Confidentiality and privacy.pptx

nursing ethics

1. Mohammed a( rn,bsc n ) Confidentiality and privacy

2. Cont.… The terms ' privacy ' and ' confidentiality ' are commonly used interchangeably. Privacy may also relate to information about oneself, and information privacy laws regulate the handling of personal information through enforceable privacy principles . Confidentiality relates to information only.

3. Confidentiality Confidentiality ;- is the protection of personal information. Confidentiality means keeping a client’s information between you and the client, and not telling others including co-workers, friends, family, etc. Confidentiality is a critical aspect of your duty of care.

4. Examples of maintaining confidentiality include : individual files are locked and secured support workers do not tell other people what is in a client’s file unless they have permission from the client information about clients is not told to people who do not need to know clients’ medical details are not discussed without their consent adult clients have the right to keep any information about themselves confidential, which includes that information being kept from family and friends.

5. The types of information that is considered confidential can include: name, date of birth, age, sex and address current contact details of family, guardian etc. medical history or records personal care issues file progress notes individual personal plans assessments or reports income or outgoing personal correspondence.

6. Other information relating to ethic or racial origin , political opinions , religious or philosophical beliefs , health or sexual lifestyle should also be considered confidential.

7. There are several instances where total confidentiality is either impossible, undesirable or illegal. These include: if the health and/or welfare of a child or young person is at risk. You are required to contact Department of Community Services and notify them of your concerns. if your client tells you he/she has committed a serious crime. You are required to notify your supervisor or the police directly.

8. if a worker is subpoenaed to present information in a court of law when the client needs to be protected from harming themselves (eg if suicidal) where others may need to be protected (if the client has threatened to harm others or will do so inadvertently). when working in conjunction with other professionals in caring for a client the requirements of professional supervision, training, workshops or seminars

9. When we tell the information of patient If welfare of pt. at risk. committed a serious crime . information in a court of law protected from harming themselves (eg if suicidal ) if the client has threatened to harm others conjunction with other professionals in caring for a client

10. Importance of confidentiality Confidentiality is important for several reasons. One of the most important elements of confidentiality is that it helps to build and develop trust . It potentially allows for the free flow of information between the client and worker and acknowledges that a client’s personal life and all the issues and problems that they have belong to them. One of the major purposes for obtaining a client’s consent before speaking to a third party (such as another agency or a family member/carer) is to protect the confidentiality and privacy of the client.

11. Cont.… Informed consent (obtaining personal information with the formal permission of the client or a person who has the legal authority to provide permission on behalf of the client) is considered essential in maintaining the privacy of the client.

12. privacy Privacy;- the right of individuals to be left alone and to be protected against physical or psychological invasion or the misuse of their property. What does privacy mean in care ? Medical privacy or health privacy is the practice of maintaining the security and confidentiality of patient records . The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility.

13. Cont.… The word privacy has four major usages , corresponding to four distinct forms, dimensions, or conceptions of privacy: physical privacy, Informational privacy, proprietary privacy, and decisional privacy.

14. Cont.… Physical privacy is a restriction on the ability of others to experience a person through one or more of the five senses; Informational privacy is a restriction on facts about the person that are unknown or unknowable; Decisional privacy is the exclusion of others from decisions, such as health care decisions proprietary privacy ;- confidentiality of works to protect patient proprieties.

15. The principle of confidentiality and privacy You must respect and protect patient information Patients must consent before you share any information about them. When asking for consent you should tell the patient : what information you want to share who you want to share it with, and how the information will be use Anyone you employ must also protect patient information .

16. Cont.… If an adult patient with capacity tells you not to share information with other people, you should firstly discuss this with them, and explain why you need to share the information . If they still refuse, you should not share their information, even if failure to share would leave the patient (but no one else) at risk of serious harm or death .

17. If you believe that the patient’s decision to refuse a service puts them at risk of serious harm, you must discuss this issue with appropriate colleagues, whilst respecting the patient’s confidence. You can share patient identifiable information if you are required to do so by law, or disclosure is justified in the public interest

18. Cont.… There are exceptions to the rule of protecting patients’ confidentiality which are : you may be required to provide information by law, for example if ordered by a court, or  you may need to disclose information if it is in the public interest, for example where failing to disclose information would expose other members of the public to risk of death or serious harm . You may disclose information without patient consent if you have reason to believe that asking for consent would put you or other people at risk of serious harm

19. Privacy and confidentiality are also supported by two principles of the Belmont Report : Respect for persons – Individuals should be treated as autonomous agents able to exercise their autonomy to the fullest extent possible, including the right to privacy and the right to have private information remain confidential. Beneficence – Maintaining privacy and confidentiality helps to protect participants from potential harms including psychological harm such as embarrassment or distress; social harms such as loss of employment or damage to one‘s financial standing; and criminal or civil liability

20. Cont…

21. Class work Define Confidentiality List types of information that is considered confidential. What does decisional privacy mean? When we tell the information of patient to the other person What does physical privacy mean?

