Diary

1. Date &
Time
Action Teachers
Signature
Moral – ethical and legal principles of Nursing. Organization of work and
responsibilities of basic structural units of therapeutic hospital. Duties of
Nurses in therapeutic department. Documentation in the reception words
Moral – ethical and legal principle of Nursing
Nurses are subject to a plethora of ethical, legal and professional duties.
These are main duties which are generally considered to be respecting a
patient’s confidentiality and autonomy and to recognize the duty of care
that is owned to all patients.
Nurses’ ethics is a branch of applied ethics that concerns itself with
activities in the field of nursing. It shares much principle with medical
ethics such as beneficence, non-maleficience and respect for autonomy.
Confidentiality Is where information about the person is only shared with
others after permission of the person unless it is felt that the information
must be shared to comply with a higher duty such as preserving life.
Autonomy refers to the capacity of a rational individual to make informed
un-coerced decision.
Organization of work and Responsibilities of basic Structural units of
Therapeutic hospital
Organization: - health core in hospital/clinics is very hierarchical. At the top
is the attending physician, a staff doctor who has ultimate responsibility, a
physician in the advanced stages of their training. They supervise the
Interns, doctors in their first year out of medical school. Some teams have
additional layers of residents depending on the complexity and volume of
work to be done.
Hospital structure usually includes of a reception ward, some different
medical department, pharmacy, laboratory department, Radiology
department, Administrative department. Many hospitals also have
designated intensive care areas (Intensive Care Unit ICC of cortical care
unit-CCU) for certain specialties of medicine.
Every department have wards, rooms for medical procedures, dining
hall, a physicians’ office, a n office of department Chiefs, head nurse,
shower room , a toilet, room for clean & dirty linen.
Duties of Nurse’s in Therapeutic Department
Typical duties of head Nurses
- Carries out therapeutic treatment as ordered by the physician.
-Giving of medication
-Carries out diagnostic procedures as ordered by physician
-Provision of Information on a patient’s status, new symptoms
responses to medication to the physician.
24
TH
March,
2010

2. Duties of Nurse Assistants
-Monitors patient’s condition by taking and recording temperature,
pulse, respiration, weight, blood pressure, observing patient’s
behavior and reporting all information to the nurse.
-Assist nurses inpatient care by performing routine duties such as
toileting, feeding, passing water and nourishments, bathing etc.
-Assist patient in maintaining mobility by assisting in ambulation,
transfer, range of motion exercises.
Reception:- It is the first unit for patient. Their function includes;
Administration and Registration of patient
Examination of the patient and preliminary diagnostics of the patient’s
disease
Sanitary Inspection and cleaning of the admitting patient
Emergency medical care, qualified medical treatment
Transportation of patient’s to the hospital equipments
Usually when arriving at the hospital, it is required to register at the
reception ward. There is a register for registration of patients’ planned
hospitalization, a register of hospitalized patients and of consulted
patient.
These register have passport date, data of laboratory test, medical
decision, description of medical procedures which are provided foe s
patient and the doctor’s advises about the following examination and
treatment in case of refusing the hospitalization.

3. ACTION
Thermometry, the measurement of blood pressure pulse, its
registration.
Organization of work and responsibilities of nurses manipulation office.
Sanitary – epidemic regimen in manipulation office.
Thermometry is an instrument used in measuring temperature. It plays
an important role in the patient examination and decision making.
Infection and products of tissue decomposition usually cause fever
(elevation of the body temperature).
The temperature is measured by a thermometer graded in 0.1
0
(C or
F)
A clinical thermometer is a small, self-registering thermometer
consisting of simple glass tube with etched scale, used for taking
temperature of body.
Types of thermometer
Mercury in glass thermometer
Alcohol thermometer
Digital thermometer
Ear thermometer
Liquid crystal thermometer
Resistance thermometer
Bi-metal mechanical
Pill thermometer
Reversing thermometer
Patch thermometer
contact thermometer
Medical thermometer: - examples; oral, rectal, basal thermometer.
A thermometer is placed in the patient’s mouth to obtain an oral
temperature, In the anal canal to obtain rectal temperature, and in the
axilla to obtain an axillary temperature.
An a.m. temperature of greater than 370C would define a fever.
Fever is an elevation of body temperature above the normal circadian
range as the result of a change in the thermoregulatory center.
It is characterized not only by elevated temperature but also by the
upset function of the entire body.
Causes of Fever
Infection diseases example Malaria, Influenza, Common cold etc.
Skin infection example Boils, Pimples, Abscess, Immunological diseases
example Lupus Erythromatous, Sarcoidosis.
Cancer;- Renal, Leukemia, Lymphomas.
Metabolic disorder:- Gout, Porphyrias
TEACHER’S
SIGNATURE
DATE & TIME
31
st
March,
2010

