put the stethoscope in situ
 Palpate and feel for the radial artery
 Inflate the cuff until the radial artery disappears
 Release the pressure from the cuff slowly until the first sound
is heard(systolic)
 Continue releasing pressure until the last sound is
heard(heard)
 Record the finding s as follows
BP=systolic/diastolic (mmhg)
The normal is ranges, systolic =110-130mmHg, diastolic=60-
90mmHg

TAKING PATIENT’S PULSE

Procedure
 Refer to the general rules
 Palpate and feel for the radial artery
 Start counting for 15secondsor 30secondsor 1minute
 If you count for 15 seconds multiply by 4e.g 16x4=64b/m
 If you count for 30seconds multiply by 2 E.g
32x2=64b/m
 If you count for 1minute, multiply by 1 E.g 64x1=64b/m
 The normal ranges is 60-90b/m

RESPIRATION

 Refer to the general rules

  Leave your fingers at the radial artery
 The look at the movement of the chest
 Start counting for 15secondsor 30secondsor 1minute
 If you count for 15 seconds multiply by 4e.g 4x4=16c/m
 If you count for 30seconds multiply by 2 E.g 8x2=16c/m
 If you count for 1minute, multiply by 1 E.g 16x1=16c/m
 The normal ranges is 16-20c/m
 Then give and record findings

OXYGEN ADMINSTRATION

Requirements

 Oxygen cylinder
 Oxygen head
 Oxygen key
 Oxygen delivery tubes
 Wolfe’s bottle
 Oxygen mask
 Nosal prongs
 Atray with
 Swabs in galipot
 Receiver for used swabs
 Sinus forceps
 Disposable gloves

Identification of the parts of oxygen cylinder and give their functions

 The cylinder is divided into three parts i.e

 Body for storage of oxygen
 Shoulder
 The head
 The cylinder has also the following
 Main tap ,it allows the flow of oxygen
 Oxygen key, opens the cylinder
  Pressure gauge, measures the amount of oxygen remaining in
the cylinder
 Fine adjustment knob, regulates the amount of oxygen to be
administered to the patient
 Dry flow meter, shows the amount of oxygen being
administered to the patient in litres per minute
 Two oxygen delivery tubes, delivers oxygen to the wolfe’s bottle
for humidification and from wolfe’s bottle to the patient
 Wolfe’s bottle , for humidification of oxygen
 Oxygen mask and nosal prongs ,for administering oxygen to
the patient

Procedure for oxygen administration

 Refer to the general rules

 Inspect the nostril
 Clean the nostril with sinus forceps
 Then administer oxygen with either face mask or nosal prongs
 Give and record findings

DECONTAMINATION

The process of rendering instruments free from micro organisms

Requirements

 Bucket of jick
 Bucket of soapy water
 Bucket of clean water
 Brush
 Flat surface
 Protect gears
 Masking tape
 Sterilizing machine

Procedure
  Put on protective gears
 Mix jick in a ratio of 1:6
 Immerse the instruments in a bucket of jick for 30 minutes
 Remove in jick and scrub them in a bucket of soapy water
using a brush
 Rinse the instrument in a bucket with clean water
 Display them on a flat surface to dry
 Pack, label and take them for sterilization
 Sterilize them for 30minutes

SEGREGATION OF MEDICAL WASTES

Is the separation of wastes in their specific containers/bins

Requirements

 Black bin for non infectious wastes

 Yellow bin for infectious wastes
 Red bin for highly infectious wastes
 Brown bin for pharmaceutical wastes
 Safety box for sharps

Procedure

BLACK BIN

 Food peelings
 Left over
 Used papers
 Cartoon

YELLOW BIN

 Used gloves
 Used swabs
 Iv giving sets
 Iv wrappings
  Iv bottles

RED BIN

 Used swabs soiled with blood

 Blood giving sets
 Placenta
 Extracted teeth
 Leftover food for infectious patients e.g T.B, CHOLERA

BROWN BIN

 Used drugs
 Vials

SAFETY BOX

 Syringes
 Needles
 Broken ampoules
 Surgical blades
 Razor blades

LIFTING OF THE PATIENT

Methods of lifting

 Australia method
 Orthodox method
 British method

Note that Australia method is for lifting infectious patient

 Refer to the general rules

 Clear the way
 It’s a two nurses procedure
 The patient is moved to the edge of the chair or of the bed
  The two nurses hold each other firmly at the level of the elbow
joint
 The nurses flex their knees while supporting the patient at the
level of the buttocks
 The other hands are passed under the patient’s thigh
 The nurses make sure that their shoulders are under the
patient’s arms axilla for British method and the arms
positioned across the fore head
 For orthodox, the patient’s are positioned across the chest
 The patient is instructed to rinse his or her limbs
 The patient is lifted gently to the bed or chair and left
comfortable

Note that for Australia method, the nurses face the opposite side of
the patient while lifting the patient as mentioned above

DUMP DUSTING

Requirements

Top shelf

 Basin for soapy water

 Basin for clean water
 3 dusters
 One for soapy for soapy water
 One for clean water to rinse
 One for drying
 Soap in a soap dish
 Vim

Bottom shelf

 Bucket for used water

 Hand brush
 Dust pan
  Protective gears

Procedure (for example dump dusting the wall or trolley)

 Put on protective gears

 Start dump dusting far away from you once until the area to
be dump dusted is covered
 Then rinse off soap starting far away from you once until the
area is covered
 Dry the area starting far away from you
 Change water whenever it gets contaminated

SURGICAL HAND WASHING

Requirements

 Running water
 Soap in soap dish
 Sterile towel
 Antiseptic solution
 Protective gear

Procedure

 Remove all the jewellery

 Put on protective gears
 Hold hands above the elbow line
 Wet hands and arms up to the level of the elbow joint
 Add cleansing agent to foam leather
 Once you start the procedure, operate the tap using the elbow
 Wash the hands , wrist and the elbow until one minute elapse
and each step consisting of five strokes, backward and forward
 Rinse off soap
 Repeat the procedure for more two minutes
 Rinse off soap
  Dry the hands from fingers to the elbow joint using a sterile
towel
 Always keep the hands above the elbow
 Proceed and put on a sterile gown

PUTTING ON A STERILE GOWN

 Hold inner surface of the neck of the gown

 Step back from the trolley
 Hold the gown from the body and let it unfold
 Take care not to let it touch the floor
 Pass your arms into the sleeves of the gown
 Do not bring the arms out of the sleeves
 An assistant adjust the gown and ties it from behind
 Proceed and wear gloves

POSITIONS USED IN NURSING

1. Recumbent (supine)
The patient lies flat on the back supported by one pillow
 This position is best for relaxation
 Best for examination of the chest and abdomen
 Best for burns of the chest and abdomen
2. Semi-recumbent
This is a half recumbent supported by 2-3 pillows
 Best for a patient recovering from general anesthesia
 Best for those who wish to read on the bed
3. Sitting up position(fowler)
This position is good for patients with cardiac conditions
4. Lateral position

The patient lies on the right or left side

 It’s used for administration of enema

 For rectal and vaginal examination
 Introducing suppository
 5. Semi-prone/sim/recovery
This position is commonly used in unconscious patients. This
position is half prone
It does not require a pillow
6. Prone position

The patient lies on the abdomen with the head turned tone
side supported with three pillows

One to support the head, abdomen and pelvis , and lower

limbs

Indication

 Wounds and burns of the back

 Relieving distension due to flatulence
7. Genu pectoral/ knee-chest position
The patient kneels with the battocks up wards
Indication
 In cord prolapse
 For colonic irrigation
 Relieving prolapsed of the abdominal organs
8. Lithotomy position
Indication
 Difficult deliveries
 Rectal operations
 Gynaecological operations
9. Dorsal position
The patient lies on his or her back
The thighs are flexed and knees apart
Indication
 Pelvic examination
 Vaginal examination
 During delivery

CONTROLLING EPISTAXIS
Requirement

 Cold compress
 Galipot with swabs
 Receiver for used swabs
 Receiver for receiving blood
 Sinus forceps
 Normal saline
 Small mackintosh
 Small towel

Procedure

 Refer to the general rules

 Put the patient in sitting up position
 Protect the patient’s clothing’s with a small towel and a
mackintosh
 Inspect the nostril
 Put the receiver at the level of the patient’s nose to receive
blood
 Tilt the head slightly forward
 Put cold compress across the fore head
 Instruct the patient to breathe through the mouth
 Pinch the nose for 10-15 times per minute
 Clean the nostril using sinus forceps
 Pack the nostril with adrenaline gauze
 Give and record findings

ARRESTING HEAMORRHAGE

Requirements

 A tray containing the following

 Galipot with cotton swabs
 Galipot with gauze swabs
 Receiver for used swabs
  Sterile gloves
 Taniquet
 Small mackintosh and towel
 Container with antiseptic solution
 Galipot for antiseptic
 Crape bandage
 strapping
 At the bed side pillow

