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1. FUNDAMENTAL NURSING FOR MIDWIFERY 1

2. BODY MECHANICS AND MOBILITY 2

3. BODY MECHANICS AND MOBILITY Body mechanics involves the coordinated effort of muscles, bones, and the nervous system to maintain balance, posture, and alignment during moving, transferring, and positioning patients The Use of safest and most efficient methods of moving and lifting is Body mechanics . This means applying mechanical principles of movements to the human body. 3

4. Mobility the ability to move freely, easily, rhythmaticly and purposefully in the environment. Normal movement and stability are the result of An intact musculoskeletal system. An intact nervous system. intact inner ear structure responsible for equilibrium 4

5. Body mechanics and mobility … Basic Principles 1. It is easier to pull, push, or roll an object than to lift it. The movement should be smooth and continuous, rather than jerky. 2. Often less energy or force is required to keep an object moving than it is to start and stop it. 5

6. Body mechanics and mobility … 3. It takes less effort to lift an object if the nurse works as close to it as possible. Use the strong leg and arm muscles as much as possible. Use back muscles, which are not as strong, as little as possible. Avoid reaching. 6

7. Body mechanics and mobility … 4. The nurse rocks backward or forward on the feet and with his or her body as a force for pulling or pushing. 5. Principles under lying proper body mechanics involve three major factors: Center of gravity Base of support and Line of gravity. 7

8. Body mechanics and mobility… Center of Gravity The person’s center of gravity located in the pelvic area. This means that approximately half the body weight is distributed above this area, half below it . When lifting an object, bend at knees and hips, and keep the back straight. By doing so, the center of gravity remains over the feet, giving extra stability. It is thus easier to maintain balance. 8

9. Base of Support A person’s feet provide the base of support. The wider the base of support, the more stable the object with in limits. The feet are spread side wise when lifting, to give side-to side stability. One foot is placed slightly in front of the other for back-to-front stability. The weight is distributed evenly between both feet. 9

10. Line of Gravity Draw an imaginary vertical (up and down) line through the top of the head, the center of gravity, and the base of support. The point at which all of the mass of an object is centered, Base of support: the foundation on which an object rests This becomes the line of gravity, or the gravity plane. This is the direction of gravitational pull (from the top of the head to the feet). 10

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13. Body alignment When lifting, walking or per forming any activity, proper body alignment is essential to maintain balance . What are the important of correct body alignment ? 13

14. When a person’s body is in correct alignment, all the muscles work together for the safest and most efficient movement, without muscle strain. 14

15. POSITIONING THE CLIENT Discussion point Discus the important of positioning of the client Discus the result of Prolonged immobility 15

16. POSITIONING THE CLIENT Encouraging clients to move in bed, get out of bed, or walk serves several positive purposes. Prolonged immobility can cause pressure ulcer, constipation and muscle weakness, pneumonia and joint deformities e.t.c. By assisting clients to maintain or regain mobility, you promote self-care practices and help to prevent deformities. 16

17. Moving and positioning is for Promoting comfort Restoring body function Preventing deformities Relieving pressure ulcer Stimulating proper respiration and circulation. 17

18. Purpose: To increase muscle strength To prevent some potential problems of immobility To stimulate circulation To increase the patient sense of independence and self esteem To assist a patient who is unable to move by himself To prevent fatigue and injury To maintain good body alignment 18

19. Practical Guidelines for positioning Maintain functional client body alignment. Maintain client safety. Reassure the client to promote comfort and cooperation. Properly handle the client’s body to prevent pain or injury. Follow proper body mechanics. Follow specific physician orders. , 19

20. Client Positioning for Examination & Treatment Horizontal Recumbent Position This position is required for most of the physical examinations. It also indicated for comfort The client lies on the back with the legs extended. The arms are placed, folded on the chest, or along side the body. One small pillow may be used. Cover the client with bath blanket for privacy 20

21. Horizontal Recumbent position 21

22. Dorsal recumbent position – Used for variety of examinations and procedures , The client lies on the back, with the knees flexed and the soles of the feet flat on the bed, Cover the client with a sheet or a bath blanket folded once across the chest, The second sheet should be cross wise over the client thighs and legs, 22

23. Wrap the lower ends of this sheet around the client’s legs and feet. Fold the sheet so the genital area is easily exposed. Keep the client covered as much as possible 23

24. Prone Position: - Is used to examine the spine and back . Promotes drainage from mouth The client lies on the abdomen with head turned to the side for comfort. The arms are held above the head or along side the body. Cover the client with a bath blanket for privacy. 24

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26. Sims’ Position: - This position is used for rectal examination and Promote drainage from mouth and prevent aspiration, reduces pressure from sacrum . The client rests on the left side , usually with a small pillow under the head. The right knee is flexed against the abdomen, the left knee is flexed slightly, the left arm is behind the body, and the right arm is in a comfortable position. 26

27. Sims’ position 27

28. Fowler’s Position: - This position is used to promote drainage or to make breathing easier. Improve respiration (dyspnea, pneumonia) Encourage post operative drainage Adjust the head rest to the desired height, and raise the bed section under the client’s knees. Place a rolled pillow between the client’s feet and use the foot of the bed as a brace, if desired. 28

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30. Knee-chest Position: - Is used for rectal and vaginal examinations and as treatment to bring the uterus into normal position . The client is on the knees with the chest resting on the bed and the elbow rested on the bed, or With the arms above the head, the client’s head is turned to the side. The thighs are straight up and down and the lower legs are flat on the bed 30

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32. Dorsal Lithotomy Position: - Is used for examination of pelvic organs . It is similar to dorsal recumbent position, except that the client’s legs are well separated and the knees are a cutely flexed. Usually client’s feet is placed in the stirrups. Keep the client covered as much as possible for privacy. 32

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34. Lateral Is a side laying position Lateral aspect of lower scapula and lower ileum support most of the body This position promotes comfort and relives pressure from iliac area and heel 34

35. Turning the Patient to a Side-lying Position Clients cannot always move independently and reposition themselves in bed. nurses must use proper turning and positioning techniques This is in order to achieve the following outcomes Increase client comfort Prevent contractures Prevent decubitus (pressure sores) Make portions of the client’s body accessible for procedures 35

36. Clients who cannot move independently must be repositioned every 2 hours, Nurses need to be aware of three essential concepts when positioning clients : Pressure : on a skin surface on which the client is lying or sitting, Friction : is caused when the skin is dragged across a rough surface such as bed sheets or stretcher surfaces, Skin shear : is the result of dragging skin across a hard surface. Deep muscles may be involved. 36

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38. Supplies and Equipment in positioning pt Pillows Side rails Cotton blanket or towels rolled for support 38