4. Types of Fever
1.Continued Fever: (Pneumonia, Typhoid Fever).
The temperature remains above normal throughout the day and
doesn’t fluctuate more than 1
0
C in 24 hrs.
2.Intermittent Fever : The elevation of temperature is present only for
some hours of the day and becomes normal for remaining hours.
Examples; Malaria, Kala-azar, pyaemia or Septicemia.
3.Remittent Fever : The temperature remains above normal
throughout the day and fluctuate more than 1
0
С in 24hrs. Example;
Infective Endocarditis, Pleurisy, Tuberculosis.
4.Hectic or Septic Fever: When the variation is extremely large. And
temperature rises sharply by 2-4
0
C and drops to normal and
subnormal level. Example; Sepsis, Grave pulmonary tuberculosis.
5.Step-ladder Fever: temperature rises gradually to a higher level with
every spike.
6.Irregular Fever: Variations are varied and irregular e.g. rheumatoid
fever, endocarditis, sepsis, tuberculosis.
7.Inverse Fever: Temperature rises in the early hours of morning
rather than in the evening e.g. Military tuberculosis, Sepsis and
Brucellosis.
8.Relapsing Fever: Fever is marked by number of febrile attacks
lasting about six days and separated from each other by apyretic
intervals of about the same length e.g. Hodgkin disease.
9.Undulant Fever: Characterized by periodic elevation of temperature
followed by its drop.
3 Phases of Fever
-Onset phases (L. Stadium Incrementi):- temperature rises little by
little. Patient experiences mild headaches, chills, feels, cold, reduce
appetite, muscle aches, lethargy.
A nurse has to cover the patient with blanket, put a lot of water
bottle on the feet, and give a lot of warm tea.
-Stationary Phase (L. Fastigium):- patient has the highest
temperature, flushed skin, attention of mental status, feels hot.
Nurse ha to apply a cold compress on the forehead, give a lot of
juice, tea with lemon.
-Resolution (L. Stadium decrement):- The temperature ma y
decrease gradually, little by little during several days.
Decreasing of Temperature
Lysis:- Gradually decreasing from 39.5, 38.5, 37.5.
Crisis:- Sudden drops 39
0
C, morning 35
0
C.
Pulse is the vibration of each wave of blood giving through the arteries as
the heart beats. It is when left ventricle of heart contracts.
Pulse can be taken in different places; Carotid, Radial, Brachial, Femoral,
Popliteal, Posterior tibia, Dorsalis pedis.
Properties of Pulse
Pulse rate:- Number of pulse rate. Healthy normal Individual is 64-72 beats
minute. Women more than Men. Pulse accelerates with physical work,
during digestion, breathing in, excitement and with diseases e.g.
Myocarditis, Endocarditis, Pericarditis, Cardiac failure.