Procedure

 Refer to the general rules

 Reassure the patient
 Position the patient’s limb
 Protect the site with small towel and mackintosh
 Apply pressure with a thumb above affected site
 Apply the toniquete for 5-10minutes
 Clean the wound with swabs soaked in antiseptic solutions
 The cleaning is done from inward to outward
 Dry the wound with a dry swab
 Dress it with gauze swabs to provide firm pressure
 Secure the dressing with crape bandage or strapping
 Rest the limb on a pillow to encourage good blood supply
 Re-assure the patient and clear away
 Document

IMMOBILISATION OF THE LIMB FOR A PATIENT WITH

FRACTURE OF THE TIBIA

Requirement

 Galipot with swabs

 Galipot for antiseptic solution
 Gloves
 Receiver for used swabs
  Small towel and mackintosh to protect the site
 Padded splints
 Crape bandage
 Pillow

Procedure

 Refer to the general rule

 Position the limb
 Protect the site with small towel and a mackintosh
 Clean the fractured site with swabs soaked in antiseptic
solution
 Dry the fractured site with gauze swabs
 Immobilize the fractured site with padded splints
 Secure the splints with crape bandage
 Rest the limb on a pillow to encourage good blood supply
 Prepare for referral

PREPERATION OF A TRAY FOR ORAL CARE

This is a clean tray and it contain the following

 Mouth gag for opening the mouth

 Airway piece
 Tongue depressor to prevent the tongue from falling back
 Long artery forceps to hold cotton swabs when cleaning the
mouth
 Galipot with cotton swabs
 Galipot with sodium bicarbonate used in cleaning the mouth
 Galipot with glycerin or borax
 Small towel and mackintosh to protect the patient
 Glass of water or mouth wash
 Non toothed dissecting forceps
 Receiver for used swabs
 Receiver for used swabs
  Bowel with clean water for dentures
 Towel to cover the tray

Procedure

 Follow the general rules

 Position the patient
 Protect the patient with a small towel and a mackintosh
 Inspect the mouth and note any abnormality
 Remove the food debris using non toothed dissecting forceps
 Grasp a swab soaked in sodium bicarbonate with long artery
forceps and press it against the side of the galipot to prevent
dripping
 Clean the outer and inner surface of the teeth, under the
tongue and the mucous membrane of the mouth
 Repeat the procedure until the mouth is clean
 Give water to rinse the mouth or mouth wash
 wipe the lips with glycerin
 leave the patient comfortable

PREPERATION OF A TRAY FOR PASSING NOSAL GASTRIC

TUBE

 Receiver with nosal gastric tube

 KY jerry
 Blue litmus paper
 Vomitus bowel
 Cup with clean water
 Jug with feeds
 Galipot with swabs
 Receiver for used swabs
 10ml syringe
 Feeding syringe
 Sinus forceps
 strapping
  Bowel with warm water
 Stethoscope
 Small towel and mackintosh

Procedure

 Refer to the general rules

 Put the patient in sitting up position
 Protect the patient with small mackintosh and towel
 Inspect the nostril for cleanness and nosal polyps
 Clean the nostril
 Put the tube in warm water to soften it
 Measure from the septum passing behind the ear to xhinphis
sternum and mark that point
 Lubricate the tip of the tube with KY jerry
 Tilt the head slightly forward to close the airway
 Identify the clear nostril
 Pass the tube slowly as you instruct the patient to swallow
 If you find an obstacle, rotate it and continue passing
 Instruct the patient to open the mouth because the tube may
coil through the mouth. if you find it coiled pull it and repeat
the procedure
 Push the tube until you reach the demarcation
 If you reach the demarcation it means that you’re in the
stomach

What shows that you have reached in the stomach?

 Put the end of the tube in water and if you see bubbles it
means you’re in the trachea ,if you don’t see bubbles it
indicate that you’re in the stomach
 Use stethoscope and fix the it’s diaphragm on the left side
to locate the stomach and push air through the end of the
tube, if you the sound it indicates that you’re in the
stomach
  Withdraw gastric content and drop it on a blue litmus
paper, if it turns red it indicates that the tube is in the
stomach
 Reaching the demarcation also indicates that you’re in the
stomach
 After fix the tube on the side of the cheek

CLEAN TROLLEYS WITH SMILLER FEATURES

The following trolleys are smiller in their arrangement but only

few items makes them different i.e trolley for

 Trolley for bed bath

 Trolley for tepid sponging
 Trolley for pressure areas
 Trolley for baby bathing

General requirements for the above trolleys

Top shelf

 Jug with warm water

 Jug with cold water
 Basin for mixing in water
 Soap in a soap dish
 Two or more flannels in a bowel

Bottom shelf

 Bath towel
 Small mackintosh and towel to protect the bed
 Bucket for used water
 Pair of bed sheets
 At the bed side protective gears
 Hand washing equipment
 Dirty linen container
Trolley for bed bath

 Jug with warm water

 Jug with cold water
 Basin for soapy water
 Basin for cleansing water
 Tray containing, soap in a soap dish, nail cutter, nail brush,
toilet paper and a comb
 Tray for oral care
 Two or more flannels in a bowel

Bottom shelf

 Bath towel
 Small mackintosh and towel to protect the bed
 Bucket for used water
 Pair of bed sheets
 Patient’s clothing’s
 Receiver for used swabs or toilet paper
 At the bed side protective gears
 Hand washing equipment
 Dirty linen container

PRCEDURE

This is performed on patients who can not help themselves

 Refer to the general rules

 Give the patient bed pan if required
 Remove the bed cover, blanket leaving the patient covered with
a top sheet
 Wash each part of the boy separately exposing only the part to
be washed
 Wash the face,
  Neck,
 Arms,
 Chest, and
 Abdomen in that order
 Change the water
 Wash each leg separately
 And wash the feet under the basin
 Dry the feet and cut the nails
 Turn the patient to the back
 Wash the back starting from the neck to the buttocks
 Pay attention to the folds of the buttocks
 Treat pressure areas
 Turn the patient to the back , change water and wash the
genitalia with different flannels
 Make up the bed with clean linen
 Dress the patient
 Carry out mouth care
 Comb the hair
 Leave the patient comfortable and clear airway

TROLLEY FOR TEPID SPONGING

This procedure is carried out to reduce patient’s body temperature

 Jug with warm water

 Jug with cold water
 Basin for mixing in water
 Bowel containing 2 face flannels in ice water(cold compress)
 Bath thermometer
 6 flannels in a bowel

Bottom shelf
  Bath towel
 Small mackintosh and towel to protect the bed
 Bucket for used water
 Pair of bed sheets
 Temperature tray
 At the bed side protective gears
 Cup with cold drinks
 screen
 Hand washing equipment
 Dirty linen container

Procedure

 Follow the general rules

 Remove the blanket, bedcover leaving the patient covered with
the top sheet
 Take the patient’s temperature and chart it
 Mix the tepid water and take it’s temperature
 The tepid water should be at temperature of 380C
 Only the part to be sponged should be exposed
 The sponging should follow this order i.e face, upper limbs,
chest and abdomen, lower limbs and the back
 Change the tepid water immediately after sponging the upper
limbs
 Also change the water before going to the lower limbs
 Carry out the procedure as follows
 Sponge the face, dry and apply cold compress across the fore
head
 Out of the 6 flannels in a bowel ,get 4 flannels and soak them
in cold water and put each in both axilla and the groins
 With a flannel in each hand, sponge the upper limbs in a slow
swiping movement and pour water over the palms(change the
tepid water)
 Change also the cold compress across the fore head
  With a flannel in each hand, sponge the chest and a abdomen
in a slow swiping movement (change tepid water in a basin)
 Sponge the lower limbs in a slow swiping movement and pour
water over the feet
 Turn the patient to the side and sponge the back and dry it
 Give a cold drink
 Wait for 20 to 30 minutes and retake temperature, it should
decrease by one 10c

Note the forehead and the backs are the only parts to be dried

TROLLEY FOR TREATING PRESSURE AREAS

Top shelf

 Jug with warm water

 Jug with cold water
 Basin for mixing in water
 Soap in a soap dish
 Two or more flannels in a bowel
 Vaseline
 Wooden spatula in a receiver

Bottom shelf

 Bath towel
 Small mackintosh and towel to protect the bed
 Bucket for used water
 Toilet paper
 Patient’s gown
 Pair of bed sheets
 At the bed side protective gears, dirty linen container, bed pan
, screen

Procedure
  Refer to the general rules
 Mix water in a basin
 Place the mackintosh and towel under the part to be treated
 First assess the part to be treated
 Wash the part with soap and water and dry it paying attention
to skin folds
 With soapy hands, massage the part in along sweeping
movement until soap get a absorbed
 Using a flannel rinse each part and pat it dry with patient’s
towel
 Apply a little Vaseline in your hand and massage the part to
nourish it
 Clear away and leave the patient comfortable