39. Procedure/Steps Wash your hands Explain the procedure to the client Adjust the bed to a comfortable height Lower the client’s head to as flat a position as he or she can tolerate and lower the side rail. Move the client to the far side of the bed. Raise the side rail. Ask the client to reach for the side rail. Roll the client toward you. 39

40. Position the client’s legs comfortably. Flex his or her lower knee and hip slightly. Bring his or her upper leg for ward and place a pillow between legs. Adjust the client’s arms Shift his or her lower shoulder to ward you slightly Support his or her upper arm on a pillow 40

41. Wedge a pillow behind the client’s back  Use rolled blankets or towels as needed for support. Lower the bed, elevate the head of the bed as the client can tolerate and raise the side rail. Wash your hands 41

42. Joint Mobility and Range of Motion Every body joint has a specific but limited opening and closing motion that is called its range of motion (ROM). The limit of the joint’s range is between the points of resistance at which the joint will neither open nor close any further. Generally all people have a similar ROM for their major joints 42

43. Passive Range of Motion If a client is unable to move, the nurse helps by performing passive range of motion (PROM) exercise. 43

44. Range-of-Motion Exercises Are performed several times a day by placing each joint through its full functional motion. Purposes: To maintain full flexibility, To maintain muscle strength To prevent contractures and To improve circulation 44

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47. BED MAKING 47 5/6/2019

48. Learning Objective ƒ Describe different types of bed making ƒ develop understanding about general instruction of bed making ƒƒ Mention purposes of bed making ƒ List necessary equipment for bed making Arrange bed-making equipment in order of their use . 5/6/2019 48

49. Bed making It is a scientific way of preparing a bed for the pt. A clean, dry, smooth bed enhances pt’s feeling of well-being. If the linens are soiled, wet, or stained, they need to be changed. In most instances beds are made after pt receives certain care 49 5/6/2019

50. Bed making … Unoccupied bed can be both open and closed Closed Bed :- is a smooth, comfortable and clean bed, which is prepared for a new patient In Closed Bed: the top sheet, blanket and bed spread are drawn up to the top of the bed and under the pillows . 5/6/2019 50

51. Closed bed 5/6/2019 51

52. Making bed… Open bed: is one which is made for an ambulatory patient are made in the same way but the top covers of an open bed are folded back to make it easier of a client to get in. . 5/6/2019 52

53. Open bed 5/6/2019 53

54. Con… Occupied bed:- is a bed prepared for a weak patient who is unable to get out of bed 5/6/2019 54

55. Placement of linen during an occupied bed linen change 55 5/6/2019

56. Anaesthetics/post operative/surgical bed It is a bed used when clients have left for operating room or procedural area Purpose : To facilitate the clients transfer from stretcher to bed Patients having surgery 56 5/6/2019

57. Con… Amputation bed: a regular bed with a bed cradle and sand bags Purpose : To leave the amputated part easy for observation Bed cradle : is a frame made of wire/ wood to keep bed linen off the injured part Fracture bed : a bed board under normal bed and cradle Purpose : to provide a flat, unyielding surface to support a fractured part Cardiac bed : is bed for pt with heart problem Purpose : to ease difficulty in breathing 57 5/6/2019

58. BED POSITIONS 58 5/6/2019

59. RULES FOR BEDMAKING Use good body mechanics at all times Follow standard precautions wash your hands before handling Bring enough linen into the person’s room Always keep clean linen covered Never put dirty linens on the floor or On top of clean linen!!! Roll dirty linen away from your body when removing it from the bed 59 5/6/2019

60. Mattress pad Bottom sheet Draw sheet Top sheet Blanket Bedspread Pillowcase COLLECT LINEN IN THE FOLLOWING ORDER Once you have collected the linen, turn the stack over onto the other hand 60 5/6/2019

61. CHANGING THE PILLOWCASE 61 5/6/2019

62. PURPOSES OF BEDMAKING Provides comfort Bed must be free from all wrinkles because wrinkles cause discomfort and can lead to formation of decubitus 5/6/2019 62

63. Why is it so important? The bed is particularly important to people who are ill. It is essential keep the bed as clean and comfortable as possible. Physical Comfort Psychological comfort 5/6/2019 63

64. Making bed … Fold, the bed spread half way down from the head Fold the bedding neatly up over patient Roll dirty bottom sheet close to patient Put on clean bottom sheet on used top sheet center, fold at center of bed, rolling the top half close to the patient, tucking top and bottom ends tightly and mitering the corner Put on rubber sheet and draw sheet if needed Turn patient towards you on to the clean sheets and make comfortable on the edge of bed 5/6/2019 64

65. Making bed … Go to the opposite side of bed. Taking basin and wash cloths with you, give patient back care Remove dirty sheet gently and place in dirty pillow case, but not on the floor Remove dirty bottom sheet and unroll clean linen Tuck in tightly at ends and miter corners Turn patient and make position comfortable 5/6/2019 65

66. Making bed … Back rub should be given before the patient is turned on his /her back Place clean sheet over top sheet and ask the patient to hold it if she/he is conscious Go to foot of bed and pull the dirty top sheet out Replace the blanket and bed spread 5/6/2019 66

67. Making bed … Tuck in along sides for low beds Leave sides hanging on high beds Turn the top of the bed spread under the blanket Turn top sheet back over the blanket and bed spread Change pillowcase, lift patient’s head to replace pillow. 5/6/2019 67

68. Making bed … Loosen top bedding over patient’s toes and chest Be sure the patient is comfortable Clean bedside table Remove dirty linen, leaving room in order Wash hands 5/6/2019 68

69. PEACE FOR ALL !!!!!! 69 I THANK YOU ALL!!!!!! 5/6/2019

70. Wound care AND DRESSING 70

71. Objectives At the end of the unit students will be able to; Describe the physiology of wound healing Differentiate between primary, secondary, and tertiary wound healing Describe different classifications of wound Discuss common complications of wound healing. Describe the principles of wound assessment and care 71

72. Wound care and dressing The skin is the body’s largest organ and is the primary defense against infection. FUNCTIONS OF THE SKIN Regulates body temperature. Prevents loss of essential body fluid Protection of the body from harmful effects of radiation Excretes toxic substances with sweat Mechanical support. Sensory organ for touch, heat, cold, socio-sexual Vitamin D synthesis from its precursors under the effect of sunlight 72

73. what is the definition of Wound and wound healing

74. Wound-definitions A loss of continuity of the skin or mucous membrane which may involve soft tissues, muscles, bone and other anatomical structure. 74 Any disruption to layers o the skin and underlying tissues due to multiple causes including trauma, surgery, or a specific disease state . WOUND HEALING Healing is a quality of living tissue; it is also referred to as regeneration (renewal) of tissue