5. Rhythm of the Pulse:- The beats follow with equal intervals and are equal
that is regular pulse.
Pulse Tension:- The pressure of blood exercised on the wall of artery. Gives
Information about arterial pressure and state of vascular system.
Pulse filling:- Amount of blood in the vessel. This is done by using proximal
finger on the radial artery to press the vessel gradually.
Pulse value:- Is a collective concept, uniting filling and tension. Depends on
the degree of the artery widening during systole and its collapse during
diastole.
How to take patient’s pulse
Use your Index and Middle finger tips or all three middle finger tips and
apply moderate pressure over the pulse point until you feel the pulsing.
Then take the reading.
Blood Pressure:- Is the force of the blood pushing against arterial walls. 2
types; Systolic and Diastolic pressure.
Blood pressure is measured in millimeters of mercury (mmHg) given as
systolic pressure followed by diastolic pressure with a slash between.
Increase in blood pressure is called Hypertension 140/90mmHg.
Decrease in blood pressure is called Hypotension and its below 100mmHg.
Blood pressure is measured with a blood pressure cuff, a
sphygmomanometer and Stethoscope.
During the practice, the patient blood pressure and pulse rate was
taken.
Arterial Pressure – 130/80mmHg
Pulse rate – 86 bpm
Arterial pressure – 140/110 mmHg
Pulse rate – 115 bpm.
Regimen: Is a prescribed systematic form of treatment such as regulation
of mode of living, diet, course of drug, sleep, special exercise for a hygienic
and therapeutic purpose for curing disease and improving health.
The main part of the regimen is elimination or decreasing an affect of
different unhealthy environmental factors to a patient.
It is regulated by keeping a strict hospital routine.
Regimen consist of the following;
-Keeping protection of patient’s mentality
-Strict keeping inside routine
-Keeping rational moving activity of patients.
Active regimen:- Patient may rise, walking around, do everything because
of his capability.
Bed regimen:- Patient lie in the bed because of his condition. Everything is
done in the bed. Semi strict bed regimen; patient may sit near the bed, sit
near the Fable and there is no moving in this case.
Hygiene regimen:- keeping the patient clean.
Sanitary regimen:- Cleaning of the units.
TEACHER’S
SIGNATURE

6. ACTION
Methods of taking the CBC, examination of serum glucose level,
biochemical and bacteriological examination.
Technique of subcutaneous, Intramuscular, Intravenous introduction of
antibacterial drugs.
Complete Blood Count (CBC):- Is one of the most common analyses of
blood. CBC usually includes a numerical estimate of number of red blood
cells, white blood cells and platelets. These numbers reflect the functioning
of bone marrow, ability to carry oxygen to cells and the patient’s Infection
Fighting Status and clotting abilities.
Deficiencies or excesses of these cells indicate specific problems.
Method of taking of CBC
It is performed by obtaining a few milliliters of blood sample directly
from the patient.
The skin is wiped clean with an alcohol pad and then a needle is inserted
through the area of cleansed skin into patient’s vein. The blood is then
pulled from the needle by a syringe. This sample is then taken to the
laboratory for analysis.
The component of CBC and the Normal range
White Blood Cells count, (WBC) ; 4.3-10.8x10
9
/L
Red Blood Cell count (RBC); 4.2-5.9x10
12
/L
Hemoglobin (Hb); 8.1-11.2mmol/L For Men
7.4-9.9mmol/L For Women
Hematocrit (Hcl); 45% - 52% For Men
37% - 48% For Women
Platelet Count; 150-400x10
9
/L
Colour Index; 0.8-0.1
ESR; 2-10 for men, 3.15 for women
Neutrophil; 65%
Eosinophil; 1.5%
Basophil; 0.5%
Segmented Neutrophil; 3-5%
Band Neutrophil; 37-72%
Lymphocytes; 25%-30%
Monocyte; 6-11%
Certain diseases states are defined by an absolute increase or decrease
in the number of a particular type of cell in the blood stream. Example;
DATE & TIME TEACHERS
SIGNATURE
7
TH
April,
2010

7. Type of cell
Increase
Decrease
Red Blood Cell (RBC)
Eythrocytosis
Erythroblastopenia
White Blood Cell
(WBC)
Leukocytosis
Leucopenia
Lymphocyte
Lymphocytosis
Lymphocytopenia
Granulocytes
Granulocytosis
Granulocytopenia
Neutrophils
Neutrophilia
Neutropenia
Eosinophils
Eosinophilia
Eosinopenia
Basophils
Basophilia
Basopenia
Platelets
Thrombocytosis
thrombocytopenia
Exa