TROLLEY FOR BABY BATHING

Top shelf

 Jug with warm water

 Jug with cold water
 Basin for mixing in water
 Baby’s soap in a soap dish
 Galipot with cotton swabs
 Galipot with clean water
 Normal saline
 Temperature tray
 Bath thermometer
 Tray for cord care

Bottom shelf

 Baby’s towel
 Small mackintosh and towel to protect the bed
 Receiver for used swabs
 Bucket for used water
  Baby’s chart
 Gloves
 Barrier cream
 At the bed side protective gears

Procedure

 Refer to the general rules

 Close the nearby windows
 Check the baby’s temperature and chart
 Mix water in a basin and test temperature with a bath
thermometer(it should be at 370c) or test with elbow( water
should feel warm)
 Undress the baby leaving the baby in nappy/diaper
 Wrap the baby in baby towel leaving the face and the head
exposed
 When bathing the baby start from face, eyes, head and then
other body parts
 Hold the baby firmly with your arm supporting the head with
the left palm
 Lower the head over the basin and wash the face using clear
water without soap
 Clean the eyes with clean cotton swabs and clear water
 If there is discharge, use normal saline cleaning from inside to
outward
 Dry the face towel
 Apply soap in baby’s head to form lather, rinse thoroughly
with bath water and dry
 Unwrap the baby and remove the nappy, clean the buttocks
with a swab
 Hold the baby firmly with the left hand across your knees
 Soapy the baby’s body, upper limbs lower limbs and between
the folds
  Use the left hand to hold the baby firmly under left axilla and
the right hand supporting the lower limbs with the baby’s
head supported by your hand
 Gently lower the baby into the basin
 Use the right hand to rinse the baby
 Place the bath towel over your knees and dry the baby paying
special attention to skin folds
 Apply barrier cream to the buttocks
 Clean umbilical cord stamp with normal saline
 Dress the baby in clean napkins and clothes
 Give the baby to the mother
 Clear away and document

TROLLEY FOR CATHETERIZATION

This is a sterile trolley

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for lubricant
 Galipot for antiseptic solution
 Sponge holding forceps
 Two Sterile hand towels
 Receiver to receive urine
 Drape

Bottom shelf

 Urethral catheter of required size

 Urine bag
 Receiver for used swabs
 Receiver for used instruments
 Sterile gloves
 Syringe
  Water
 Small towel and small mackintosh
 Specimen bottle
 Strappings
 Measuring jar
 Fluid balanced chart
 Plastic apron

At the bed side

 Screen
 Hand washing equipments

Procedure

 Follow the general rules

 Put on protective gears
 Put the patient in a recumbent position with the knees widely
flexed
 Put a small towel and a mackintosh under the patient’s
buttocks
 Clean the site with swabs soaked in antiseptic solution
 Put the drape to provide a sterile field
 Assistant opens for the catheter
 Lubricate the tip of the catheter
 Put the end of the catheter in a receiver
 Pass the catheter slowly and gently until you see urine coming
 Barron it with sterile water with about 5-15mls
 Connect the urine bag
 Leave the patient comfortable
 Clear away and document
CHANGING A TRACHEOSTOMY TUBE

Trolley

Top shelf

 Tracheal dilators
 Tracheostomy tube
 Dressing pack
 Sterile towel
 Sterile artery forceps
 Suction catheter

Bottom shelf

 2ml syringe
 Sterile gloves
 Sterile normal saline

At the bed side

 Screen
 Protective gears
 Bucket

Procedure

 Get the consent from the relatives

 The assistant unties the tape from the tracheostomy tube and
removes the dressing
 Wash hands and put on sterile gloves
 Deflate and remove the tube using a dressing forceps
 Clean the site with gauze soaked in normal saline
 Insert the tube in position as the assistant inflates the cuffed
tube
 the assistant applies suctioning
  Insert gauze swab on either side of the opening and ties the
tube in position
 The assistant applies suction again
 Put the saline soaked gauze across the opening
 Leave the relative comfortable
 Clear away
 document

TROLLEY FOR WARD ROUND

Top shelf

 Patient’s files
 gloves
 BP machine
 Stethoscope
 Thermometer
 Pulsometer
 File with
 Lab request forms
 Scan/ x-ray forms
 Discharge forms
 Referral forms
 Ward round book
 Specimen bottles
 strapping

Bottom shelf

 Syringes
 Antiseptic container
 Receiver for used swabs/ bucket
 Drum with cotton swabs
 Drum with gauze swabs
 Tray for emergency drugs
At the bed side

 Screen
 Hand washing equipments

TROLLEY FOR CARRYING OUT ENEMA

An Enema is the introduction of fluids into the lower bowel

Top shelf

 Apparatus consisting of a funnel or douche-can

 Rubber tubing of plastic connection
 Disposable rectal catheter
 Swabs in galipot
 Jug of solution in a bowel with hot water
 K-Y jelly
 Lotion thermometer
 Clean gloves

Bottom shelf

 Mackintosh and a towel

 Receiver for used swabs
 Receiver for used catheter
 Bed pan and cover
 Toilet paper

Commonly used fluids

 Enemax
 Soap solution( 50mls of soap in 450mls of water)
 Saline enema( 2tea spoons of salt in 500mls of water)

Procedure

 Follow the general rules

  Position the patient on his or her left side with knees bent and
buttocks close to the edge of the bed
 Joint up the apparatus and run a little fluid through the tube
to warm it, expel air and clip the tube
 Lubricate the end of the tube
 Insert the tube into the rectum in an upward and forward
direction for 8 to 10cm
 Hold the funnel about 24cm above the buttocks
 Open the clip and run the fluids into the rectum at a steady
rate not too quickly
 When most of the fluids has been given, gently withdraw the
catheter and put it in a receiver
 Encourage the patient to retain the fluids for 15 minutes to a
better result
 Help the patient into a bed pan
 When the patient is done with passing stool, remove the bed
pan and put it on the bottom of the trolley
 Let the patient wash his/ her hands
 Leave the patient comfortable
 Take the trolley to the sluice room
 Note the colour, amount , consistency of the stool and report
any abnormality

TRAY FOR RECTAL EXAMINATION

This is a clean procedure

Indication

 For diagnostic purpose

 To exclude the imperforated anus
 To exclude abnormal growth e.g. hemorrhoids, prostate
enlargement
 To evacuate the rectum in case of impacted faces
Requirements

 A receiver with a proctoscope

 K-Y jelley
 Spatula
 Mackintosh and a small towel
 Galipot with swans
 Galipot with antiseptic solution
 Toilet paper

At the bed side

 Bed pan
 Mackintosh apron
 Screen

CARING FOR A PATIENT WITH COLOSTOMY

Requirement

Tray

 Bowel of warm water

 Disposable glooves
 Large receiver
 Galipot with gauze swabs
 Soap in a dish
 New colostomy bag
 Colostomy adhesive and measuring guide
 Barrier cream

Procedure
  Follow the general rules
 Screen the bed and close the windows
 Wash and dry hands
 Turn down the bed clothes and expose the stoma
 Remove the soiled bag gently, taking care not to pull the skin
 Wash the area around the stoma with soapy water and dry
well.
 Apply a little barrier cream
 Re-measure the stoma to make sure that the bag fits correctly
 Cut the correct size of the circle in the stoma adhesive, using a
measuring guide
 Apply a clean bag as instructed
 Leave the patient comfortable
 Clear away
 document

PREPERATION FOR RETURN OF A PATIENT FROM THEATRE

Requirements

 make a post operative bed

 at the bed side
 observation tray
 airway tray containing , tongue depressor, mouth gag, tongue
clip, suction catheter
 vomitus bowel
 tray for emergency drugs
 suction machine
 suction tube
 oxygen apparatus and cylinder
 infusion stand
 bed elevator/ bed block

PROVIDING A FOOT DROP

  Great the patient
 Introduce self
 Explain the procedure
 Screen and wash hands
 Inspect the foot for infections
 Wash the foot with soap and water
 Dry the foot
 Wrap the foot drop with a cloth
 Put the foot drop in position
 Leave the patient comfortable
 Clear away and document

HEALTH EDUCATION

 When health educating the follow the following steps

 Introduction ,under this great, introduce self, assess their
understanding
 Set objectives
 Body of content, under this explain thoroughly the set
objectives
 Allow questions from participants
 Ask them questions to know whether they have understood
 Summarize
 Schedule for the next talk

COUNSELLING ON FAMILY PLANNING

 When counseling the client, follow GATHER

 G-great ( this involve introducing self ,explaining the
procedure)
 A-ask(asses what they know about family planning)
 T-tell( -define f/p,various methods of f/p, advantage and
disadvantage of f/p )
 H-help ( help them to chose the best method)
 E-explain (explain how the selected method is to be taken)
  R-return date(tell the client when to come back)