75. Types of wound healing 1.p rimary union:- (Healing by first intension ) occurs in wounds with minimal tissue loss , such as surgical incisions or sutured wounds. Edges are approximated (close to each other); thus they seal together rapidly. Scaring and infection rate with first intention healing are low . 75

76. 2. s econdary union ( h ealing by secondary intention) It healing occur when the wound edges can’t be brought together. occurs with tissue loss, such as in deep laceration, burns, and pressure ulcers. Because edges don’t approximate, openings fill with granulation tissue that is soft and pinkish. The risk of infection is greatly increased by the partially large-scale loss of tissue, or an infection has already occurred. The healing of such wounds often leads to major scarring. Secondary wound healing occurs e.g. in acute wounds with large tissue loss as in dog bites, when primary closure is not possible, or in chronic wounds . Later, epithelial cells grow over the granulation greater than that for first intention healing .

77. 3.h ealing by third intension:- occurs when there is a delay in the time between the injury and closure of the wound. E.g , a wound may be left open temporarily to allow for drainage or removal of infectious materials. This type of healing some times occurs after surgery, when the wound closes later. Scaring is common.

78. Physiology of wound healing When an injury is sustained, a complex set of responses is set into motion The body begins a three-phase process of wound healing a. The inflammatory phase (3-6 days) b. The regenerative (Proliferative ) (day 4-day21) c. The maturation (Remodeling) (day 21- 1/2 yrs ) 78

79. Defensive (Inflammatory) Phase Occurs immediately after injury and lasts about 3 to 6 days. The major events that occur in this phase are; Hemostasis, or cessation of bleeding, Occurs by vasoconstriction of large blood vessels in the affected area . Platelets, activated by the injury, aggregate to form a platelet plug and stop the bleeding. 79

80. This clotting cascade results in the formation of fibrin. The result is fibrin clot formation which Provides initial wound closure Prevents excessive loss of blood and body fluids & Inhibits contamination of the wound by microorganisms . 80

81. Inflammation Is the body’s defensive adaptation to tissue injury It involves both vascular and cellular responses. During the vascular response, tissue injury and activation of plasma protein systems stimulate the release of various chemical mediators, such as Histamine (from mast cells), Serotonin (from platelets) and kinins . 81

82. These vasoactive substances cause blood vessels to dilate and become more permeable This increases blood flow and leakage of serous fluid into the surrounding tissues. The increased blood supply; Carries nutrients and oxygen Transports leukocytes to the area to participate in phagocytosis, Removes the “debris of battle,” 82

83. con… Debris of the battle includes; dead cells, bacteria, and exudates, or material and cells discharged from blood vessels. The area becomes red , edematous , and warm to touch, and it has varying amounts of exudate as a result During the cellular response, leukocytes move out of the blood vessel into the interstitial space . Neutrophils are the first cells to arrive at the injured site and begin phagocytosis . 83

84. Reconstructive (Proliferative) Phase It begins on the third or fourth day after injury and lasts for 2 to 3 weeks. cytokines released by inflammatory cells drive the proliferation of the fibroblasts and the formation of granulation tissue This phase contains the process of collagen deposition, angiogenesis, granulation tissue development and wound contraction. Collagen is the most abundant protein in the body and is the material of tissue repair. 84

85. con… Through time it cross-links to form collagen fibrils and adds tensile strength to the wound. The wound can resist normal stress such as tension or twisting after 15 to 20 days. During this time, a raised “healing ridge” may be visible under the injury or suture line. 85

86. Maturation Phase Maturation phase is the final stage of healing Begins at about 21 day and may continue for up to 1/2 years or more During this phase, the scar tissue is remodeled( wound to provide strength in the region , ). Although the scar tissue continues to gain strength, it remains weaker than the tissue it replaces. 86

87. Sign and Symptom of Presence of wound Infection 87

88. Sign and Symptom of Presence of Infection Wound is swollen. Wound feels hot on palpation. Drainage is increased and possibly purulent. Foul odor may be noted.. 88

89. Wound assessment A complex process Involve examination of the entire wound Clinician visually assess wounds and document their findings to monitor and evaluate the progress of wound healing What to assess? Location Dimensions/Size Exudates/Drainage Pain Stage or extent of tissue damage Swelling 89

90. Wound Drainage/Exudates =Exudates is material, such as fluid and cells, that has escaped from blood vessels during the inflammatory process and deposited in or on tissue surfaces. = The Nature and amount of exudates vary according to : -Tissue involved, -The presence of microorganisms 90

91. Types of Wound Drainage 1.Serous Exudate Mostly serum Watery, clear of cells E.g., fluid in a blister 91

92. 2. purulent Exudates Is thicker than serous exudates because of the presence of pus. It consists of leukocytes, liquefied dead tissue debris, dead and living bacteria. The Process of pus formation is referred to as suppuration, and the bacteria that produce pus are called pyogenic bacteria. 92

93. 3. A sanguineous (hemorrhagic) Exudate It consists of large amount or blood cells, indicating damage to capillaries that is very severe enough to allow the escape of RBCs from plasma This type of exudate is frequently seen in open wounds. Nurses often need to distinguish whether the exudate is dark or bright. Bright indicate fresh blood, whereas dark exudate denotes older bleeding. 93

94. Wound Classification A variety of terms are used to describe and classify wounds. Wounds are usually described based on their etiology since the treatment for the wound varies depending on the underlying disease process. the status of skin integrity, cleanliness of wounds the extent of tissue damage,( Thickness of Skin Loss ) descriptive qualities of the wound such as color. 94

95. Based on Cause of Wound Intentional wounds occur during treatment or therapy. These wounds are usually made under aseptic conditions . Examples include surgical incisions and veni punctures. Unintentional wounds are unanticipated and are often the result of trauma or an accident. These wounds are created in an unsterile environment and therefore pose a greater risk of infection . 95

96. Based on skin continuity ( the status of skin integrity) Open wound:- is when there is a break in the skin or mucous membrane, c losed wound :- is when there is injury to the underlying tissue without breaking in the skin or mucous membrane. 96

97. Based on degree of on the Cleanliness of Wound 1. Clean wounds A re intentional wounds that were created under conditions in which no inflammation was encountered and the respiratory, alimentary, genitourinary, and oropharyngeal tracts were not entered. ( expected infection rate: 1% to 5%) 2. Clean-contaminated wounds Are intentional wounds that were created by alimentary, respiratory, genitourinary, or oropharyngeal tract under controlled conditions. (infection rate: 8% to 11%) 97