8. ACTION
Responsibilities of nurse for the diagnostic process in a therapeutic
hospital. Basic rules for preparing the patient for Gastroscopy,
Retromanoscopy, Colonoscopy, and Ultrasound scan of abdomen. The
main types of enema and rules for their using.
Gastrocopy
Is an examination of the upper digestive tract (The oesophagus,
Stomach and Duodenum) using an endoscope; a long, thin, flexible tube
containing a camera and a light. It is usually done to Investigate the cause
of abdominal pain, vomiting or bleeding from digestive tract & to make or
confirm a diagnosis.
Prepare a patient for gastroscopy. You should tell the patient not to eat
or drink anything for at least 6 hours before the test.
Procedures
·Patient is asked to lie on the table on his/her left side
·Sedative will be given to patient by Injection. It will help to and may
put patient to sleep. In some cases can be done without sedatives.
·The back of the throat is sprayed with a local anaesthetic to make it
numb. A small mouth guard is put between your teeth to stop
patient from biting the endoscope.
·Place endoscope on the patient’s mouth and instruct to swallow it
down into the stomach. Make sure it doesn’t enter the windpipe so
that there is plenty room to breathe around it.
·Direct air into the stomach via endoscope. This will make viewing
easier.
This procedure takes about 15-30minutes.
Contraindication:- Perforation, and penetration, bleeding, intoxication,
heart failure, respiratory disease, asthma, epilepsy.
Colonoscopy
Colonoscopy is a procedure in which the inside of the large Intestine
(Colon and Rectum) is examined using a Colonscope. Colonoscopy is
commonly used to evacuate gastrointestinal symptom such as rectal and
intestinal bleeding, abdominal pain or changes in bowels habits. Also
perform in individual without symptoms to check for colorectal polyp or
cancer.
To prepare patient for colonoscope; he should be asked to stop eating
solid food the day before the test. Drink plenty of clear fluids in 24hrs
before the test. Take a strong laxative and needed to stay close to toilet.
Procedure
-wash your hand
-Ask patient to lie on his left side
-Gently insert the colonoscope into the rectum
Lubricate jelly will be used to make this easy as possible.
-Air is pumped through the colonoscope and into the bowel to make
it expand and the bowel wall easier to see.
-Patient may feel mild cramping during the procedure; cramping can
be reduced by taking slow, deep breaths.
DATE & TIME TEACHERS
SIGNATURE
14
TH
April,
2010

9. -The colonoscope is slowly with drawn while the lining of the bowel
is carefully examined.
-The procedure lasts from 30minutes to 1hour.
Rectoscopy
Is a common medical procedure in which an instrument called
rectoscope is used to examine the anal cavity, rectum or sigmoid colon.
Indication for Rectoscopy:- are distended vein, external and internal
hemorrhoid, polyp, tumor, cancer, constipation, blood in faeces.
Contraindication: diarrhea, hemorrhage, infection.
Procedure
·Wash your hands
·Position patient in the left lateral decubitis in the buttocks at or over
the edge of the couch.
·Rectoscope is lubricated and inserted into the rectum. Ensure that
there is no obstruction to the scope as it is passed. OR
·Tip of the obturator and scope is then passed into the canal in the
direction of the umbilicus.
·Once the scope has passed through the canal the obturator is
removed and the eyepiece secured, allowing an unobstructed view
of the interior of the rectal cavity.
·Procedure last for
1
/2 hour
Ultrasound Scan of the abdomen
Ultrasound scan is a method of obtaining image of almost any part of
the body.
An ultrasound of abdomen gives a structural view of many abdominal
organs including the liver, spleen, gallbladder, kidney, urinary bladder,
uterus, ovaries, pancreas and its duct, prostate gland, aorta, venal portal.
Indication: For abdominal pain, Gallstone, Kidney failure, Liver diseases,
Pregnancy, Ovarian cyst.
Enema:- Is a medical procedure in which fluid or substances is injected into
the rectum to empty it.
Indication:- To relieve constipation, prepare for an exam of the rectum,
prior to surgery on the bowel, prior to certain x-ray Procedure, before
labour, removes feaces.
Types of Enema
1.Barium enema: x-ray film that visualized colon
2.Medication enema: anti-inflammatory drug for sleeping and anti-
angina for pain.
3.Therapeutic enema: used to insert drugs to rectum
4.Siphon enema: is given to remove poison & toxic substance from
the intestine.
Procedure
-Patient will be asked to lie on his/her left side. The right leg should
be bent up forward the chest. This position helps the solution to
flow easily in to the colon.
-The solution most used is a mixture of mild soap and warm water
known as soap suds enema.
-This solution is placed into a small plastic container with s flexible
tube. The tube is rubbed with lubricating jelly.

