Gastric Analysis for nursing students in

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1. Gastric Analysis diagnostic procedure to measure the quantity and acidity of gastric secretions . Indications for Gastric Analysis Diagnostic: Peptic ulcer disease Gastric cancer anemia GERD Monitoring Treatment: Assessing acid-suppressing therapies (PPIs, H2-receptor blockers)

2. Cont.… Purpose of Gastric Analysis Evaluate gastric acid secretion levels. Diagnose acid-related conditions or low stomach acid. Monitor gastric function with stimuli or medications. Contraindications Recent gastric/esophageal surgery Severe gastric/esophageal bleeding Suspected gastrointestinal perforation Unstable medical conditions (e.g., severe cardiovascular instability)

3. Cont.… Precautions Ensure patient is fasting for 8–12 hours. Assess for medication allergies (e.g., histamine). Watch for signs of distress (nausea, dizziness). Position to reduce aspiration risk. Equipment Specific : NG tube or gastric suction tube pH indicator strips or pH meter Syringes for sample collection Gastric stimulants (if needed) General: PPE Suction apparatus Specimen containers

4. Procedure Verify identity, get informed consent. Explain the procedure to reduce anxiety. Ensure fasting (NPO). Position patient comfortably . Insert NG tube, confirm placement. Collect baseline gastric secretions. If required, administer gastric stimulant and collect samples at intervals. Measure pH and volume of gastric contents . Remove NG tube gently. Monitor for complications. Provide oral care.

5. Complication Discomfort during NG tube insertion Nausea or vomiting Throat irritation Aspiration of gastric contents Reactions to gastric stimulants (flushing, hypotension, tachycardia) Nasal/esophageal trauma

6. Assisting the Patient in Endoscope Examination supporting the patient and physician during procedures using an endoscope (flexible or rigid tube with a camera and light) to visualize internal structures ( e.g., esophagus, stomach, intestines, airways).

7. Types of Endoscopic Procedures Upper Endoscopy (EGD): Examines the esophagus, stomach, and duodenum. Colonoscopy: Examines the colon and rectum. Bronchoscopy: Visualizes airways and lungs. Cystoscopy: Examines the bladder and urethra. Sigmoidoscopy: Inspects the lower colon. Laparoscopy: Examines abdominal or pelvic organs.

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9. Indications for Endoscopy Diagnostic : GI bleeding Abdominal pain, nausea, vomiting, diarrhea Suspected tumors or cancers Inflammatory bowel diseases (e.g., Crohn's, ulcerative colitis) Therapeutic: Removal of foreign bodies, polyp/tumor excision Biopsy collection

10. Cont.… Purpose of Endoscopy Diagnose or treat internal organ disorders. Guide interventions like biopsies. Monitor disease or treatment progress. Contraindications Severe cardiopulmonary instability Perforation of the organ to be examined Uncontrolled bleeding Severe infections (e.g., sepsis) Non-cooperative patients

11. Precautions Ensure fasting (6–12 hours) before procedure. Review medical history (allergies, medications). Stop blood-thinning medications as directed. Confirm informed consent and sedation protocols . Equipment Endoscope System: Flexible/rigid endoscope, light source, camera Suction apparatus, biopsy tools Support Equipment: Oxygen supply, monitoring devices Sedation, emergency resuscitation equipment Specimen containers, sterile covers

12. Procedure Confirm identity, explain the procedure. Ensure fasting and bowel prep (for colonoscopy). Position patient: Upper endoscopy: Left lateral Colonoscopy: Left lateral, knees drawn up Administer sedation or local anesthesia .

13. Cont.… Assist with endoscope insertion. Monitor vital signs. Provide suction, assist with biopsies/interventions. Ensure patient comfort and safety . Monitor recovery from sedation (e.g., drowsiness, nausea). Educate on post-procedure symptoms (sore throat, abdominal discomfort). Encourage hydration and gradual diet reintroduction.

14. C omplication Common: Discomfort (e.g., bloating, sore throat) Nausea/vomiting from sedation Serious (rare): Perforation Bleeding (biopsy, polyp removal) Aspiration Sedation/anesthesia reactions Infection

15. Gastric Aspiration involves removing stomach contents through a nasogastric (NG) or gastrostomy tube for diagnostic, therapeutic, or monitoring purposes.