98. 3. Contaminated wounds are open, traumatic wounds or intentional wounds in which there was a major break in aseptic technique , spillage from the gastrointestinal tract, or incision into infected urinary or biliary tracts. have acute non purulent inflammation present. ( infection rate: 15% to 20% 4. Dirty and infected wounds are traumatic wounds with retained dead tissue or intentional wounds created in situations where purulent drainage was present. (infection rate: 27% to 40%) 98

99. Classification by Thickness of Skin Loss This classification system is based on the depth of the wound and is used for wounds whose etiology is other than pressure wounds such as skin tears,, vascular ulcers, surgical wounds or burns. 99

100. Classification By Thickness Of Skin Loss … Superficial epidermal (first degree) : Are confined to the epidermis layer, which comprises the four outermost layers of skin. Partial-thickness (first to second degree) : Involves the epidermis and upper dermis, which is the layer of skin beneath the epidermis. 100

101. Deep (second degree) : Involves the epidermis and deep dermis. Full thickness (third degree) : Refers to skin loss that extends through the epidermis and the dermis, and into subcutaneous fat and deeper structures. Fourth degree : Are deeper than full-thickness loss, extending into the muscle and bone. 101

102. The RYB Wound Classification System This classification assist the nurses in assessing the wound surface color. The three color system is a tool to direct treatment of open wounds With each color corresponding to specific therapy needs . 102

103. Red wounds Are the color of normal granulation tissue and are in the proliferative phase of wound repair. These wounds need to be protected and kept moist and clean . 103

104. How to protect red wounds: Gentle cleansing Applying a topical antimicrobial agent. Appling a transparent film/hydrocolloid dressing. Changing the dressing as infrequently as possible . 104

105. Yellow wounds Have purulent exudate from bacteria. These wounds need to be cleansed of the purulent exudate, and nonviable slough needs to be removed. 105

106. Mgt may include Applying wet-to-wet dressing; irrigating the wound; using absorbent dressing material such as impregnated no adherent, hydro gel dressing, or other exudates absorbers; topical antimicrobial to minimize bacterial growth . 106

107. Black Wound Covered with thick necrotic tissue or scar. e.g third degree burns and gangrenous ulcer. Required debridement . When the scar is removed, the wound is treated as yellow, then red. 107

108. Care of wounds Since there are many types of wound, there are also many ways of caring for wounds depending on the type of wound. Ex:- clean wounds, septic wounds wound with drainage tube, wound that need irrigation. The care is done as an open method & clean method Open method :- refers to the care of wound with out dressing. Closed method :- is the care of wound with dressing 108

109. Cleanse the Wound The goal of cleansing the wound is to remove debris and bacteria from the wound with little trauma to the healthy granulation tissue as possible. Choice of cleansing agent depends on the physician’s prescription as well as agency protocol. It is recommended that isotonic solutions such as normal saline used to preserve healthy tissue. Note -principles to keep in mind when cleansing a wound are: 1. Use Standard Precautions at all times. 2. work from the clean area to toward the dirty area. Example: -When cleaning a surgical incision, start over the incision line, and swab downward from top to bottom. 109

110. Antiseptics used for wound care Iodine 1%:- for small, dry and clean wounds Hydrogen peroxide3%:- to clean septic wound Savalon 1%:- for normal wound care Savalon 3-5% for very septic wounds normal saline 0.9% for wound irrigation GV 1% - for dry, clean wound potassium permanganet 1:1000 as a disinfectant ( soacks ) Ointments Petroleum (Vaseline gauze):- is used to protect tissue from drying It prevent dressing adherence to the wound f uracin gauze :- antibacterial materials used for wound care. 110

111. Irrigating a wound Defn:- Is the washing out of a wound. Purpose- To remove excess drainage with sloughing tissue To facilitate healing. To apply antiseptic solution To cleanse and maintain free drainage of infected wound. 111

112. Discussion point Discuss Factor affecting wound healing

113. Factors Affecting Wound Healing Wounds may fail to heal or may require a longer healing period when unfavorable conditions exist. Factors that may negatively influence healing include age , nutrition , oxygenation , smoking , drug therapy and diseases such as diabetes. 113

114. Age :- Blood circulation and oxygen delivery to the wound, clotting, inflammatory response, and phagocytosis may be impaired in the very young and the elderly people Nutrition :- A balanced diet is needed to increase the body’s resistance to pathogens and to decrease the susceptibility of skin and mucous membranes to infection and trauma 114

115. Oxygenation :- Decreased arterial oxygen tension alters the synthesis of collagen and the formation of epithelial cells, causing wounds to heal more slowly Smoking :- Functional hemoglobin levels decrease, impairing oxygenation to tissues Drug-therapy :- Steroids and anti-inflammatory drugs suppress protein synthesis, wound contraction, epithelialization, and inflammation. 115

116. Discussion point Discus with in pair what are the important of Dressing 116

117. Dressing:- It is covering the wound with sterile material after cleaning with an antiseptic solution to provide the conditions necessary for healing. Purpose of dressing To provide proper environment for wound healing To absorb and promote drainage To splint or immobilize wound (prevent bleeding ) To protect the wound & new epithelial tissue from mechanical injury. 117

118. purpose… To protect the wound from contamination (microorganism) Provide mental and physical comfort to the patient To approximate edges of wounds To keep in position drugs applied locally. 118

119. Dressing equipments Pick up forceps Sterile bowl or kidney dish Sterile cotton balls Sterile galipot Sterile gauze Three sterile forceps Rubber sheet with its cover Antiseptic solution as ordered Adhesive tape or bandages Scissors Ointment or other types of drugs as needed Receiver Spatula if needed 119

120. NB :- Start wound cleaning from the cleanest part to the most contaminated part using antiseptic solution If sterile forceps are not available, use sterile gloves Immerse used forceps, scissors and other instrument in strong antiseptic solution before cleansing and discard soiled dressing properly. 120

121. In a big ward it is best to give priorities to clean wounds and then to septic wounds Consideration should be given to provide privacy for the patient while dressing the wound. Wounds should not be too tightly packed in effort to absorb discharge as this may delay healing. 121

122. Quize 1. What is the definition of wound and wound healing 2.List types of wound healing 3. Discus th classifications of wound 3.List factor affecting that affecting wound

123. Suturing 123

124. Suturing The application of stitch on body tissues with the surgical needle and thread or Sutures are a surgical means of closing a wound by sewing When placed deep within the tissue layers, sutures made of absorbable material are used(will not need to be removed) For surface closures, steel staples or sutures made of wire, nylon, cotton, or other materials are used 124