10. -The tube is inserted in the rectum about 10-12cm
-The solution is then slowly released with the help of funnel.
After an enema, patient is asked to hold the solution in the rectum for
3minutes. After that he/she can expel the enema while sitting in the toilet.
Contraindication:- diarrhea, collapse, hemorrhage, tumor.
Preparation of patients and necessary equipment for taking stool,
coprogram. Rules of taking urine, Zimniski Test, Addi-Kkovski test. Their
diagnostic value.
Stool Specimen
Are collected for many examinations. The most common is the ova and
parasites test, a microscopic examination of faeces for detecting parasites
such as amebas or worm.
Supplies and equipment required for stool collection
·Gloves
·Clean bedpan and cover
·Specimen container and lid
·Wooden tongue blades
·Paper bag for used tongue blades
·Label
·Plastic bag for transport of container with specimen to laboratory.
Procedure for stool Specimen
·Wear glass and give the bedpan when patient is ready
·Remove the bedpan and use the tongue blade to transfer a portion
of the feces to the specimen container.
·Cover the container and label it with the patient’s name and social
security number.
·Take the specimen to the laboratory immediately examination for
parasites, ova and organism must be made while the stool is worm.
Rules of taking Urine
-Instruct the patient to clean the urethral area thoroughly. This will
prevent external bacteria from entering the specimen.
Instruct the patient to void a small amount of urine into the
specimen cup and the last of the stream into the toilet. The midstream
urine is considered to be bladder and kidney washing
-Complete laboratory request form, label the specimen container
with patient identifying information and send to the laboratory
immediately.
-Wash your hand and instruct patient to do likewise.

11. Zimnistskiy Method
This method helps to determine functional renal capabilities to osmotic
concentration and dilution in diurnal dieresis.
Technique
·Collect 8 portions of urine per24hrs. Patient performs this by
avoiding every 3hrs. if patient needs to discharge between these
hours, he urinates into container marked by the next hour.
The following data are taken into account
-Daily volume of urine (daily dieresis)
-Night dieresis
-Changes of specific gravity during 24hrs
-Correlation of day time and nocturnal urine volume
Addi-Kakovski Test
Is quantitative estimation of urinary cellular excretion method of
collecting the sediment (casts and cells) in a 12hrs (24hrs) urine sample.
Technique:
·The day before patient should take high protein and low fluid diet
and should not drink at night time.
·Collect all the urine into container during 12hrs (From 22pm – 8am)
The normal values are;
WBC – not more than 2,000,000 per 24hrs
RBC – not more than 1,000,000 per 24hrs
Cylinders – not more than 20,000 per 24hrs

12. ACTION
The preparation and conduct of gastric and duodenal probing. Gastric
lavage.
ECG registration is the easiest analyze its basic element
Gastric Probing
Research of secretory function of stomach due to elimination of stomach
juice.
Indication:-
-Diagnostic
-Determine the acidity of stomach
-For stomach cancer
Technique of Gastric Probing
→ Position the patient in a sitting position
→ Insert the tube through the mouth to the stomach
→ Aspirate all amount of stomach content and put in glass
→ In 1 hour take 5 portion of the content every 15 minutes for
determination of the basal secretion
→Stimulate stomach secretion by drug e.g. Pentagastrin for secretion
Increase
→ After that, aspirate 9 portions in 2 hours.
All portion should be examine for; general amount of acidity, volume of
juice and free acidity of HCl.
Duodenal Probing
It determined the bile secretion.
Indication:
-Chronic cholecystitis
-Hypofunction/hyperfunction, dysfunction of gallbladder.
Contraindication:
-Mechanical jaundice
-Cholecystitis
-Acute cholecystitis
-Cancer of common bile duct
Technique of duodenal probing
·Position patient in sitting or lying to the right
·Insert the tube through mouth to the duodenum
·Aspirate a portion from the duodenum → colour of juice is yellow,
specific gravity → 1.008 – 1.016 and PH → 7.8
·We need to open the sphincter artificially by induction of food or
drinks but it’s better to give patient drug e.g. Magnesium Sulfate
25% in 20-50ml
·In 10-15minutes, take B portion bile from gall bladder colour→ dark
brown or dark Olive, specific gravity → 1.016 – 1.0034, Acidity → 6.5
– 7.3
·If in 15 minutes, bile doesn’t appear, prescribe subcutaneous
TEACHER’S
SIGNATURE
DATE & TIME
21
st
April,
2010