16. Cont.… Indications Diagnostic: Analyze gastric acidity, volume, or detect pathogens Test for Helicobacter pylori Assess gastric emptying or motility

17. Cont.… Therapeutic: Relieve gastric distension Remove toxins or poisons Prepare for surgery Monitoring: Evaluate effectiveness of acid-suppressing medications Monitor gastrointestinal bleeding

18. Cont.… Contraindications Recent nasal, esophageal, or gastric surgery Severe bleeding disorders Facial trauma or nasal obstruction GI tract perforation Precautions Verify patient identity and medical history Confirm proper tube placement Use aseptic techniques Avoid excessive suction pressure

19. Equipment Basic : NG or gastrostomy tube Sterile syringe (50 mL) Low intermittent suction device Specimen containers Supportive: PPE (gloves, mask) pH test strips/meter Saline for flushing

20. Procedure Preparation : Explain procedure; obtain consent Position patient in semi-Fowler's Perform hand hygiene NG Tube Insertion: Measure tube length (nose-ear-xiphoid) Lubricate and insert through nostril Verify placement by aspirating and checking pH

21. Cont.… Aspiration: Manual: Attach syringe and aspirate gently Mechanical: Use suction device for gradual removal Collect aspirate in sterile containers if needed Post-Aspiration: Flush tube with saline Monitor patient for discomfort Label and send samples for analysis

22. Complications Common : Nasal or throat irritation Mild discomfort or gagging Serious: Aspiration pneumonia Esophageal or gastric damage Tube misplacement Bleeding from tissue trauma

23. Performing Gastrostomy Feeding A method to deliver nutrition, fluids, and medications directly into the stomach using a gastrostomy tube (G-tube ).

24. Cont.…

25. Cont.… Indications Swallowing Issues: Stroke, cerebral palsy, head/neck cancer Nutritional Support: Long-term enteral feeding, malnutrition Obstruction: Esophagus or upper GI tract blockages Contraindications Active GI obstruction Severe abdominal infection or peritonitis Recent abdominal surgery complications Severe bleeding disorders

26. Cont.… Precautions Ensure proper tube placement Maintain upright position during feeding Prevent rapid feeding to avoid nausea/diarrhea Confirm appropriate feeding formula Equipment Feeding Supplies: G-tube, formula, syringe, feeding pump Support Items: Gloves, sterile water, tube clamp

27. Procedure Explain procedure; Wash your hands Collect all necessary equipment position upright (30–45°) Inspect tube site for redness/infection Aspirate stomach contents and check pH (≤5.5 ) Use syringe, let formula flow by gravity Flush with 20–50 mL water

28. Cont.… Attach bag, control flow with clamp Flush tube after feeding Set pump rate and volume Flush tube after feeding Post-Feeding Care Keep upright for 30–60 minutes Clean site with mild soap, dry thoroughly Secure tube

29. Complication Common: Site irritation, nausea, diarrhea, clogging Aspiration pneumonia, infection, tube dislodgement Precautions During Feeding Prevent aspiration: Proper positioning Prevent blockages: Flush before/after feeding Monitor tolerance: Watch for bloating, nausea, or vomiting

30. Gastric Lavage Washout the stomach with sterile water or saline Indications Toxic Ingestion: Drug overdose, certain poisons GI Bleeding: Clear blood for diagnosis or stabilization Preoperative Prep: When an empty stomach is required

31. Cont.… Contraindications Corrosive substance ingestion Altered consciousness (without airway protection) Esophageal varices, recent surgery, or perforation Solid objects (coins, batteries) Precautions Ensure airway protection (intubation if needed) Monitor vital signs throughout Avoid excessive force to prevent injury

32. Equipment Basic : Large-bore NG/ orogastric tube, sterile water/saline, syringes Support: PPE, suction apparatus, absorbent pads

33. Procedure Explain procedure , perform hand hygiene Collect equipment P osition patient Accordingly Ensure airway protection, Measure , lubricate, and insert tube Verify placement of tube Instill 200–300 mL warm fluid (adults) Withdraw fluid immediately Repeat until clear or target volume reached Remove or secure the tube Clean patient and monitor for complications

34. Complications Common : Gagging, vomiting, throat irritation Serious: Aspiration pneumonia Esophageal/gastric perforation Electrolyte imbalance

35. Colostomy Care A surgically created opening in the abdomen (stoma) that diverts fecal matter to an external pouch .

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37. Cont.… Indications for Colostomy Bowel Obstruction (cancer, diverticulitis) IBD (Crohn's disease, ulcerative colitis) Trauma or Injury to the Bowel Congenital Anomalies Rectal Cancer or Tumors Types of Colostomy End Colostomy: Permanent diversion through stoma Loop Colostomy: Temporary diversion of a loop of colon Double-Barrel Colostomy: Two stomas from divided colon