125. Purpose of suturing:- To approximate wound edges until healing occurs To speed up healing of wound To minimize the chance of infection For esthetic purpose(cosmetic appearance) 125

126. Suturing Equipment Tray or trolley covered with a sterile towel Sterile needle holder Sterile silk Sterile cat- gut Sterile tissue forceps Sterile scissors Sterile cotton swabs in a galipots Sterile solution for cleaning Sterile dressing forceps Sterile receiver Sterile gauze 126

127. Types of sutures material Sutures are of two types : Absorbable sutures Non absorbable sutures. 127

128. ABSORBABLE SUTURES Absorbable sutures are also known as catgut . A tough thin cord made from the treated and stretched intestines of certain animals, especially sheep This type of suture are commonly used to suture the inner structure of the body such as: Walls of the organs Rectal sheath Muscles Subcutaneous tissue Peritoneum Intestinal anastomosis Example:- Plain catgut, Chromic catgut, traumatic catgut 128

129. Non absorbable sutures These types of sutures are not absorbed. used for closing or suturing outer surface of the body such as skin. Is cheaper ,easy to handle and to sterile ,have smooth surfaces & knot securely with the ends cut short. 129

130. non absorbable … But these kind of sutures are liable to cause stitch infection The infection cab be arrested by only removing the stitch . For this reason sutures on the superficial surface of the skin should always be interrupted suture & never be continuous suture. Because the disadvantage of the continuous suture is when infection occurs on one site it is difficult to remove the infected stitch from the site without removing the rest of the stitch. 130

131. Types of non absorbable sutures a) Silk suture : Their sizes vary from 10/0 to 2 . These are used for skin closure after abdominal operation. b) Linen suture : their sizes vary form 3/0 to 2 . These are used for skin closure in hernia operation. c) Monofilament Nylon suture ( Ethilon ) Their sizes vary from 10/0 to 2. these sutures are used as tension sutures in hernia repair. d) Stainless steel wire used in areas of known infection. It is also used for secondary repair of disrupted wound. It is further used for surgery of ligament ,tendons. It is again used for repair of cleft lip .hair lip cleft palate ,hernia operations ,thoracic & orthopedic surgery . e) Prolene – Ethifex merseline : are used for cardiovascular & plastic surgery. 131

132. Methods of suturing stitches should not be too tight because extremely tight stitches may cause ischemia of the tissues that may lead to delayed healing. Also for the interrupted & continuous stitches the distances between stitches should be equal & all the knots in the interrupted stitches are placed at the one side of the surgical wound. 132

133. Types of stitches 1. Interrupted stitches It is the most commonly used technique in the closure of skin. It is interrupted stitch because the individual stitches aren't connected. Placing and tying each stitch individually is time-consuming, but this technique keeps the wound together even if one suture fails. The knot crosses the wound perpendicularly. 133

134. 2) Continuous stitches One in which a continuous, uninterrupted length of material is used. It means that the tissue is held together by a suture which runs over and over wound. Uses less suture material 134

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136. Removing Sutures 136

137. Removing Sutures Wounds typically heal in approximately 10-14 days. Scalp and facial wounds tend to heal a bit faster because of rich blood supplies to those areas When removing sutures, never pull a suture back through the skin. Sutures beneath tissue are sterile, but those that are visible are considered contaminated, and pulling them via the tissue introduces infection. Instead, cut the suture as close to the skin as possible on one side, then pull it through the skin from the other side. 137

138. Removal of the Stitch During the removal of suture use aseptic technique Sutures may be removed all at a time Suture is lifted slightly by the knot to allow scissors to go under and one part of the suturing from the cleanest part of the wound to the most contaminated part . 138

139. con… After the completion of the removal the area needs to be cleaned and dressed Keep patient comfortable and tide Bandages and binders are applied over wound dressing sites. Bandages are long rolls of material, such as gauze, webbing, designed to be wrapped around body parts. Binders are bandages made for specific body parts, usually the abdomen, perineal area or arm 139

140. Con… Abdominal binders support the abdomen and are used following abdominal surgery or childbirth. Perineal binders, called T binders, are used to hold pads or dressings in the Perineal area. Because of urination and defecation needs of clients, T binders must be changed regularly. A sling is a cloth support for an injured arm that wraps around the back of the neck to maintain the arm in a set position 140

141. Bandages, Binders , sling

142. Con… Generally the Purpose of bandaging/binder/ tape includes : To secure, immobilize, or support a body part; to hold a dressing in place or To prevent or minimize swelling of a body part 142

143. BOWEL AND URINARY ELIMINATION 143

144. BOWEL Elimination 144

145. Learning objective By the end of the this session students will be able to Define normal and altered bowel elimination Describe types of enema Explain purpose of enema 145

146. Learning objective By the end the secession students will be able to Define alter and normal bowel elimination Define Enema and catheterization Explain indication of enema and catheterization describe types of enema and cauterization 146

147. The Normal bowel movement Most adults experience bowel elimination every 1 to 2 days. The urge to defecate most commonly occurs 30 to 45 minutes after a meal, when the gastro colic and defecation reflexes stimulate peristalsis. The ideal frequency of bowel movements is 1 or 2 times per day. The goal is to have bowels completely emptied. Bowel movements should be soft and easy to pass, with no pain, straining or stool leakage 147

148. BOWEL ELIMINATION Diseases and conditions that affect bowel function are; Constipation Diarrhea and Fecal incontinence Colonic constipation is the infrequent and difficult passage of hardened stool. 148

149. Constipation(Causes) : Dietary factors may contribute to constipation. Dehydration causes drying of the stool Inadequate dietary bulk also dehydrates the stool. Diverticular disease, increases the chance of constipation. Neuropathic conditions diminishing the efficiency of gastric motility 149

150. Diarrhea Is the passage of liquefied stool that, because of its increased frequency and consistency, represents a change in the person’s bowel habits Causes Infectious agents Malabsorption disorders Inflammatory bowel disease Side effects of drugs and Laxative 150

151. Fecal Incontinence It is the involuntary loss of stool of sufficient magnitude to create a social or hygienic problem. The primary mechanisms that predispose the adult to incontinence of stool are; Dysfunction of the anal sphincter Disorders of the delivery of stool to the rectum Disorders of rectal storage and Anatomic defects 151

152. Enema Is the introduction of fluid into rectum and sigmoid colon for cleansing, therapeutic or diagnostic purposes Purpose: For emptying (cleanse the lower bowel)– soap solution enema For diagnostic purpose (to assist in the evacuation of stool) For introducing drug/substance (retention enema) 152