22. Transport client Definition : Transfer is defined as preparing patient, completing necessary records and shifting patient to another department within the hospital or to another hospital/home. Transfer/referral is the preparation of a patient and the referral records to the shift the patient to another department within the hospital or to another hospital

23. Purpose  To obtain necessary diagnostic tests and procedure  To provide treatment and Nursing care  To provide specialized care  To place most appropriate utilization or available personnel and services  To match intensity( quality) of Nursing care, based on patients level of needs and problems

24. Types of transfer of the patient Internal transfer : to transfer the patient in a unit that provide special care or care suited to his need, e.g. from general ward to ICU 2 . External transfer : to transfer the patient from one hospital to another hospital for the purpose of special care, e.g. from general hospital to specialized hospital- cancer center

25. Preliminary( preceding) assessment A. Assess the method for transport, inform receiving nurse B. Maintain patient‘s physical wellbeing during transport to new Nursing unit C. Provide verbal report about patient‘ s condition to the receiving unit nurse D. Be sure all documentation including care plan is completed

26. E. Assist‘s patients arrival to the new unit F. Announce patients arrival to the new unit G. Transport patient to the new room and assist in transfer to bed H. Hand over( pass responsibility to someone else) to receiving nurse

27. Equipment 1. Wheelchair/ stretcher 2. Identification labels 3. Patients belongings 4 . X-rays 5 . Investigation reports 6. Patient records and file

28. Procedure 1.Check the doctor‘s orders for transfer of patient 2. Inform the patient and relatives 3. Inform to the ward nurse where the patient needs to be transferred

29. 4. Check the chart for complete recording of vital signs, Nursing care and treatment given 5. Collect patient x-ray, medicine and other belongings 6. Cancel the hospital diet or transfer

30. Cont.… 7. Assist the relative to collect other belongings 8. Make arrangement to settle the due bills if patient is goining to be transferred another hospital 9. Record time, mode of transfer and general condition of the patient

31. 10. Assist transferring sink patient to wheel chair/stretcher and accompany patient to new area 11. Handover patient documents , belonging and report verbally to the in charge nurse

32. Cont.… 12 . Collect the ward articles 13. Inform to the concern person / department regarding transfer of the patient 14. Clean unit thoroughly and keep ready for next patient

33. Caring for a patient on discharge Definition: Patient discharge is sending the hospitalized patient to home or to referral after successful discharge planning process. Patient discharge planning is systematic process for preparing the patient to leave the hospital & for continuity of care at home.

34. Purpose  To continue self care at home  To adjust the patients setting out of the hospital  To ensure adequate home health care support  To minimize the patient‘s anxiety at discharge

35. Indications for discharge  Progress in the patient's condition (cured)  No change in the patient's condition (Referral)  Against medical advice  Death

36. Procedure 1.Check for the doctor‘s written order that pt. to be discharged. 2. Inform patient and relative about discharge 3. Document relevant dis charge information

37. 4. Make sure all the fees( a payment made to a professional person) are included 5. Send admission card to registration office

38. Cont.… 6. Plan for continuing care of the patient  Give information for a person involved in the patient care.  Contact family or significant others, if needed.  Facilitate transportation with responsible unit 7. Assist patient to dress up

39. Cont.… 8 . Teaching the patient about ;  What to expect about disease outcome  Medications (Treatments)  Activity  Diet  Need for Follow up and others as needed 9 . Do final assessment of physical and emotional status of the patient and the ability to continue own care.

40. Cont.… 10 . Check and return all patients‘ personal property (bath items in patient unit and those kept in safe area ). 11 . Help the patient or family to deal with business office for customary financial matters and in obtaining supplies . 12 . Accompany( occur at the same time as) patient to the gate, if possible

41. Cont.… 13 . Write Discharge summaries note which usually include:  Time and date of discharge  Description of client‘s condition at discharge  Treatment (e.g. Wound care, Current medication)  Diet  Activity level  Restrictions N.B: If a patient insists upon going home against medical advice he should be requested to sign a statement indicating that he is responsible for his action.