COUNSELLING DSCORDANT COUPLES

Discordant couple this where the couple one is positive and another
one negative

 Great the couple

 Introduce self
 Ask if they want to receive the result together
 Ask them what they can do if one is positive
 Help them to get the facts about the disease(define HIV,risk
factors and preventive measures)
 Ask if they are ready to receive the results
 Break the bad news
 Deal with client’s reactions
 Allow questions and answer them
 Share options about positive leaving
 Thank them for coming

TROLLEY FOR DRUG ADMINISTRATION

Top shelf

 Bottle of mixtures
 Jug with drinks
 Drinking glass
 Mortar and pestle
 Tea spoon
 Medicine list
 Medicine cup
 Vomitus bowel
 Small towel to wipe the bottles of mixture
 Small tray to carry the drugs to each patient

Bottom shelf
  Bowel with soapy water
 Patient’s files
 Gloves

At the bed side

 Hand washing equipment

Procedure

 Follow the general rules

 Identify the patient by calling his or her name
 Identify the drug to be given by reading on the label three
times
 Cross check drug with another person
 Give the patient water to wash the hands
 Give the drug to the patient
 Provide drinking water
 Observe the patient as she takes the drug
 Ask the patient to open the mouth to confirm whether she has
taken the drug
 Give relevant information concerning the drug
 Clear away
 Document

CLEANING OF TH E PATIENT’S EYE

Requirements

 Galipot with cotton swabs

 Receiver with for used swabs
 Gloves
 Galipot for normal saline
 Bottle of normal saline
 Small towel and mackintosh to protect the patient

Procedure
  Follow the general rules
 Position the patient either in sitting up lying down
 Protect the patient with a small towel and mackintosh
 Wash ,dry hands and put on gloves
 Dip the swabs in a solution and clean the eye
 The cleaning is from the nasal to the temporal aspect( from
inward to outward)
 The cleaning is repeated until the procedure is cleared
 Dry excess fluids with a dry swab
 Thank and leave the patient comfortable
 Clear away and document

APPLICATION OF TETRACYCLINE EYE OITMENT OR EYE DROP

 Requirement
 Tray with
 Normal saline
 Galipot with swabs
 Galipot for normal saline
 Receiver for used swabs
 gloves
 small mackintosh and towel to protect the patient
 the drug

Procedure

 Follow general rules

 Put the patient on sitting up position
 Wash hands and put on gloves
 Inspect the eyes
 Clean the eyes with swabs soaked in normal saline
 Clean from inward to outward once and discard
 Place folded swab on the lower lid and draw up the upper lid
 Place the nosal of the eye ointment 1cm away from the lower
lid
  Press the ointment horizontally from outward to inward
 Get a dry swab to clear the excess ointment
 Thank the patient
 Clear away and document

INSTALLATION OF EAR DROP E.g. CHLORAMPHENICAL EYE

DROP

 Follow the general rules

 Inspect the ear
 Clean the auditory canal with a dry swab
 Hold the pinna in upward and outward direction to
straighten the canal
 Allow three drops to tickle into one side of the canal
 Plug the canal with small cotton swab
 Observe the patient for any complaint
 Clean the side with cotton swab
 Thank the patient and clear away

IRRIGATION OF THE EYE

This means washing the conjunctiva of the eye

Indication

 To remove foreign body from the eye

 To remove chemicals which has been splashed accidentally
from the eye
 To wash out discharges
 Before administration of medications
 In preparation for eye surgery

Requirements

 Normal saline or plain boiled cold water

 Undine in a bowl or rubber bulb
 Sterile gloves
  Small mackintosh and towel
 Litmus paper
 Eye pad
 A bottle of ophthalmic irrigation fluids
 Galipot with cotton swabs
 Receiver for used swabs

Procedure

 Follow the general rules

 The patient is put in a sitting up position with the head
slightly turned to the affected side
 Protect the patient with small mackintosh and a towel
 Wash hands and put on gloves
 Inspect the eye
 If there is much discharge first remove it with moist swab
 The undine is filled with ophthalmic lotion
 Some lotion is run into the inner side of the fore arm to test
for the temperature
 The patient is given a receiver to hold placed against the
cheeks to receive the lotions
 The eye lid is held apart with the first and second finger
 The undine is held 3 to 5cm away from the eye
 The flow is started from the cheek then to the nosal side of the
eye
 The flow is kept up steadily until all the lotion is used
 The eye lid and cheek are gently dried by the swab
 Clear away and leave the patient comfortable

GIVING INTRAMUSCULAR INJECTION

Requirement

 Sterile syringe and needle

 Drug to be injected
  Galipot with swabs
 Galipot with antiseptic solution
 Receiver for used swabs
 Water for injection
 Gloves

Procedure

 Refer to the general rules

 Read the prescription and check the drug with another person
 Reconstitute the powdered drug according to the instruction
 Draw up the prescribed dose
 Expel the air from the syringe
 Choose the site for injection, clean and it into four quadrant
 Introduce the needle in the upper outer quadrant at an angle
of 900
 Withdraw the piston a little to make sure that the needle is not
in the blood vessel
 After confirming then you push the drug
 With the syringe and put a swab to provide to provide firm
pressure
 Clear away , thank the patient and document

PASSING THE INTRAVENOUS LINE

 Follow the general rules

 Prepare the prescribed infusion fluids
 Allow the fluid to run through the receiver to expel air
 Support the patient’s arm on a pillow
 Use the tourniquet or sphygmomanometer to locate the vein so
easily
 Tell the patient to close and open his fist in order to distend
the vein
 Tap and palpate the vein over the selected site
 Clean the site with antiseptic solution
  Hold the cannula at an angle of 200 to 300 and insert it
through the skin and into the vein
 Stop advancing the cannula as soon as it is in the vein
 Hold the needle part of the cannula with one hand to stop it
from advancing
 Apply pressure to the vein immediately at the end of the
cannula to minimize blood flow
 Remove the needle and connect the apparatus
 Clean up any blood, place sterile gauze under the cannula
 Apply sterile dressing ensuring that the cannula is held
securely in place and secure the dressing with strapping
 Leave the patient comfortable

DISCONTINUING AN INFUSION

Requirement

 Receiver for used swabs

 Strapping
 Swabs in galipot
 Gloves

Procedure

 Follow general rule

 Wash hands and put on gloves
 Remove strapping and dressing
 Remove the cannula and apply firm pressure on the puncture
site with swab
 Secure the dressing with strapping on the puncture site
 Take down the apparatus and place on the receiver to be
discarded
 Clean the stand with detergent solution before storing it.

ASSESSING A PATIENT USING GLASSGOW COMA SCALE

The following are the elements to be considered

 Eye opening
 Best motor response
 Best verbal response

Eye opening

 Opens eyes spontaneously , give=4

 Opens eyes on command, give =3
 Opens eyes on pain =2
 Does not open eyes =1

Best motor response

 Obeys command =[6

 Localized pain =5
 Flexed to pain =4
 Abnormal flexion =3
 Extension to pain =2
 No response =1

Best verbal response

 Oriented words =5
 Confused words =4
 In appropriate words =3
 In comprehensible words =2
 None =1

PREPERATION OF A TRAY FOR EAR SYRINGING

This is a clean procedure

Indication

 To remove and soften impacted cerumen

 To dislodge foreign body
  To relieve inflammation and discomfort
 To clean the canal with discharges

Tray

Ear syringe

 Auroscope
 Basin
 Receiver
 Clean gloves
 Mackintosh cape
 Prescribed solution in a bowel of warm water
 Patient’s towel mackintosh
 Cotton swabs galipot
 At Bed side
 Adjustable light

Procedure

 Follow the general rules

 Inspect the auditory canal using auroscope
 Ask the patient to be seated with the head turned to the
affected side
 Protect the patient with small mackintosh and towel
 Let the patient hold the receiver close to his /her shoulder
 Clean the auditory canal with moistened swabs
 Draw the solution into the syringe and expel air
 Straighten the auditory canal
 Insert the tip of the syringe on the side of the canal and start
the flow until the return flow is clear
 Using the auroscope inspect the canal for cleanliness
 Dry the patient’s auricle
 Let the patient lie on the affected side to promote drainage of
the residual debris and solution
  Clear away and document

PREPERATION OF A TROLLEY FOR LAST OFFICE

This is a clean trolley

Top shelf

 Basin for warm water

 2 or more flannels
 Soap in soap dish
 Nail brush
 Small tray with the following
 Nail cutter
 Brush and comb
 Pair of scissors
 Sinus forceps
 Dissecting forceps
 Bowel with cotton wool
 Mortuary label with tape
 A roll of toilet paper
 Gauze for dressing