38. Cont.… Why Colostomy Care Matters Prevent skin irritation or infection Maintain hygiene and pouch function Ensure comfort and quality of life Precautions Maintain hand hygiene Avoid tight clothing around the stoma Educate on signs of complications (infection, leaks)

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40. Procedure Explain the procedure Wash your hand Gather equipment Position patient comfortably Gently peel off pouch starting from the top Remove adhesive residues Use Normal saline Pat dry; inspect for redness or infection Measure and cut adhesive barrier (1/8–1/4 inch gap) Apply barrier and attach pouch securely Seal drainable pouch if needed Dispose of used materials Perform hand hygiene Monitor for complications

41. Complications Skin Irritation: Ensure proper barrier fit, use skin protection Stoma Prolapse/Retraction Infection: Clean gently, watch for redness or odor Leakage: Check pouch size and integrity Patient Education Hygiene: Clean with warm water, dry thoroughly Diet: Avoid gas-producing foods (beans, cabbage) Complications: Report redness, swelling, or blockage

42. Giving Enemas introduction of liquid into the rectum and colon to stimulate bowel movement, relieve constipation, or prepare for procedures .

43. Cont.… Indications for Enemas Constipation Relief: When other treatments are ineffective Preparation for Diagnostic Procedures: Colonoscopy or bowel exams Medication Administration: Corticosteroids or antibiotics for bowel conditions Colon Cleansing: For fecal impaction or pre-surgery

44. Types of Enemas Cleansing Enemas Retention Enemas Rectal washout enema Carminative enema

45. Cont.… Contraindications Bowel obstruction or perforation Severe rectal bleeding Heart or kidney failure Recent abdominal/rectal surgery Precautions Use sterile equipment when necessary Administer slowly to reduce cramping Ensure patient is well-hydrated Position patient for optimal flow

46. Equipment Needed Enema Solution: Saline, salt, soap Enema can Lubricant: Water-based for easier nozzle insertion Gloves: Clean or sterile Rubber and drawsheet;To protect surroundings Lotion thermometer Emesis basin Iv stand Bedpan or Toilet: For expulsion Tissue paper Gauze

47. Procedure Explain procedure to the patient Wash hands, wear gloves Prepare equipment (correct solution temperature ) Take vital sign Screen the patient Position in left lateral decubitus (left side, knees bent ) Lubricate nozzle tip Gently insert 3–4 inches toward colon Release air from the bag

48. Cont.… Open clamp for steady flow (bag height: 12–18 inches) or 45 cm from bed and 30 cm from patient Slow or pause if cramping occurs Cleansing enema: 5–10 minutes Retention enema: 30 minutes (or as prescribed) Help patient to toilet or bedpan

49. Cont.…

50. Complications Cramping: Slow the flow or pause Perforation: Avoid excessive force Electrolyte Imbalance: Avoid frequent enemas Rectal Bleeding: Be cautious with hemorrhoids Dependency: Educate on moderate usage

51. Rectal Washout A procedure using fluid to cleanse the rectum and lower colon. Indications: Severe Constipation/Fecal Impaction: When other treatments fail. Preparation for Procedures: Colonoscopy, rectal surgery, etc. Chronic Conditions;- spinal injuries. Rectal Condition Relief: manage prolapse or chronic hemorrhoid discomfort

52. Cont.… Contraindications: Rectal/colonic perforation or severe bleeding Recent abdominal or rectal surgery Inability to retain fluid Precautions: Use cool sterile saline Gentle technique to avoid trauma Monitor hydration and electrolytes

53. Equipment's Enema Solution: Saline, salt, soap Lubricant : Water-based for easier nozzle insertion Gloves: Clean or sterile Rubber and drawsheet;To protect surroundings Lotion thermometer Emesis basin Iv stand Bedpan or Toilet: For expulsion Tissue paper Gauze Funnel Rectal tube

54. Procedure Explain the procedure Wash your hand gather equipment position patient on the left side Rectal tube Insertion: Lubricate and insert 3–4 inches gently toward the colon. Irrigation: Introduce fluid slowly (container 12–18 inches above rectum). Pause if discomfort occurs . Maximum fluid you can use once is 6l. Expulsion : Assist patient to expel fluid and stool. Post-Care: Ensure comfort, monitor for complications, dispose of materials, and perform hand hygiene.

55. Complications: Rectal Trauma: Injury from improper technique Cramping/Discomfort: Due to rapid fluid introduction Electrolyte Imbalance: From frequent washouts Infection: If non-sterile equipment is used Perforation: Rare but serious

56. Flatus Tube Insertion A flatus tube is a flexible tube inserted into the rectum to relieve excessive gas buildup, bloating, and abdominal distension when natural expulsion is impaired .