153. Con… Enemas can be classified as large or small depending on their purpose. Large-volume enemas ; Contains 500 to 1000 ml fluid Are administered to cleanse the bowel. Small-volume enemas ; Are used for the purpose of evacuating stool or instilling medications in the lower bowel. Usually found as prepackaged solutions which contain 150 to 240 ml fluid 153

154. Enema can also be classified into: Cleansing : before surgery or diagnostic studies Retention- should be retained at least for 30 minute Carminative- relieve of distension and flatulence 154

155. Cleansing enema Two kinds of cleansing High enema Is given to clean as much of the colon as possible Low enema Is administered to clean the rectum and sigmoid colon only 155

156. Solution used: Soap solution – sol. Soap 1gm in 20 ml of H2O Epsum salt 15 gm – 120 gm in 1,000 ml of H2O 156

157. Con… Guidelines Enema for adults are usually given at 40-43oc and for children at 37.7 oc Hot – cause injury to the bowel mucous Cold – uncomfortable and may trigger a spasm of the sphincter muscles The amount of solution to be administered depends on: Kind of enema The age of the person and The persons ability to retain the solution 157

158. Con… purpose To stimulate peristalsis and remove feces or flatus e.g. For constipation Preparation for an examination(Colonoscopy) Clean the rectum and colon For incontinent patients to keep the colon empty For diagnostic test, e.g. Before certain x-ray exam – barium enema To take stool specimen for certain parasites 158

159. Retention Enema Administration of solution to be retained in rectum for short or long period Are enemas meant for various purpose in which the fluid usually medicine is retained in rectum for short or long period for local or general effects E.g. Oil retention enema Antispasmodic enema 159

160. Con… Principles : Is given slowly by means of a rectal tube The amount of fluid is usually 150-200 cc Cleansing enema is given after the retention time is over Temperature of enema fluid is 37.4 c or body (Return flow Enema) Harris fluid 160

161. Con… Purpose To supply the body with fluid. To give medication E.g. stimulants, paraldehyde or antspasmodic . To soften impacted fecal matter. Other equipment is similar except that the tube for retention enema is smaller in width . 161

162. Procedure of Administering a Enema Equipments Enema bag Bedpan, commode, or toilet Towel and washcloth Solution per physician’s order Water-soluble lubricant Clean gloves Towel and washcloth 162

163. Procedure … Introduce yourself and explain procedure. Prepare the solution, assure temperature within range of 99° to 102°F by using a thermometer or placing a few drops on your wrist. Wash hands and don gloves. Assist patient to left side-lying position, with right knee bent. 163

164. Procedure … Lubricate 4 to 5 inches of catheter tip. Place bedpan, commode, robe and slippers within easy reach. Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 4 inches. Slowly infuse solution via gravity flow; bag height may be increased but not to exceed 18 inches above anal opening 164

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166. Procedure … If client complains of increased pain or cramping or if fluid is not being retained, stop procedure, wait a few minutes, then restart. Clamp tubing when fluid finishes infusing; remove catheter tip. Assist client to bedpan, commode or toilet Discard equipment in proper place Remove gloves and wash hands. Instruct client to call for assistance when finished eliminating 166

167. Urinary Elimination Catheterization :- Is the introduction of a tube (catheter) through the urethra into the urinary bladder Is performed only when absolutely necessary for fear of infection and trauma NB :- Strictly a sterile procedure, i.e. the nurse should always follow aseptic technique 167

168. Purpose For incontinent as last resort that is if other measures have been exhausted Relieving bladder distention when clients cannot void Assessing fluid balance accurately 168

169. Purpose… Keeping the bladder from becoming distended during procedures such as surgery Obtaining sterile urine specimens Instilling medication within the bladder

170. Types of Catheters 1. External Catheters An external catheter is not inserted within the bladder; instead, it surrounds the urinary meatus . Examples condom catheter It is more effective for male clients. 170

171. Application of condom catheter 171 5/3/2019 asiya.H

172. 172 5/3/2019 asiya.H

173. 2. Internal catheter 2.1 Straight Catheters(plain or robinson ) A straight catheter is a urine drainage tube inserted but not left in place. It drains urine temporarily or provides a sterile urine specimen

174. . 2.2 Retention Catheters( foley or indwelling) A retention catheter , also called an indwelling catheter, is left in place for a period of time The most common type is a Foley catheter. 174 Types of urinary catheters A ) Retention (Foley) catheter(2, 3 way) with balloon . ( B ) Straight catheter .

175. Purpose of indawelling To manage incontinence To provide for intermittent or continuous bladder drainage and irrigation To prevent urine from contacting an incision after perineal surgery (prevent infection) To measure urine out put needs to be monitored hourly

176. Unlike straight catheters, retention catheters are secured with a balloon that is inflated once the distal tip is within the bladder. Both straight and retention catheters available in various diameters, sized according to the French scale: for adults, sizes 14, 16, and 18 F are commonly used . 176

177. Position-dorsal recumbent Female-for better view of urinary meatus -Reduce risk of catheter contamination Male-allows greater relaxation of abd. & perennial muscle

178. Equipment for catheterization Sterile Kidney dish Galipot Gauze Towel Solution Lubricant Catheter Syringe Water Specimen bottle Gloves 178

179. II . Clean Waste receiver Rubber sheet Flash light Measuring jug Screen

180. Thank you 180

181. Summary question Discus types of catheter Discus the purpose of each types of catheter why catheterization follow strictly aseptic techniques 181

182. OXYGEN THERAPY

183. Learning objectives: Define the oxygen therapy Discuss the type of oxygen therapy List the purpose of using the oxygen therapy Explain procedure List Complication of oxygen therapy

184. OVERVIEW Introduction Indications Oxygen delivery systems Complications of oxygen therapy

185. Oxygen therapy Definition: Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive.

186. What is meaning of O2 therapy Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere The air that we breathe contain approximately 21% oxygen T he heart relies on oxygen to pump blood.

187. Purpose The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury.

188. O 2 Therapy : CLINICAL OBJECTIVES Correct documented or suspected hypoxemia The symptoms associated with chronic hypoxemia Decrease the workload hypoxemia imposes on the cardiopulmonary system

189. INDICATIONS acute respiratory failure acute myocardial infarction cardiac failure shock hypermetabolic state induced by trauma, during anaesthesia for surgery

190. oxygen therapy is used to treat Example in case :- Documented hypoxemia Severe respiratory distress (acute asthma or pneumonia) Severe trauma Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)

191. OXYGEN a prescribed drug must be written legibly by the doctor prescription should be dated by the doctor during prescribed o2 doctor must indicate duration concentration flow rate

192. Preparation A physician's order is required for oxygen therapy , except in emergency use. Clinical observations. indicated in Artial Blood Gas measurements,(ABGs ) . Pulse Oximetry.