Bottom shelf

 2 clean sheets
 Draw sheet and draw mackintosh
 2 mortuary sheets
 Strapping
 2 receivers , one for used swabs and another for used
instruments
 2 bath towel
 Two buckets , one with disinfectant and another for used
water
  Burial clothes
 Death forms
 Protective gears
 Bedside ,hand washing equipment

Procedure

 Get a consent from the relatives

 This is a two nurses procedure
 Remove the patient’s gown, all bed appliances, infusion set,
drainage tubes e.g. catheter
 Remove all jewelry
 Wash the body all over with soapy water and rinse with clean
water
 Cut the nails
 If there is a wound, redress it with a dry dressing and secure
with strapping
 Brush and comb the long hair and shave beards in men and
the private part
 Pack the body openings e.g. mouth, nostril, auditory canal and
other body orifices
 Support the jaw with gauze thread and tie it over the head
 Tie the big toes together
 Fill the mortuary label with patient’s name, age ,date and time
of death, ward and next of kin and tie it around the ankle or
wrist
 Dress the body in burial clothes
 The body is then packed in mortuary sheets and taken to the
mortuary on a special trolley

URINE TESTING

Requirements

 Uri sticks
  Urinometer
 Measuring jar
 Uri stick chart
 Sample of urine
 Blue litmus paper
 Gloves
 Specimen bottle

When carrying out urine testing, follow the ward CASDORA

 C-colour
 A-amount(quantity)
 Specific gravity(urinometer)
 Deposit (pus, blood etc)
 Odour(smell)
 Reaction (blue litmus paper)
 Abnormality(Uri sticks)

Procedure

 Colour, observe the colour of urine and the normal colour

should be of clear umber fluid
 Amount, use a measuring jar to measure the quantity of urine
and the normal person pass an average of 1.5L
 Specific gravity, use the urinometer to measure the specific
gravity and normal specific gravity of a person is 1.010-1.025
 Deposit , pour the urine in a specimen bottle and leave it to
settle and observe for deposit like pus, blood etc and report
 Odour, open the bottle and note the smell of urine
 Reaction, use a blue litmus paper and dip it’s tip in urine,
draw it over the edge of the container to remove excess. Acidic
urine turns the blue litmus paper red and alkaline turns pink
litmus paper blue and the urine that does not change of the
either litmus paper is neutral
  A abnormality, dip the Uri stick in urine glass container for
few seconds , draw it at the edge to remove excess and the
readings are recorded in 1minute by comparing with the Uri
stick chart noting the presence of the following glucose,
protein, leucocytes, blood etc

GIVING A BED PAN TO A PATIENT

Requirements

 A warm bed pan

 Toilet paper
 A jar of water
 Gloves
 Soap and small towel

Follow the general rules

 This is a two nurses procedure

 Make sure the bed pan is warm
 Lift up the bed clothes and prepare the patient’s clothes so
that can sit on the bed pan
 Put on gloves to prevent contact with body fluids
 Flex the patient’s knees and press the heels against the bed
 Place your hand under the patient’s thigh and raise the hips
 Then slip the bed pan underneath and make sure the bed
pan is in the right position of the patient
 Raise the back rest or put pillows to support the patient’s
back
 Then keep on supporting the patient until she gets done
with emptying the bowel

REMOVING THE BED PAN

 The two nurses lift the patient

  The third nurse clean the patient’s buttocks with toilet paper ,
soap and water
 With the bed pan gently pressing it under the mattress
 Wash the patient’s hands and dry with a towel
 Leave the patient in a comfortable position

PREPERATION OF A TRAY FOR BLOOD SAMPLE FOR MALARIA

PARASITES

The tray should contain

 Galipot with cotton swabs

 Receiver for used swabs
 Galipot with antiseptics
 Glass slide
 Sterile needle and syringe
 Taniquet
 Prickers
 Sterile gloves
 Strapping
 Lab request form

Procedure

 Follow the general rules

 Wash hands
 Clean the patient’s finger
 Press the part with the fingers and then prick it sterile needle
 Wipe off the first drop and then receive the second drop on to
a clean slide
 Press the finger with cotton swab to control any bleeding
 A allow the slide to dry
 Fill the laboratory request form and send the sample to the lab
 Leave the patient comfortable
 Document
ASSESSMENT OF A PATIENT FOR ANEAMIA

When assessing for Anemia, look for the following sites

 General outlook of the face

 Conjunctiva of the eyes
 Mucous membrane of the mouth, tongue and the gums
 Jugular vein
 Finger nails
 Palm
 Ankles
 Nails of the toes
 Planter
 Vulva

Procedure

 Refer to the general rules

 Look for the general outlook of the face and the normal one
should not be pale
 Check the conjunctiva and the normal one should be pink
 Assess the mucous membrane of the mouth, gum , tongue and
they should be pink in normal circumstances
 Palpate the jugular vein to find out whether it’s distension
because it tends to distend in anemic patients
 Press the finger nails and observe for the capillary refill and
report whether it’s good or not
 Check for palmer paler
 Instruct the patient to make a fist and release and still observe
for the palmer paler
 Press the nails of the toes and observe for capillary refill
 Still check for planter paler
 In ladies examine the vulva and whether it’s pink or not
 Lastly give feed back to the patient and advise accordingly
 EXAMINATION APATIENT FOR OEDIMA

Sites to examine are

 General outlook of the face

 Orbital region
 Fingers
 Abdomen(use fetal scope)
 Tibia
 Ankles
 Sacrum

The above mentioned are the sites where fluids always collects

Note, when examining for oedima use the thumb

Procedure

 Refer to the general rules

 Observe the general outlook of the face and the normal one
should not be puffy
 Press the orbital regions and in normal circumstances they
should not be swollen
 Press the fingers to find out whether they are swollen or not
 Ask the mother whether her wedding ring fits. If it does not fit
it means that she has oedema of the fingers
 Instruct the mother to make a fist and ask her whether she
feels difficult on making the fist
 Put the mother in sitting up position and use a fetal scope to
examine for abdominal oedima
 Press the tibia, count up to 10 and note whether the skin
comes back slowly, very slowly or very first and report
 Cross your arms and examine for ankle oedima
 Press the toes to find whether they are swollen or not
 Put the mother in a prone position and examine the sacral
oedima
  Lastly give findings to the mother and advise her accordingly

EXAMINATION OF THE LOWER LIMBS

 When examining the lower limbs, look for the following

 Size
 Signs of Oedima
 Signs of infection
 Signs of anemia
 Varicose vein
 Pain
 DVT

Procedure

 Refer to the general rules

 Put the two lower limbs together and note whether they are
normal and equal in size
 Check for scars and deformities
 Examine for tibia oedema and ankle edema
 Examine for signs of anemia by pressing the nails of the toes,
and also checking for planter paler
 Look for signs of infection between the toes
 Feel for varicose vein by passing the palm from the knee joint
to the heel
 Palpate the cuff muscle as you look at the mother’s facial
expression for pain
 Carry out hormans test to rule out DVT
 Give the findings to the mother and advise accordingly

IDENTIFYING THE LAND MARKS OF THE FETAL SKULL

When identifying the land marks of the fetal skull, talk about

 The bones that make up the vault of the fetal skull

 Sutures
  Fontanels
 Diameters

Procedure

 Hold the skull in anatomical position

 Start with the bone i.e. two parietal bones, two temporal
bones, one occipital bone and frontal bones

Talk about the sutures

 Saggital suture, separate the two parietal bones

 Lumbdoidol suture, separate the occipital from the two
parietal
 Coronal suture, separate the frontal bones from the two
parietal
 Squamous suture, separate parietal from the temporal bone

Fontanels

 Anterior fontanel, this is kite or diamond shaped and lies at

the junction of saggital, coronal and frontal suture
 Posterior fontanel, this one is triangular in shape and it lies at
the junction of saggital and lumbdoidal sutures

Diameters

There two transverse and six longitudinal diameters

Transverse diameters

 Bi-parietal diameter, this lies between the two parietal

eminences and it measures 9.5cm
 Bi-temporal diameter, this lies between the two furthest
points of the coronal suture

Longitudinal diameters

Three originate from behind and they are

  Sub occipital bregmatic diameter, it originate from below the
occipital protuberance to the center of anterior fontanel and
measures 9.5cm
 Sub occipital frontal, it also originate from below the occipital
protuberance to the center of the frontal suture and measures
10cm
 Occipital frontal diameter, this originate from occipital
protuberance to the glabella and measures 11.5cm

Also three originate from in front

 Sub mental bregmatic, originate from the point where the chin
meets the neck to the anterior fontanel and it measures 9.5cm
 Sub mental vertical diameter, it also originate from the point
where the chin meets the neck to the vertex and measures
11.5cm
 Mental vertical diameter, originate from the chin to the highest
point of the vertex slightly near the posterior fontanel