13. Injection of atropine Solution and take B portion after that take C
portion from hepatic duct. Colour → White or Yellow, Viscocity →
not so high, Specific Gravity → 1.007 – 1.010;
PH → 7.5 – 8.2
Gastric Lavage
Is used for therapeutic evacuation of undesirable stomach contents
following orogastric or nasogastric tube placement. Also used to treat
patients who have ingested poisons or taken an overdose of medication.
Indication:
-Used before surgery to clear the content of digestive tract before it
is opened
-For overdosed on a drug
-Poisoning
Techniques or Gastric Lavage
It involves the passage of tube via the mouth or nose down into the
stomach. Followed by sequestrial administration and removal of small
volume of liquid.
The placement of the tube in the stomach must be confirmed either by;
·Air sufflation while listening to the stomach
·By PH testing a small amt of aspirated stomach content.
This is to ensure that the tube is not in the lung. In adult, small
amount of warm water or saline are administered and via a siphoning
action removed again
In children, normal saline is used as children are more at risk of
developing. Hyponatremia if lavaged with water. Because of the
possibilities of vomiting, a suction device is always on hand in case of
pulmonary aspiration of stomach contents.
Lavage is repeated until the returning fluid shows no further gastric
contents.
If patient is unconscious, patient should be intubated before
Performing lavage.
contraindication:
-Perforation, gastrointestinal hemorrhage, when patients have
compromised, unprotected airway due to infection.
Complication:
-Aspiration pneumonia
-Laryngospasm, hypochloremia
-Hypoxia, hyponatremia
-Bradycardia, mechanism injury of stomach
-Epistasis, water intoxication
Complication:
-Aspiration pneumonia
-Laryngospasm, hypochloremia
-Hypoxia, hyponatremia
-Bradycardia, mechanism injury of stomach
-Epistasis, water intoxication

14. ECG (ELECTROCARDIOGRAPHY)
Is a diagnostic tool that measures and records the electric activity of heart
in exquisite detail. Being able to interpretate these details allows diagnosis
of wide range of heart problem.
Technique of ECG
Patient is asked to lie on the back and the skin is clean with an alcohol
wipe, If the patients are very hairy.
ECB standard Leads
There are three of these leads I, II, III.
Lead I: - is place between the right arm and left arm electrodes, the left
arm being positive.
Lead II:- between the right arm and left leg electrodes, the left leg being
positive
Lead III: - is between the left arm and left leg electrodes, the left leg again
being positive.
Chest Electrode Placement
V1- (Red) 4
th
Intercostal space to the right of the sternum
V2– (Yellow) 4
th
Intercostal space to the left of the sternum
V3 – (Green) directly between Leads V2 and V4 in diagonal line on top of
breast tissue.
V4 – (Brown) 5
th
Intercostal space at midclavicular line
V5 – (Black) Level of V4 at left anterior axillary line (directly under the
midpoint of the armpit)
The ECG records the electrical activity that results when the heart
muscle cell in the atria and ventricle contract.
·Atria contraction shows up as the P-wave
·Ventricular contraction show as a series known as ORS-complex
·The third and last common wave is T-wave. It is produce when the
ventricles are recharging next contraction (repolarizing).
ECG Interpretation
The graph paper that ECG records on is standardized to run at
25mm/sec and is marked at 1sec intervals on the top and bottom. The
horizontal axis correlates the length of each electrical even with its
duration in time. Each small block (defined by lighter lines) on the
horizontal axis represents o.o4 seconds. Five small blocks (shown by heavy
lines) is in large block and represents 0.02 seconds.
Duration of waveform, segment or interval is determined by counting
the blocks from the beginning to the end of the wave, segment or interval.
P-wave:- Represents atria depolarization. The time necessary for an
electric impulse from the S.A. node to spread throughout the atria
musculature.
Location: preceded QRS Complex
Amplitude: should not exceed 2 to 2.5mm in height
Duration: 0.6 – 0.11 sec.
P-R Interval :- Represents the time it takes an impulse from the atria
through the AV node, Bundle of His and Bundle branches to the
Purkinje fibres.
Location: Extends from the beginning of the P-wave to the beginning
of QRS Complex.
Duration: 0.12 to 0.20 seconds.