193. Pulse oximetry

194. Cautions For Oxygen Therapy Oxygen toxicity – can occur with FIO2 > 50% longer than 48 hrs Danger of fire Infection

195. ASSESSMENT The need for oxygen therapy should be assessed by 1. monitoring of ABG - PaO2 2. clinical assessment findings .

196. PaO2 as an indicator for Oxygen therapy PaO2 : 80 – 100 mm Hg : Normal 60 – 80 mm Hg : cold, clammy extremities < 60 mm Hg : cyanosis < 40 mm Hg : mental deficiency memory loss < 30 mm Hg : bradycardia cardiac arrest PaO2 < 60 mm Hg is a strong indicator for oxygen therapy

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198. Oxygen supply Piped in wall outlets – at the client’s bedside Portable (Tanks or cylinders) – for transporting oxygen dependent clients, in home use; Humidifier – add water vapor to inspired air because Oxygen is a dry gas that dehydrates respiratory mucous membrane Prevents mucous membrane from drying and becoming irritated Loosens secretions for easier expectoration

199. Classification of Oxygen Delivery Systems Low flow systems contribute partially to inspired gas client breathes Ex: nasal cannula, simple mask , non-re breather mask , Partial rebreather mask High flow systems deliver specific and constant percent of oxygen independent of client’s breathing Ex: Venturi mask,, trach collar, T-piece

200. Methods of oxygen administration: 1- Nasal cannula

201. Nasal cannula It is a disposable. plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. Used for low-medium concentrations of Oxygen (24-44%).

202. Nasal cannula It is a disposable. plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. Used for low-medium concentrations of Oxygen (24-44%).

203. Face mask The simple Oxygen mask The partial rebreather mask: The non rebreather mask: The venturi mask:

204. The simple Oxygen mask Simple mask is made of clear, flexible , plastic or rubber that can be molded to fit the face.

205. The simple Oxygen mask It delivers 35% to 60% oxygen . A flow rate of 6 to 10 liters per minute. Often it is used when an increased delivery of oxygen is needed for short periods (i.e., less than 12 hours ).

206. The partial rebreather mask The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not rebreathe large amounts of exhaled air. The remaining exhaled air exits through vents.

207. The non rebreather mask This mask provides the highest concentration of oxygen (95-100%) at a flow rate6-15 L/min. It is similar to the partial rebreather mask except two one-way valves prevent conservation of exhaled air. The bag is an oxygen reservoir

208. Venturi mask It is high flow concentration of oxygen . Oxygen from 40 - 50% At liters flow of 4 to 15 L/min .

209. T-piece Used on end of ET tube when weaning from ventilator Provides accurate FIO2 Provides good humidity

210. Complications of Oxygen therapy

211. Complications of Oxygen therapy Oxygen toxicity . Retinopathy of Prematurity Absorption atelectasis Fire hazard

212. oxygen toxicity It is a condition in which ventilator failure occurs due to inspiration of a high concentration of oxygen for aprolonged period of time. Oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs.

213. Signs and symptoms of oxygen toxicity: • Non-productive cough. • Nausea and vomiting. • Substernal chest pain. • Fatigue. • Nasal stuffiness. • Headache. • Sore throat. • Hypoventilation. . Nasal congestion. . Dyspnea. . Inspiration pain.

214. Evaluation: Breathing pattern regular and at normal rate. pink color in nail beds, lips, conjunctiva of eyes. No confusion, disorientation, difficulty with cognition. Arterial oxygen concentration or hemoglobin Oxygen saturation within normal limits.

215. Documentation: Date and time oxygen started. Method of delivery. Oxygen concentration and flow rate. Patient observation. Add oronasal care to the nursing care plan

216. O2 DELIVERY DEVICES EQUIPMENT FLOW FIO2 SPECIAL NOTES NASAL CANNULA 1/2 - 6 L/M .24 – 44 6 L/M MAX. SIMPLE O2 MASK 6 - 10 L/M .35 – 55 USE 5 L/M (WITHOUT BAG) MINIMUM RESERVOIR MASK 10-15 L/M .60 -80 PAGE RT IF USED (MASK WITH BAG) (BAG TO NOT COLLAPSE) VENTI MASK 3 L/M .24, 26, 31, READ ENCLOSED 6 L/M .35, .40, .50 INSTRUCTIONS NEBULIZER 8 L/M OR > .28, .30, .35 MIST MUST BE .40, .50, 70 VISIBLE *** SHOWS THAT FIO2 VARIES WITH DIFFERENT F, VT, INSPIRATORY FLOW RATES.

217. Sleep and rest Normal sleep and rest function Altered sleep and rest function 5/18/2024 217

218. Objectives At the end of the session the students will be able to: 1. Define sleep, rest 2. List functions of sleep 3. List signs of sleep deprivation 4. Explain physiology of sleep 5. Identify the characteristics of REM & NREM sleep 6. Give the stages of NREM 7. List factors affecting normal sleep 8. Describe nursing interventions that promote normal sleep. 5/18/2024 218

219. Sleep and rest 219

220. Sleep and rest con--- Rest: Rest implies to calmness, relaxation without emotional stress, freedom from anxiety . Sleep: It is a basic human need .  Sleep is a biological process common to all human beings. It is an altered state of consciousness in which individual’s perception and reaction to environment or stimuli are decreased . lessened movement of the skeletal muscles, and slowed-down metabolism 5/18/2024 220

221. con… is a naturally recurring state of mind and body, characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity and inhibition of nearly all voluntary muscles during rapid eye movement (REM) sleep and reduced interactions with surroundings Sleep occurs in repeating periods 5/18/2024 221

222. Sleep and rest con… Characteristics of sleep: 1. Minimal physical activity 2 . Changes in the body’s physiological processes 3. Decreased response to external stimuli 4. Relatively Easily to reverse 4,reduce consciousness 5/18/2024 222

223. Functions of sleep: (essential for health) 223

224. Sleep and rest con--- Functions of sleep: (essential for health) 1. To regain health after illness 2. Restores person’s energy 3. Restores normal level of activity and balance among parts of the nervous system 4. Necessary for protein synthesis for repairs to  occur. 5/18/2024 224

225. type of Sleep non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep Non-REM and REM sleep are so different that physiologists identify them as distinct behavioral states. 5/18/2024 225

226. 5/18/2024 226

227. Non rapid eye movement sleep : Deep and restful sleep brings a decrease in some physiologic functions as metabolism, vital signs. During this phase, body temperature and heart rate fall, and the brain uses less energy 5/18/2024 227