42. Discharging a patient against medical advice (AMA) 1. When the patient want to leave an agency without the permission of the physician – unauthorized discharge the following activities are indicated: 2. Ascertain why the person wants to leave the agency 3. Notify the physician of the client‘s decision

43. 4. Offer the patient the appropriate form to complete 5. If the client refuses to sign the form, document the fact on the form and have another health professional witness this

44. Cont.… 6 . Provide the patient with the original of the signed form and place a copy in the record 7. When the patient leaves the agency, notify the physician, nurse in charge, and agency administration as appropriate

45. 8. Assist the patient to leave as if this were a usual discharge from the agency (the agency is still responsible while the patient is on premises)

46. Lifting the patient Dangling ; is sitting on the side of the bed with the feet hanging down . Purpose ; To prepare patient before walking ,moving to chair or wheelchair or performing others To relive pressure in case of pulmonary edema ( fluid accumulation in the tissue and air spaces of the lungs. It leads to impaired gas exchange and may cause respiratory failure ) Indication Moving patient out of bed

47. Cont.… Contraindication ;- Unconscious patient Spinal injury Precaution Do not leave the patient alone when dangling. If the patient becomes dizzy lie him down. Have the patient cough, deep breathe, and exercise their leg muscles when dangling Check the person‘s pulse and respirations

48. Cont.… Equipment Turn sheet or draw sheet Screen Procedure 1 . Greet the patient and explain the procedure 2. Perform hand hygiene 3. Collect the necessary material 4. Provide privacy 5. Assess the patient condition

49. Cont.… 6 . Position yourself and client appropriately before performing the move a . Assist the client to a lateral position facing you b. Raise the head of the bed slowly to its highest position c. Position the clients feet and lower legs at the edge of the bed d. Stand beside the client‘s hips and face the far corner of the bottom of the bed

50. Cont.… 7 . Move client to sitting position a . Place one arm around the client shoulder and the other arm beneath both of the client thighs near the knee b. Tighten your gluteal , abdominal, leg and arm muscle c. Lift the client thighs slowly d. Private on your feet in the desired direction facing the foot of the bed while pulling the client feet and legs off the bed e. Keep supporting the client until client is well balanced and comforted f. Assess vital signs as indicated

51. 8 . Document all relevant information

52. Log rolling Definition: Logrolling is a technique used to turn a patient whose body must at all times be kept in a straight alignment. Purpose  To turn a patient to the side of bed Indication  Spinal injury

53. Cont.….

54. Cont.… Equipment 1. Hospital bed with side rails 2. Turn sheet or draw sheet 3. Pillows

55. Cont.… Procedure 1. Wash your hands 2. Greet and explain the procedure 3 . Provide privacy 4. Position the bed in the flat position at a comfortable working height 5. Lower the side rail on the side of the body at which you are working 6. Position yourself with your feet apart and your knees flexed close to the side of the bed

56. Cont.… 7. Fold the patient's arms across his chest 8. Place your arms or turn sheet under the patient so that a major portion of the patient's weight is centered between your arms. 9. The arm of the other nurse should support the patient's head and neck. 10 . On the count of three, move the patient to the side of the bed, rocking backward on your heels and keeping the patient's body in correct alignment.

57. Cont.… 11. Move to the other side of the bed. 12. Place a pillow under the patient's head and another between his legs. 13. Position the patient's near arm toward you. 14. Grasp the far side of the patient's body with your hands evenly distributed from the shoulder to the thigh. 15 . On the count of three, roll the patient to a lateral position, rocking backward onto your heels. 16 . Place pillows in front of and behind the patient's trunk to support his alignment in the lateral position. Provide for the patient's comfort and safety.

58. Cont.… 15. On the count of three, roll the patient to a lateral position, rocking backward onto your heels. 16. Place pillows in front of and behind the patient's trunk to support his alignment in the lateral position. Provide for the patient's comfort and safety. 17 . Report and record as appropriate

59. Moving patient up in bed with two nurses using draw sheet Definition ;- Moving patients up in bed refers to returning the patient to previous correct position in bed if he/she slides to the foot side of the bed. Purpose To make patients in comfortable position in bed To maintain good body alignment Indication Patient slides to the foot of the bed

60. Equipment Documentation format Draw sheet Pillow

61. Cont.… Procedure 1. Explain the procedure 2. Perform hand washing 3. Collect necessary equipment 4. Lower head of the bed to flat position and raise level of bed to comfortable height 5. Remove all pillows from under the client. Leave one at head of bed 6. One nurse stands on each side of the bed with leg positioned for wide base of support and one foot slightly in front of bed frame 7. Each nurse rolls up and grasps edges of turn sheet close to client‘s shoulder buttocks 8. Flex knees and hips tighten abdominal and gluteal muscle. 9. Raise the patient up in bed 10. Observe the condition of the patient 11. Record the procedure

62. Positioning the patient Definition ;-Positioning is turning or putting the patients in a proper body alignment for the purpose of preventive, promotive ,curative and rehabilitative aspects of health.