15. QRS-Complex:- Represents ventricular depolarization. The QRS Complex
consists of 3 waves. The Q-wave, R-wave and the S-wave.
·The Q-wave is always located at the beginning of the QRS Complex.
It may not always be present.
·The R-wave is always the first positive deflection.
·The S-wave is the negative deflection, follows the R-wave.
Location: follows the P-R Interval
Amplitude: Normal values vary with age and sex.
Duration: Not longer than 0.10 seconds.
Q-T Interval:- represents the time necessary for ventricular depolarization
and repolarization.
Location: Extends from the beginning of QRS Complex to the end of
the T-wave (includes the QRS Complex, S-T Segment and the T-wave)
Duration: varies according to age, sex & heart rate.
T – wave:- Represents the repolarization of the ventricles on rare
occasions, a U wave can be seen following the T-wave. The U wave reflects
the repolarization of the His – Purkinje Fibres.
Location: Follows the S-wave and S-T Segment
Amplitude: 5mm or less in standard leads I, II and III; 10mm or less in
precordial leads V1-V6.
Duration: not usually measured
S-T Segment:- Represent the end of the ventricular depolarization and the
beginning of ventricular repolarization.
Location: Extends from the end of the S-wave to the beginning of the
T-wave.
Duration: Not usually measured.

16. ACTION
Working of the manipulation room and office duties of nurses for their
support. Technique of application of compresses, mustards plaster,
cupping glass, using a hot water bottle, ice bottle. The use of medicinal
leeches, their storage conditions.
Oxygen therapy: Indication, equipment, methods of administration.
Physiotherapeutic procedures (hydrotherapeutic, light, electromagnetic).
Manipulation room is room for taking of Injection room for procedures.
Duties of Nurses in manipulation room: Includes
·Check for list of administration of drug
·Giving note of x-ray
·Sterilization of used equipment and their disposal
·Disinfecting and cleaning of the room ever week
·To check the result of the cleaning of room
·Ordering of filling by the physician
Compresses:- Are absorbant pad press on to part of the body to relieve
inflammation or stop bleeding.
2 Types are distinguish
-Hot compresses which are used to treat old injuries, muscle pain
rheumatic pain, menstrual cramps, boils and toothache.
-Cold compresses that are used for recent sprains, bruising, swelling
and inflammation, fever, headaches.
Technique of hot Compresses
Take about a pint of hot water as you can comfortably stand it and add
about 4 drops of essential oil to it. Then place your folded pieces of
material, bandage or small towel, on top of the water and let it soak it up.
Next wring out the excess water and place it over the area to be treated.
Cover the warm compress with either cling wrap or a plastic bag and
another towel on top to keep it in place. You may bandage the compress
lightly if applied to an awkward place where it keeps slipping off, leave and
replace with a new compress as soon as it has cooled to body temperature.
Technique of cold compresses
It is made exactly the same as the hot compresses but ice or refrigerated
water is used instead of the hot water and the compress is replaced when
it has heated up to body temperature.
Mustard Plasters
Are oily or waxy mixtures blended with herpes and applied to the chest
and abdomen to stimulate internal organs, relieve pain and have an anti-
inflammatory effect.
It’s used for the treatment of bronchitis, bronchopneumonia,
hypertension crisis, cardiac pain.
Contraindication: High temperature.
Techniques of Mustard Plasters
TEACHER’S
SIGNATURE
DATE & TIME
28
th
April,
2010