EXAMINATION OF THE PLACENTA

Aims

 To rule out abnormalities

 To rule out extra l lobes
 To rule out infections

Requirements

 Flat surface
 Measuring jar
 Tape measure
 Running water
 Protective gears
 Gloves
 Placenta in a receiver
  Bucket with disinfectant

Procedure

When examining the placenta look for the following

 Put on protective gears

 Length of the cord (use tape measure)
 Blood vessels
 Insertion of the cord
 True knot and false knot
 Maternal and fetal surface
 Cotyledon
 Infarcts

Carry out the procedure as follows

 Wear protective gears

 Remove clots and put in a measuring jar
 Wash the placenta under running water
 Hold the placenta by cord to check the hole through which the
baby passed
 Put the placenta down on a flat surface
 Examine the cord to confirm the presence of three blood
vessels i.e. two arteries and one vein
 Look for true and false knots
 Take the length of the cord
 Examine the fetal surface and it’s normal colour is bright
bluish
 Note the insertion of the cord and the normal insertion is at
the center
 Turn the placenta at the maternal surface and the colour
which is dark red in colour
 Examine the membranes which must be two in normal
circumstances i.e. amnion and chorion
  Report on their completeness
 Count the number of cotyledon which must be 16-20
 Note the signs of infections like dead tissues
 Lastly weigh the placenta and discard

COMPLETING 3rd STAGE OF LABOUR

 Follow general rules

 Put on protective gears
 Palpate the abdomen to rule out undiagnosed twins
 After ruling out for undiagnosed twins then give pitocin
 Observe for signs of placenta separation
 Extend the cord slightly to the vulva give good hold
 Support the fundus using the left hand
 With the first contraction, turn the palm of the left hand
facing the fundus applying counter traction above pubic bone
 The right hand grasps the clump and then deliver the placenta
in down ward and out ward direction until the placenta is seen
at the vulva
 Apply upward traction and then receive the placenta with your
both cupped hands
 Roll the membranes to prevent them from breaking
 Deliver the placenta in down ward and upward movement
 Rub the fundus to promote contraction of the uterus
 Carry out quick examination of the placenta to confirm it’s
completeness and put in a receiver
 Remove the blood clot and retained product
 Examine the vulva, vagina and cervix for lacerations
 Clean the vulva and pad the mother
 Note the blood loss
 Weigh the placenta and discard

CORD CARE

Requirements
  Galipot with six swabs
 Receiver for used swabs
 Sterile gloves
 Normal saline
 Cord scissors
 Cord ligatures
 Small towel and mackintosh

Procedure

 Follow the general rules

 Inspect the cord for signs of infections e. g discharge, foul
smell , and reddening
 Hold the cord with dry swab using your left hand
 Clean the base of the cord in circular manner
 Use 4 swabs to clean the cord all around from the base to the
stump once and discard
 Get six swab to clean the stump once and discard
 Leave it to dry by air
 Advise the mother to continue cleaning the cord at home
 The mother should measure one liter of boiled cooled water
and put in salt which taste like her tears and be using it to
clean the cord
 Leave the mother comfortable
 Clear away and document

VULVA SWABING

Requirements

 Prepared trolley for vaginal examination

 Prepare six swabs in a galipot

Procedure

 Follow the general rules

  Put on protective gears
 Position the mother in a dorsal position
 Put a small mackintosh and a towel to protect the bed
 Inspect the vulva for cleanliness
 Soak five swabs in a galipot with normal saline one by one as
you put in your left hand side
 Transfer the swabs in your right hand
 It is the left hand to swab
 Carry out the swabbing as follow
 Swab the left majora top to bottom once and discard
 Swab the right majora top to bottom once and discard
 Swab the left minora top to bottom once and discard
 Swab the right minora top to bottom once and discard
 Swab the vestibule top to bottom and discard
 After the procedure for vaginal examination, use the 6thdry
swab to swab the vestibules
 Pad the mother
 Clear away and document

VAGINAL EXAMINATION

Requirements

 Prepared trolley for vaginal examination

Procedure

 Put on protective gears

 Position the mother in dorsal position
 Protect the bed with small mackintosh and a towel
 Inspect the vulva for cleanliness
 Swab the vulva with clean swabs wetted with normal saline
 Put the drape to provide a sterile field
 Lubricate your two fingers of the right hand
  Insert them into the vagina and note the state of the vagina
and the normal one should be warm and moist
 Feel for the state of the cervix which should either be thin and
soft or thick and soft
 Note the OS and should range from 0-10cm. This is
determined by how many fingers are fitting in the cervical OS
and each finger accommodates two 2cm
 Feel for the state of the membranes whether they are intact or
ruptured
 Note the presentation and the normal presentation is cephalic
 Note also the presenting part and should either be in upper
cavity, mid cavity and lower cavity
 Clean and pad the mother
 Clear away and document

INTERNAL PELVIC ASSESSMENT

This is also a sterile procedure

When assessing the pelvis internally, check for the following

 Sacral promontory
 Sacral hole
 Greater sciatic notches
 Ischial spines
 Sub pubic arch
 Intertuberous diameter

Procedure

 Follow the general rules

 Put on protective gears
 Position the mother in dorsal position
 Protect the bed with a small mackintosh and a towel
 Inspect the vulva for cleanliness
 Swab the vulva until it gets clean
  Put drape to provide a sterile field
 Lubricate your fingers and enter the vagina
 Feel for the sacral promontory whether it is tipped or not and
the normal one should not be tipped
 Feel for the sacral hole and the normal one should be smooth
and well curved
 Feel for the greater sciatic and should be wide enough
 Feel for the ischial spine and they should not be prominent
 Feel for the sub pubic arch as you move out of the pelvis and
should accommodate 2-3 fingers and average 21/2
 Remove the fingers as you make a fist to fit between the
intertuberous diameter and it should accommodate 4 nackles
 Clean the vulva
 Leave the mother comfortable
 Clear away and document

EXTERNAL PELVIC ASSESSMENT

This is a clean procedure

Procedure

 Follow the general rules

 Ask about three histories
 Medical history, ask whether she had ever suffered from any
medical disease like diabetes mellitus, T.B, poliomyelitis etc
 Surgical history, ask whether she had ever got involved in any
accident which involve the bones of the lower limbs, spine and
pelvis
 Obstetric history, ask whether she has ever delivered if yes
ask about the weight of the previous baby and mode of
delivery
 Check the mother’s palm and they should be big enough
 Check the shoe size and the normal range is 5-8
  Take mother’s height and the normal one is between 150-
172cm
 Ask about the age of the mother
 Ask the mother to move around and note the gait
 Give the findings to the mother
 Clear away and document

ABDOMINAL EXAMINATION

Procedure

 Follow the general rules

 Ask the mother to empty her bladder
 Put the mother in a recumbent position
 Expose the three land marks of the abdomen i.e. symphysis
pubis , umbilicus and xiphysternum
 Inspection
 Far inspection , stand at the foot of the bed and note the size
and shape of the abdomen and the normal one should be
enlarged and ovoid or pendulous in shape
 Nearby inspection, move nearer the abdomen and observe
signs of pregnancy like linear nigra, strae graviderium and
fetal movement. Still report on scars and birth mark.
 Palpation(warm your palms)
 Superficial palpation, carry out superficial palpation as you
look at the mother’s facial expression to rule out tenderness
and pain and ask whether she feels pain on the abdomen
 Left hypochondriac palpation, palpate the left
hypochondriac region to exclude enlargement of the spleen
 Right hypochondriac palpation, also palpate the right
hypochondriac region to exclude enlargement of the liver
 Fundal estimation
  Place the fingers of the left hand flat at the level of the
sternum and estimate the height of fundus( each finger
represent 2 weeks)
 Deep pelvic palpation, turn and face the foot of the mother
and slide your hands to words the lower pole of the uterus
 Palpate the lower pole to determine what’s presenting in the
pelvis and take note of bal table or hard round mass
 And the normal presentation should be cephalic
 Fundal palpation, turn and face the mother’s face and slide
both hands to words the upper pole and feel what’s in the
fundal region
 Take note of the soft mass to determine the lie and the normal
lie is longitudinal
 Right lateral palpation, press the opposite side and palpate
from the lower pole to words the midline 3times to feel for the
curved mass or irregular nodules
 Left lateral palpation, still press the opposite side and
palpate from the lower pole to the upper pole 3times still to
feel for irregular nodules or curved mass
 Where you detect the curve it’s where the position is which
may either be ROA or LOA
 Auscultation , auscultate to listen to the fetal heart and place
the fetal scope on the side of the back
 Give the findings to the mother

BREAST EXAMINATION

Requirements

 A tray with
 Two towels , one to cover the back and the next to cover the
breast
 Galipot with swabs
 Receiver for used swabs
 Disposable gloves
Procedure