63. Purpose of positioning  To relief pressure on various parts or lessen possible stress on pressure points  To prevent formation of deformity  To Improve circulation  Preserve muscle function as different muscle group‘s contract and relax.  To provide comfort, support, and good body alignment  To make the patient ready for different procedures

64. Type of positioning Common positioning methods of patient in a bed include but not limited to 1. Front lying (prone): 2. semi-prone position(or Sims‘ position) 3. Dorsal Supine (back lying): 4. Dorsal recumbent position 5. Lateral recumbent (on either side) 6. Fowler‘s position position 7. Knee chest position 8 . Trendelenburg position 9. Lithotomy position

65. Front lying (prone) Definition ;- Prone position is putting the patient in a flat on the abdomen, legs extended, feet over the edge of the mattress, and toes pointing to the floor. Purpose  To Promotes drainage from mouth  To prevent contractures of hips and knee  To examine the spine and the back

66. Cont.… Indication  Patient with excessive secretion from mouth  Patient with potential risk of knee and hip contracture Contraindication  Cervical –spine fracture  Respiratory impairment/breathing difficulties  Foot drop (DAMAGE OF FRONT FOOT)  Pregnant women  Clients with abdominal incisions

67. Cont.…. Equipment 1 . Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4 . Documentation format 5. Receiver for drainage( if any)

68. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4 . Provide privacy 5. Elevate bed to highest position. 6 . Place turn or draw sheet under client‘s back and head 7. Assist the client to lie on abdomen. 8. Place a small pillow under client‘s head; turn head to side. 9. Extend the client‘s arms near side or flexed toward head. 10. Place a small pillow under chest for female clients and for clients with barrel chest. 11. Place a small pillow under ankles or allow toes to rest in space between foot of bed and the mattress.

69. Cont.… 12. Assess client for comfort. 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 16. Document the procedure

70. Cont.…

71. Semi-prone position Definition ;Semi-prone position putting or assisting patients with upper arm flexed at shoulder and elbow; lower arm positioned behind client and both legs flexed in front of client with more flexion in upper leg either of body side . Purpose To promotes drainage from mouth To prevents aspiration Comfortable for sleeping sacrum and greater trochanter of hip Promotes comfort especially in pregnant clients

72. Cont.… Indication For rectal examination Pressure sore on the buttocks/sacrum and hips Contraindication lumbar lordosis (EXCESSIVE INWARD CURVATURE OF THE SPINE) Foot drop client with leg injuries or arthritis

73. Cont.… Equipment 1. Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Sand bag 5. Documentation format 6. Receiver for drainage( if any)

74. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3 . Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Flexed at shoulder and elbow 8. Position lower arm behind and away from the back 9. Put pillow between chest and upper arm;

75. Cont.… 10. Flex both legs in front with more flexion in upper leg. 11. Put pillow between legs 12. Support ankle with sand bag (if necessary ) 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 16. Document the procedure

76. Cont.…

77. Supine (back lying) Definition: Supine position is putting patient in back lying often with a small pillow to support the head and shoulder. Purpose Promote comfort To help healing after certain abdominal operations Indication After abdominal, chest and neck surgery For physical examination of anterior part of the body Usual position for the patient

78. Cont.… Contraindication  Spinal injury  Cardiac patient (CHF)  Breathing impairments  Pressure sore (buttock, scrum, heal and shoulder ) Equipment's 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Wrist splint 5. Air rings 6. Cotton rings 7. Footboard or high-top tennis shoes 8. Documentation format

79. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5 . Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Place bed in a flat position. 8 . Place the patient‘s head in a straight line with his or her back, shoulders, hips and knees 9. Place small pillows under head, back and ankles.