17. Soak the Mustard Plaster in moderate warm water and put to the
affected area except the trunk, cover worth towel and blanket. Asked
patient to lie on his front part of the body because the Mustard Plaster is
applied to the back.
After that take off and clean the sediment of the Plaster with a clean
towel.
Cupping Glass
Is a practice of applying a heated cup to the skin and allowing it to cool
which causes swelling of the tissues, beneath and an increase in the flow of
blood in the area.
Technique of Cupping Glass
·Lubricate the patient’s body
·Fire or spirit is put into the glass and close.
·Soon as possible so that it will be air free.
·After 20-30minutes, remove the glass by pressing the skin so that air
will enter for easily removal.
Hot water bottle
Are use for bruises, burn, trauma, reduce swelling, headache, causes
vasodilatation.
Technique of Hot water bottle
·
2
/3 of the bottle is filled with a hot water (60
0
C -70
0
C), the reason for
this is for flexibility.
·Make sure that there is air in the bottle
·Place a special cloth on the affected area and then apply the hot
bottle on it for about 20-30minutes.
Ice Bottle
Are used for inflammation. It causes vasoconstriction; it reduces
muscle spasm and pain. It also reduces swelling.
Technique
·Put a piece of crushed ice in the bottle, make sure is flexible.
·Place a cloth on the affected area and then apply the bottle on it for
about 20-30minutes.
The use of Mechanical Leeches
Leeches:- are small worm-like animal that can attach themselves to
human body and suck out blood thereby removing about 20ml of
blood before falling off.
Uses:-
·Reduce blood coagulation
·For venous insufficiency
·Used to repair venous system in damaged area
·Restore normal blood flow in certain damaged part of the body.
Internal means of hydrotherapy range from drinking the recommended
amount of water daily or receiving an intravenous (IV) Infusion, to getting a
large amount of water in an enema.
Hydrotherapy can be useful for patients with severe burns, rheumatoid
arthritis, spinal cord injuries and bone injuries.
People with diabetes, numbness or poor sensation may be at higher risk
of scalding or burn from hot soaks or warm compresses.
NO PRACTICAL SKILLS MADE

18. 1.Checking the medication package in the medication administration
area (Infusion unit)
2.Filling in nurse’s documentation of therapeutic department.
3.Filling in nurse’s documentation of Infusion Unit.
4.Measurement and recording body temperature
5.Measurement and recording radial pulse
6.Measurement of blood pressure.
7.Taking blood for biochemical examination.
8.Collection of urine specimen.
9.Collection of stool specimen for coprological and bacteriological
tests.
10.Doing of Subcutaneous Injections
11.Doing of Intramuscular Injections
12.Doing of Intravenous Injections
13.Taking part in doing of IV Infusion
14.Calculate of doses, dilution of antibiotics according to medication
order
15.Taking part in managing equipment
16.Assist with a sterile procedure
17.Taking of throat and nasopharynx specimen
18.Giving enemas
19.Taking part in Gastric and Duodenal Intubations
20.Preparation patient to abdomen’s US and X-ray examination
21.Taking 12-leads cold compress
22.Applying of hot/cold plaster
23.Applying of a Mustard Plaster
24.Taking part in physical therapy’s procedures

8 times
8 times
8 times
5 times
7 times
times
6 times
9 times
7 times
6 times
5 times
5 times
6 times
7 times
6 times
7 times
9 times
8 times
8 times
6 times
8 times
5 times
4 times
4 times

19. DIARY
OF PRACTICAL TRAINING IN THERAPEUTIC –
PROPHYLACTIC INSTITUITION AS NURSE FOR
3
rd
YEAR STUDENTS OF MEDICAL FACULTY,
Alhayki huda
Group 4
DEPARTMENT: PROPEDEUTICS OF INTERNAL
MEDICINE N2 KNMU
HOSPITAL: KHARKIV REGIONAL CLINICAL
HOSPITAL.