 Follow the general rules

 Put the mother in sitting up position
 Position the arms of the mother over the head or around the
waist
 Inspect the axilla for cleanliness and dry
 Cover the back
 Stand at the foot of the bed and inspect the breasts for size
and shape
 Note that the two breasts are not always equal in size and they
are pawpaw shaped
 Carry out nearby inspection for signs of pregnancy like
 Darkening of primary aleora, dilatation of blood vessels,
prominence of the nipple
 Note the cleanliness of the sub-mammary areas
 Cover the right breast
 Support the left breast with your left hand and palpate the
axilla starting from the tail of space downwards to rule out
enlargement of axillary gland and axillary tail
 Continue to palpate the breast in circular motion in clockwise
direction to rule out breast lumps
 Use your left hand to support the back and compress the
breast to feel for deep masses
 Pull the nipple to protract and observe for nipple discharges
 The same steps should be followed for the opposite breast
 Leave the mother comfortable
 Clear away and document

TAKING ANTENATAL HISTORY

 Refer to the general rules

 Personal history, ask the mother her name, age, address,
occupation, religion, tribe, marital status, next of kin,
 relationship with next of kin, occupation of next of kin,
address of next of kin.
 social history, ask whether she takes alcohol ,smoking habit,
source of income, source of water, housing and whether
adequate for the family etc
 family history, ask whether both parents are a live , family
diseases i. e essential hypertension, asthma, sickle cell,
epilepsy mental illness, diabetes and twin delivery
 medical history, diseases ever suffered e.g. T.B, diabetes,
asthma, sickle cell, hypertension, child hood illness like
poliomyelitis etc
 surgical history, operation of pelvic floor muscles, accidents
involved bones of the lower limbs, spine and pelvis, blood
transfusion, RVF and VVF etc
 Gynecological history, dilatation and curettage, vaginal
rectal fistula, vaginal vesicle fistula and myoctomy.
 Obstetric history, operations e.g. caesarean section, number
of previous pregnancies and deliveries, vacuum extraction,
forceps delivery, PPH. ETC
 Menstrual history, inquire the length of the menstrual cycle,
number of days she menstruate, amount of blood and
regularity of menstrual cycle.
 Contraceptives history, find out the family planning methods
used plus and when it was discontinued.
 Present health, ask about appetite, sleep pattern, bowel and
maturation
 Present obstetric history, ask about the last normal
menstruation period, expected date of delivery and calculate
the amenorrhea, complaints during pregnancy
 Clinical examination and investigations, take vital
observations e.g. temperature, respiration pulse and blood
pressure, then weight and height. Do routine laboratory
 investigations like Hb grouping and cross matching, VDRL,
HIV and mps.

MANAGEMENT OF SECOND STAGE OF LABOUR

Requirements
Top shelf
 Galipot for antiseptic
 Galipot for lubricant
 Sterile hand towels
 Sponge holding forceps
 Drape or four sterile towels
 Towel clips
 Two receiver, one for the placenta
 Bulb syringes
 Cord ligature
 Cord scissors
 Cord ligatures

Bottom shelf

 Oxycitocin/ ergometrine
 Sterile gloves
 Antiseptic container
 Syringes and needles
 Clean pads
 Episiotomy pack
 Clean linen
 At the bed side, resuscitation equipment, bucket with
disinfectants, drip stand

Procedure

 Follow the general rules

 Ensure an empty bladder
 Bring the trolley to the right side of the bed
  Position the mother in dorsal position
 Confirm second stage of labour by carrying out vaginal
examination
 Put on protective gears and scrub your hands thoroughly
 Put on sterile gloves
 Swab the vulva
 Drape the mother
 Place a sterile vulva swab over the anus
 Encourage the mother to push with each contraction
 Maintain flexion of the head
 At crowning perform episiotomy if indicated
 Deliver the head by aiding extension
 Clear the airway by sucking mucous from the mouth and nose
using bulb syringe
 Feel for the cord around the neck, if loose slip it over the head
and if tight clump and cut
 Deliver the anterior shoulder by down word traction until the
axilla is seen
 Deliver the posterior shoulder by up word traction .
 Deliver the body by lateral traction towards the mother’s
abdomen
 Note the time o delivery
 Score the baby and congratulate the mother
 Clump and cut the cord
 Show the baby’s face and sex to the mother
 Wrap the baby in a sterile towel and put the baby on mother’s
breast to breast feed
 Put an identification band on the baby’s hand
 Put the end of the cord in a receiver in between the mother’s
legs
 Provide warmth to the mother and thank her for cooperation

EXAMINATION OF A NEW BORN

Aims

 To determine the maturity of the baby

 To exclude congenital abnormality
 To exclude birth injuries
 To assess baby’s conditions

Requirements

 Galipot with cotton swabs

 Receiver for used swabs
 A bottle of normal saline
 Tape measure
 Rectal thermometer
 Gloves stethoscope
 Cord ligature
 Cod scissor
 Baby’s chart
 Weighing scale
 Baby’s linen
 Adequate light

Procedure

 Put the baby on a flat surface

 Expose the part to be examined
 Check the general condition of the baby

HEAD

 Examine the head for size and shape

 Palpate the fontanel’s to see whether they are sunken or not
 Note the sutures
 Take the head circumference
FACE

 Note the appearance of the face whether both sides are equal
in size
 Examine the eyes whether they are asymmetrical, note the
discharges, colour and openings
 Examine the nose for the patency of the nares , and any
congenital abnormality
 Examine the mouth for colour, presence of thrush, palpate the
hard and soft palate to rule out swellings, exclude false teeth
 Examine the tongue for size and congenital abnormality

EARS

 Assess for firmness, presence of cartilage, placement and

hearing

NECK

 Turn the neck gently and palpate it for masses

 Palpate the clavicles for enlargement

HANDS

 Note the size and length of the hands

 Examine the axilla, elbows and note the flexion and rotation of
the wrist and elbow joints
 Count the fingers and note extra digits
 Examine for palmer creases
 Take the MUAC

CHEST

 Note size and location of the nipples, extra nipple and

discharge
 Note the apex beat and regularity. Normal ranges 120-160
 Count the respirations
  Take the chest circumference. Normal range 30-33

ABDOMEN

 Inspect the abdomen, note the abdominal muscles and they

should be firm and intact
 Auscultate for bowel sounds
 Palpate the liver and the spleen for enlargement
 Examine the cord for colour, bleeding or any other infection

GENITALIA

 Determine the sex of the baby and note any abnormality like
hypospadias for a male baby, imperforated hymen for female
baby

LOWER LIMBS

 Note whether they are normal and equal in size

 Note any fractures, paralysis
 Flex the thighs and abduct them to exclude congenital
dislocation( balow/ ortlons test)
 Note the size, length and exclude talipes

BACK

 Turn the baby lie on the abdomen and pass a finger through
the vertebral column to exclude any congenital abnormality
like spine befuda and meningocele

ANUS

 Pass a rectal thermometer into the rectum to exclude

imperforated anus
 Note if baby has passed stool

Test for the following reflexes

Rooting
  Touch the baby’s mouth and the response of the baby

Sucking reflex

 Put a finger in the mouth of the baby, the respond by sucking

vigorously

Moro reflex

 Hold the baby in supine position and then displace the baby
down wards. The baby responds by extending and abducting
the extremities

Grasp reflex

 Put a finger in the baby’s palm, the baby responds by grasping

it firmly

Step reflex

 Hold the baby upright with feet touching flat surface, the
baby makes stepping motions

Babinski sign

 Stroke the baby’s foot outside edge, the baby responds by

fanning the toes up ward and in outward direction
 Lastly measure the length and take his or her weight

Points to remember when examining the baby

 Adequate light
 Warm room at temperature not less than 210c
 Flat surface best for examination
 Only part to be examined is exposed
 Examination is done from head to toes

TAKING THE ARTHROPOMETRIC MEASUREMENTS

Head circumference
  Measure the head of the baby in a circular way starting from
the fore head back to the fore head and the normal one at
birth is 34cm

Mid- upper arm circumference

 Measure from the shoulder to the elbow joint and note mid-
point of the length
 Turn the tape measure at the mid- point of the upper arm and
measure the circumference
 The normal circumference at birth is 10cm

Chest circumference

 Measure from the sternum passing around back to the

sternum
 The normal chest circumference is 30-33cm

Height

 Put the baby on a height meter board lying on supine position

and the his or her height and it’s 50cm at birth

Weight

 Take the baby’s weight and it’s 2.5-3.5 at birth

TAKING THE BABY’S WEIGHT

 Explain the procedure to the mother or care taker

 Reduce the baby’s clothing’s by leaving the baby in a pant
 Put the baby in a weighing pant
 Weigh the baby
 Give findings to the mother
 Clear away
 Document

IMMUNIZATION OF THE BABY

  Explain the procedure to the mother
 Break to open the top of the ampoule or remove the top of the
rubber cap
 Reconstitute the powdered vaccines according to the
instructions on the bottle
 Undress the baby and expose the site for immunization
 Position the baby
 Clean the injection site with cotton swab and clean water
 Immunize the baby
 Teach the mother about the side effect of the vaccine and what
to do when they occur
 Clean the surrounding site
 Record the dose given and give the return date
 Thank the mother