80. Cont.… 10. Place air ring under the hips/buttock 11. Flex the arm and rest on the stomach or straighten and support with wrist splint 12. Support the feet with padded footboard or high-top tennis shoes 13. Place the cotton ring under the heal 14. Lower the bed and elevate the side rails 15. Wash your hand 16. Note the patient reaction 17. Document the procedure

81. Cont.…

82. Dorsal recumbent position Definition: Dorsal recumbent position is putting patient in back lying position with knees are flexed and the soles of the feet flat on the bed. Purpose Promote comfort For visualize the perineum To insert urinary catheter To relief pressure from ileum, knee and ankle

83. Cont.… Indication  Rectal , vulval and vaginal examination  Pelvic surgical procedures  Vaginal douche (VAGINAL WASH)  Perineal care  Catheterization  Supra-pubic puncture

84. Contraindication  Spinal injury  Cardiac patient (CHF)  Breathing impairments  Pressure sore (buttock, scrum, heal and shoulder )

85. Equipment's 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Bath Blanket or sheet 5. Air rings 6. Cotton ring 7 . Bed block ( if necessary) 8 . Documentation format

86. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4 . Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client‘s back and head 7. Place bed in a flat position

87. Cont.… 8. Cover the client with a sheet or a bath blanket folded once across the chest. 9. Place the patient‘s head in a straight line with his or her back, shoulders, hips and knees 10. Place small pillows under head and shoulder or elevate the top of the bed with block. 11. Place air ring under the hips/buttock 12. Flex the leg and wide apart 13. Place cotton ring under the heels

88. Cont.… 14. Lower the bed and elevate the side rails 15. Wash your hand 16. Note the patient reaction 17. Document the procedure

89. Lateral recumbent (on either side) Definition: Lateral recumbent position is putting patient on either of the side with the legs flexed at knee (The upper leg is more flexed than the lower leg ). Purpose  To perform back care  To relieves pressure on sacrum and heels  To perform enema  To take rectal body temperature  To insert suppositories

90. Cont.… Indication  Enema and colonic irrigation  Pressure sore on heel and sacrum  Rectal examination  To measure rectal temperature Contraindication  Arm and rib fracture  Spinal injury  Flank injury

91. Cont.… Equipment's 1. Pillow of different size (4) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Documentation format

92. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place turn or draw sheet under client‘s back and head 6. Elevate bed to highest position 7. Logroll client to side

93. Cont.… 7. Logroll client to side a. For left lateral position, place the patient on left side with buttocks to the edge of the bed both thighs flexed and left arm underneath b. For right lateral position, Place the patient on right side with buttocks to the edge of the bed both thighs flexed and right arm underneath

94. Cont.… 8. Place a small pillow under client‘s head. 9. Place pillow or foam wedges behind client‘s back. 10. Put a pillow tucked by the client‘s abdomen. 11. Place a pillow between client‘s legs. 12. Run your hand under the client‘s dependent shoulder and move the shoulder slightly forward 13. .Lower the bed and elevate the side rails 14. Wash your hand

95. Cont.…. 15 . Note the patient reaction 16. Document the procedure

96. Knee chest Definition: Knee chest position is putting a patient on the Knee and the chest with the head turned one side, arms above the head and one cheek on a pillow. Purpose 1. Used for vaginal and rectal examination 2. Used in first aid treatment in cord Prolapse or retroverted uterus 3. Assumed for postpartum and gynecologic exercises

97. Indication 1. Sigmoidoscopic examination 2. Vaginal and rectal examination 3. Cord Prolapse 4 . Retoverted uterus

98. Contraindication  Cardio-pulmonary problem  Upper arm, spine and ribs fracture  Increased intra-cranial pressure (IICP) Equipment's 1. Pillow (1) 2. Drape/ Bath Blanket or sheet 3. Screen 4. Documentation format

99. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Make the patient on the knees and chest 7. Turn the head to one side with the cheek on pillow

100. 8. Extend the arms on the beds and flex it at the elbows to support the patient partially 9. The weight should rest on the chest and knees which are flexed so that the thighs are at right angles to the legs 10. Cover the client with a sheet or a bath blanket. 11. Lower the bed and elevate the side rails 12. Wash your hand 13. Note the patient reaction

101. Fowler's position (semi-upright with back and knee rests elevated) Definition: Fowler's position is sitting position in which the head is elevated at different angle (15-90) o angle and may have knees either bent or straight. Type 1. High Fowler's position is when the patient's head is raised 80-90 degrees, 2. Semi-Fowler's position is when the patient's head is elevated 30-45 degrees. 3. Low Fowler's position is when the head of bed is elevated 15-30 degrees 4. Fowler's which is 45-60 degrees