228. Rapid eye movement It is chacterized as;   Recurs every 90 minutes    Not restful as NREM   Dreams take place in this sleep eye movements, loss of muscle tone 5/18/2024 228

229. Rapid eye movement… Increase in H.R., B.P., and breathing rate Breathing more shallow and irregular Eyes jerk rapidly Limb muscles temporarily paralyzed Most people have 3-5 intervals of REM each night Infants spend 50% of time in REM 5/18/2024 229

230. Stages of sleep Stages of sleep are checked by EEG . Electrodes are placed on various part of the sleeper’s scalp which record the brain waves on graph paper. The electrodes transmit energy from the cerebral cortex to record on the graph paper. 5/18/2024 230

231. Stages Stage 1 Light sleep, drift in and out, awaken easily Eyes move slowly, muscle activity slows May experience a sense of falling followed by sudden muscle contractions Eyes roll side to side Person feels drowsy and relaxed. Heart and respiratory rates drop slightly lasts for few minutes 5/18/2024 231

232. Stage 2 Eye movement stops Body processes continue to slow down Lasts for 10-15 minutes or up to 25 minutes Stage 3 Heart and respiratory rate further slows Parasympathetic nervous system dominates Difficult to arise the sleeper  Skeletal muscles are very relaxed Considered deep sleep No eye or muscle movement, difficult to awaken Time when sleep walking, bed wetting, or terrors occur 5/18/2024 232

233. Sleeper may snore Lasts for 20-40 minutes 5/18/2024 233

234. Stage 1V 1. Also known as delta sleep or deep sleep 2. Sleeper is very relaxed 3. Thought to restore the body physically 5. Heart and respiratory rate fall about 20-30% of during aweaking 5/18/2024 234

235. Discussion point Discuss Factor that increased comfort rest and sleep 5/18/2024 235

236. Factor that increased comfort rest and sleep The promotion of daily exercise . The avoidance of , caffeine , heavy meals and exercise at least a couple of hours before bedtime. The promotion of comfort using techniques such as white noise, dim lighting, pain management, stress reduction techniques, massage and the elimination of environmental noise 5/18/2024 236

237. How much sleep do we need ? Infant Children Adult 5/18/2024 237

238. How much sleep do we need? Infants 16-20 Toddlers( young child 12-14 Pre School 11-13 School Age 10-11 Teens 9.5-10 Most adults need 7 ½ -8 hours to function well About 10% require more or less sleep Pregnant women need more sleep 5/18/2024 238

239. sleep deprivation Sleep deprivation is not a specific disease . It is usually the result of other illnesses and life circumstances that can cause its own symptoms and poor health outcomes . Sleep deprivation means you're not getting enough sleep 5/18/2024 239

240. The common negative effects of sleep deprivation include feeling too sleepy during the day, accidents from lack of attention, mood changes, and change in appetite . Reducing your sleep time by even 1 hour can affect your thought process and reaction time the following day 5/18/2024 240

241. Sleep Deprivation Can Lead to Serious Health Problems Heart disease(Heart failure). Irregular heartbeat. High blood pressure. Stroke. 5/18/2024 241

242. WHAT ARE CAUSE OF SLEEP DEPREVATION 5/18/2024 242

243. What causes sleep deprivation? Sleep disorder. These include insomnia, sleep apnea, narcolepsy, and restless legs syndrome. Aging. People older than 65 have trouble sleeping because of aging, medicine they're taking, or health problems they're having. Illness . ... 5/18/2024 243

244. In the simplest terms, chronic sleep deprivation refers to the case of getting insufficient sleep or experiencing sleeplessness over an extended period of time . Chronic sleep deprivation can vary in its severity 5/18/2024 244

245. What is poor sleep hygiene? Inadequate sleep hygiene is a form of insomnia primarily caused by bad sleeping habits . Many common factors may keep you awake at night, such as: Background noise. Temperature extremes. Uncomfortable bedroom 5/18/2024 245

246. Children 2/3 of children have several sleep problems per week 25%-40% of children have sleep disorders 10-12% snore regularly 5/18/2024 246

247. Discussion point Discuss Factor Contributors to Sleep Disorders 5/18/2024 247

248. Factor Contributors to Sleep Disorders Genetics Aging Menopause, hot flashes, hormone changes 1/3 of older adults have insomnia Overweight 40% have sleep apnea Diabetes ½ of people with sleep apnea have diabetes Pain/Illness Arthritis, osteoporosis, heart disease, lung disease, cancers Medications Stress 5/18/2024 248

249. Common Sleep Disorders Over 80 different disorders in world but the commonest one are Snoring/Apnea Insomnia 9-12% Lack of sleep during the night Narcolepsy (sleep attack during the day) Restless leg syndrome-5% sleep apnea (cessation of breathing during sleep ). 5/18/2024 249

250. Discussion point what are general symptoms of a sleep problem 5/18/2024 250

251. General Symptoms of a Sleep Problem Performance decrease: academic, physical, etc. Behavioral difficulties Irritable Hyperactive Frequent illness Headaches, jaw pain, earaches Depression, anxiety Daytime sleepiness 5/18/2024 251

252. General Symptoms of a Sleep Problem… Tiredness Poor control over emotions Deterioration (decline) in mental functioning  Have poor concentration Experience difficulty in decision making 5/18/2024 252

253. Insomnia 5/18/2024 253

254. 1/3 of Americans are affected by Insomnia 50% consider their insomnia serious 10% have been prescribed a medication for the insomnia 5/18/2024 254

255. Transient – less than 2 weeks (excitement or stress) Intermittent – repetitive episodes of transient ( personal/professional problems) Chronic – insomnia greater than 6 months (20 million Americans a year) 5/18/2024 255

256. What are the nursing intervention and sleep and rest 5/18/2024 256

257. Nursing Interventions to Promote rest and sleep 1. Nurse can promote sleep by supporting the rituals like music, TV, bath and prayer. 2. Creating a restful environment; darkened room or dim lit room can be provided 3. Noise should be reduced to minimum 4. Environmental distractions should be eliminated. 5/18/2024 257

258. Nursing Interventions to Promote rest and sleep 5. Providing comfort and relaxation 6. Loose fitting nightwear  7. Assisting in hygienic routines 8. Providing clean and dry linen 9. Offering back massage 10. Positioning in comfortable position 11. giving correct medication to avoid sleep interruptions 12. Enhancing sleep with medication .   5/18/2024 258

259. summary 1. What are the different between rest and sleep what are the normal function of sleep List the characteristics' of sleep and rest what are the common sleep disorder which types of autonomic nerve system activated during sleep 5/18/2024 259

260. QUESTIONS? Thank you!! 260

261. Thank you….