RESUSCITATION OF ASPHYXIATED BABY

Requirements

 Stethoscope
 Bulb syringe
 Ambubag
 Small towel
 Sterile gloves
 Warm bed sheets
 Galipot with gauze swabs
 Receiver for used swabs
 Flat surface
 Adrenaline
 Dextrose 20%
 Penguin sucker

Procedure

When resuscitating a baby, follow A, B, C, D

A-airway

B-breathing

C-circulation

D- drugs

Dry the baby and wrap in a warm sheet

Airway

 Explains the procedure to the mother

 Washes hands and puts on surgical gloves
 Puts the baby on a flat surface in supine position with the
head tilted back ward to open the airway
 Support the shoulders with a small towel
 Remove the secretions from the mouth and nostrils

Breathing

 Apply the ambubag making sure the mask seals the mouth
and nose
 Squeeze the bag for about 30 to 40 times per minute
 Assistant checks the airway entry to the lungs using
stethoscope and counts the heart rate

Circulation

 Use a stethoscope to listen to the heart beats, if it’s less than

80 beats per minute, continue with ventilation
 If no heart beat after one minute, carry out chest
compression 90 to 100 times per minute
 Then four cardiac compression every after one ventilation until
the heart rate reaches 100
 If after 20 minutes breathing is not established, consider
intubation

Drugs
  Inject 0.5mls 1:10000 adrenaline solutions intravenously or
through the umbilical cord
 Give 2mls per kilogram body weight of 20% dextrose
 Transfer the baby to a special unit and administer oxygen.
 Keep baby warm

Keep re-assuring the mother

Document whatever has been done

SCORING THE BABY USING APGAR SCORE

This the quickly assessment of the presence or absence anoxia in a

new born

The assessment is based on five elements

 Skin colour
 Heart rate
 Respiratory effort
 Muscle tone
 Response to external stimuli

Score 0 1 2
Skin colour Blue, pale or Body pink and Body
white limbs blue completely
pink
Heart rate Absent Less than Above 100b/m
100b/m
Respiratory Absent Gasping or Strong cry
effort weak cry
Muscle tone Limp Some flexion Active
movement
Response to Absent Facial grimace Cry
external
stimuli

PACKING A VACCINE CARRIER

 Place four conditioned ice packs a round the inside of a

vaccine carrier
 Pack polio vaccine in a polythene bag as check expiry date and
place at the bottom of the vaccine carrier
 Next pack rota , BCG and measles vaccines in their polythene
bags well labeled and place in a pre-cooled condition on top of
the polio vaccine
 Place DPT- hep B vaccine, TT and PCV vaccine well packed
and labeled on top of rota, BCG and measles vaccines
 Put the thermometer and place a sponge on top of the vaccine
carrier
 Close the head of the vaccine carrier

ASSESSING THE CHILD FOR DEHYDRATION

 Follow the general rules

 Look and feel for the general condition of the baby
 See if the eyes are sunken
 Check for sunken fontanelles
 Offer a drink to assess thirsity
 Pinch the skin to check for it’s elasticity
 Classify the degree of dehydration
 Explain the findings to the mother
 Thank the mother

ASSESSING THE CHILD FOR GENERAL DANGER SIGNS

  Follow the general rules
 Ask the mother if the child does not drink of breast feed
 Ask if the child vomit’s every thing
 Ask if the child has had convulsions
 Check to see if the child is lethargic or unconscious
 Explain the finding to the mother
 Refer the mother
 Thank for cooperation

STERILE TROLLEYS

General requirements for all sterile trolleys

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Small towel and small mackintosh
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove
 Plastic apron
TROLLE FOR CATHETERIZATION

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Galipot for lubricant
 Receiver to receive urine
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Small towel and small mackintosh
 Specimen bottle
 Pair of bed sheets
 Laboratory request form
 Sterile gloves
 Lubricant
 Folley’s catheter
 Urine bag
 10ml syringe
 Water for injection
 Strapping
 Measuring jar
 Plastic apron
 Fluid balanced chart
At the bed side

 Hand washing equipment

TROLLEY FOR VAGINAL EXAMINATION

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Galipot for lubricant
 Receiver with vaginal speculum
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Small towel and small mackintosh
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove
 Lubricant
 Clean pads

At the bed side

 Bed pan
 Screen
 Hand washing equipment
EPISIOTOMY TROLLEY

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels
 Needle holder
 Episiotomy scissors
 Artery forceps
 Toothed dissecting forceps
 Blade holder

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Small towel and small mackintosh
 Suturing materials
 Lignocaine
 10ml syling
 Water for injection
 Pair of bed sheet
 Sterile glove

TROLLEY FOR SECOND STAGE OF LALOUR

Top shelf

 Galipot with cotton swabs

  Galipot with gauze swabs
 Galipot for antiseptic solution
 Receiver for the placenta
 Galipot for lubricant
 Vulva swabs
 Two cord clumps
 Episiotomy scissors
 Bulb syringe
 Cord ligatures
 Cord scissors
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Small towel and small mackintosh
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove
 Ergometrine or oxytocin
 Syringes
 Clean pads
 Episiotomy pack

At the bed side

 Resuscitation equipment
  Bucket with disinfectants
 Drip stand

TROLLEY FOR TRACHEOSTOMY

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Bowel for normal saline
 Receiver with needle holder, toothed and non toothed
dissecting forceps, blade handle, tracheal dilator , scissors
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Bottle of normal saline
 Lignocaine
 10ml syringe
 Water for injection
 Suction catheter
 Suction tube
 Tracheotomy tube
 Strapping
 Dressing pack
 Small towel and small mackintosh
 Specimen bottle
  Laboratory request form
 Pair of bed sheet
 Sterile glove

At the bed side

 Suction machine
 Mouth care tray
 Bell
 Pen and a paper
 Oxygen cylinder
 Hand washing equipment
 Protective gears
 screen

TROLLEY FOR LUMBER PUNCTURE

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Spinal needle
 Greenfield manometer
 Lignocaine
  10ml syringe
 Water for injection
 Strapping
 Small towel and small mackintosh
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove
 Tray for emergency drugs

At the bed side

 Hand washing equipment

 Protective gears
 screen

TROLLEY FOR UNDER WATER SEAL DRAINAGE

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Receiver with needle holder, toothed dissecting forceps, blade
handle, artery forceps , scissors
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
  Lignocaine
 10ml syringe
 Water for injection
 Suction catheter
 Suction tube
 Strapping
 Dressing pack
 Small towel and small mackintosh
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove

At the bed side

 Suction machine
 Hand washing equipment
 Protective gears
 Screen

TROLLEY FOR INTRAVENOUS INFUSION

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Receiver with dissecting forceps, artery forceps
 Sponge holding forceps
 Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

  Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Bottle of iv fluids
 cannula
 10ml syringe
 Water for injection
 Strapping
 Tourniquet or sphygmomanometer
 Small towel and small mackintosh
 Specimen bottle
 IV giving set
 Padded splints
 Bottle holder
 Laboratory request form
 Pair of bed sheet
 Sterile glove

At the bed side

 Drip stand
 Hand washing equipment
 Protective gears
 Extra pillow
 screen

TROLLEY FOR BLOOD TRANSFUSION

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Receiver with dissecting forceps, artery forceps
 Sponge holding forceps
  Towel clips
 Drape
 Hand washing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Unit of blood
 Observation chart
 Fluid balanced chart
 Normal saline
 Patient’s chart with details of transfusion
 Blood giving set
 Drugs like flusemide
 cannula
 10ml syringe
 Water for injection
 Strapping
 Tourniquet or sphygmomanometer
 Small towel and small mackintosh
 Specimen bottle
 Padded splints
 Bottle holder
 Laboratory request form
 Pair of bed sheet
 Sterile glove

At the bed side

 Drip stand
  Hand washing equipment
 Protective gears
 Extra pillow
 screen

TROLLEY FOR WOUND DRESSING

Top shelf

 Galipot with cotton swabs

 Galipot with gauze swabs
 Galipot for antiseptic solution
 Receiver with non toothed dissecting forceps, stitch scissors,
dressing forceps
 Sponge holding forceps
 Towel clips
 Drape
 Dressing towels

Bottom shelf

 Chital forceps container

 Antiseptic container
 Receiver for used swabs
 Receiver for used instruments
 Normal saline
 Strapping or bandage
 Small towel and small mackintosh
 Specimen bottle
 Padded splints
 Bottle holder
 Specimen bottle
 Laboratory request form
 Pair of bed sheet
 Sterile glove
At the bed side

 Hand washing equipment

 Screen

Organised GESSA KENNETH KIU-WC