102. Cont.… Purpose 1 . To relive dyspnea 2. To improve circulation 3 . To prevent thrombosis 4. To prevent aspiration during the introduction of feeding tubes 5. To facilitate drainage from abdomen and pelvic cavity post operatively 6. To relax the muscle of the abdomen, back and thighs 7. To relive tension on abdominal suture 8. To promote comfort 9. Increase comfort during eating 10. To relieve edema of the chest and abdomen

103. Indication  Cardio-pulmonary problem (Respiratory distress, CHF, pulmonary edema..)  Increased intra abdominal pressure  Thrombosis  Abdominal, back and thigh muscle strain  Nasal or oral passageway procedures (e.g. NGT…)

104. Contraindication 1. Comatose/unconscious patients 2. Spinal injury 3. Foot drop 4. Head injury 5. Shoulder dislocation

105. Equipment 1. Small pillow (3) 2. Foot rest/foot board 3. Back support 4. Hand wrist support 5. Screen if necessary

106. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place the patient in sitting position with arms at sides knees raised with pillow 6. Place bed in a 15° to 30° angle for low-Fowler‘s position, 45° to 60° angle for Fowler‘s position, or 70° to 90° angle for high-Fowler‘s position. 7. Turn patients head to one side and align the patient in good position

107. 8. Place a small pillow under client‘s head. 9. Support the backs and arms with pillows. 10. Place a pillow between client‘s legs. 11. Lower the bed and elevate the side rails 12. Wash your hand 13. Note the patient reaction 14. Document the procedure

108. Trendelenburg position Definition: Trendelenburg is putting the patient in a flat on the back with the feet higher than the head by 15-30 degree. Purpose  To increase cerebral perfusion pressure  To allow better access to pelvic organ during pelvic surgery  To help in surgical reduction of hernia  To enhance access to central venous line

109. Cont.… Indication  Hypotension/shock  Abdominal and gynecologic surgery  Placing central venous line  Surgical reduction of hernia .

110. Cont.… Contraindication  Cervical –spine fracture  Respiratory impairment/breathing difficulties  Brain injury with increased intracranial pressure  Spinal injury  Cardiac patient (CHF)  Breathing impairments  Pressure sore (buttock, scrum, heal and shoulder )

111. Cont.… Equipment's 1. Bed block(if necessary 2. Drape 3. Screen 4. Documentation format

112. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Place the patient‘s head lower than the feet with arms at the side

113. Cont.… 6. Place bed blocks at the foot end of the bed. 7. Lower the bed and elevate the side rails 8. Wash your hand 9. Note the patient reaction 10. Document the procedure

114. Lithotomy position Definition: Lithotomy position is positioning the client feet above or the same level as hips with perineum positioned at the edge of examination table. Purpose  To provide good visual and physical access to perineum  To perform simple pelvic procedures to major surgeries  To conduct delivery

115. Cont.… Indication  Pelvic medical examination and surgeries  Delivery Contraindication  Spinal injury  Breathing impairments

116. Cont.… Equipment's 1. Pillow (1) 2. Bed with side rails/examination table/delivery couch 3. Draw sheet /drape 4. Screen 5. Documentation format

117. Procedure 1 . Great the patient and explain the procedure 2. Perform hand washing 3. Collect all necessary equipment's 4. Provide privacy 5. Elevate bed to highest position. 6. Place bed in a flat position. 7. Cover the client with a sheet or a bath blanket

118. Cont.… 8. Lie the patient flat with pillow under the head 9. Flex the feet above or the same level as hips and support with knee rest over a couch ( if available) 10 . Wash your hand 11. Note the patient reaction 12. Document the procedure

119. Patient ambulation Patient ambulation Patient ambulation Patient ambulation Patient ambulation Patient ambulation Patient ambulation patient A mbulation Definition: Client ambulation is assisted or unassisted walking which encouraged soon after the onset of illness or surgery to prevent the complications of immobility. Purpose  To Keeps client more active  To prevent the complications of immobility  To improves muscle tone and strength in his legs  To slow down loss of bone mass and density related to osteoporosis

120. Cont.…  To improves appetite , peristalsis and circulation  To give a sense of accomplishment and maintains greater independence for clients( psychological wellbeing)

121. Indication  Immobile patients unless contraindicated  Postoperative patient Contraindication  Unstable vital sign  Spinal fracture  Patient with traction

122. Equipment  Assistive devices ( Gait belt , Cane, Walker and Crutch )