57. Cont.… Indications: Abdominal Distension: Excessive gas buildup causing discomfort Post-Surgery: Helps expel gas after abdominal operations GI Disorders: Ileus, non-mechanical bowel obstruction, chronic constipation Poor Gas Passage: Neurological conditions or limited mobility

58. Cont.… Contraindications: Suspected bowel perforation Active rectal or colonic bleeding Severe unexplained abdominal pain or distension Recent rectal trauma or surgery Precautions: Use gentle insertion techniques Proper patient positioning (left lateral with knees drawn) Avoid frequent use to prevent irritation Monitor for discomfort or complications

59. Cont.… Equipment: Flatus Tube: Flexible, 10–20 inches Lubricant : Water-based for smooth insertion Gloves: Clean disposable gloves Rubber sheet and draw sheet: Protect patient’s surroundings

60. Procedure Explain the procedure to the patient Perform hand hygiene and wear gloves Gather equipment and ensure cleanliness Position patient in the left lateral decubitus position Lubricate the tube tip generously Gently insert the tube toward the rectum Avoid forceful insertion

61. Cont.… Observe for the release of gas Allow time for the patient to expel gas comfortably Monitor for discomfort or cramping Gently remove the tube Assist with hygiene and ensure patient comfort Properly dispose of used equipment Monitor for complications such as bleeding or pain

62. Complications Rectal Injury: From forceful insertion Discomfort/Pain: Particularly in patients with hemorrhoids or fissures Gas Retention: May require additional medical intervention Infection: From poor hygiene practices Perforation: Rare but serious, due to improper technique

63. Urinary Catheterization involves inserting a flexible tube (catheter) into the bladder via the urethra to drain urine .

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66. Indications : Urinary Retention: Obstruction (e.g., enlarged prostate, stones) Impaired bladder function (spinal injury, neurological conditions) Urine Output Monitoring: Critical care and major surgeries Pre-Surgical Preparation: For pelvic or prolonged surgeries Urinary Incontinence: In cases where other methods fail Urine Collection for Testing: For sterile sample collection Bladder Irrigation: Post-surgical care to clear blood clots or debris

67. Cont.… Contraindications: Urethral Injury/Trauma Recent Urethral Surgery: Allergies to Catheter Materials Severe Urethritis/UTI Severe Bladder Obstruction Precautions: Maintain aseptic technique to prevent infections Adequate lubrication for a smooth, painless insertion Ensure patient comfort and privacy Monitor for signs of infection or complications

68. Equipment Sterile Catheter Lubricant Sterile Gloves Antiseptic Solution: Povidone-Iodine Sterile Drapes Urine Bag Syringe (for Balloon Inflation Cleaning Materials: Sterile wipes or gauze

69. Procedure Explain the Procedure: Address patient concerns to ensure cooperation Hand Hygiene: Thoroughly wash hands and don gloves Assemble Equipment: Maintain a sterile setup T ake vital sign Screen the patient Positioning: Female: Lithotomy or recumbent position Male : Supine with legs extended Put rubber and draw sheet under hip Attach your bag to bed side by plaster Open sterile field Lubricate Catheter: Generous application of sterile lubricant Check functionality of catheter

70. Cont.… Sterile Field: Use drapes to maintain sterility Clean the Genital Area Far_near_center Insert Catheter: Female: Direct upward and slightly backward Male: Insert upward, taking care around the prostate Confirm Placement: Urine flow indicates successful insertion Inflate Balloon: Fill with sterile water to secure catheter Secure Catheter: Ensure proper placement before attaching the drainage bag Position bag below bladder level to prevent backflow Remove Gloves: Dispose of used materials properly Monitor Patient: Watch for discomfort, infection, or improper urine flow Patient Education: Provide hygiene instructions and signs of complications

71. Complications Urinary Tract Infection (UTI): Bacteria introduction during catheterization Urethral Trauma: Damage from forceful insertion Blockage/Dislodgement: Can cause urinary retention or leakage Bladder Spasms: Discomfort and catheter management issues Hematuria: Minor bleeding post-insertion Skin Irritation: Prolonged catheter use causing sores

72. Performing Bladder Irrigation Introduction of sterile solution into the bladder via catheter. Indications Post-Surgical Care – Removes clots & debris UTIs – Assists in bladder cleansing Obstruction Prevention – Clears mucus/sediment Catheter Maintenance – Ensures proper flow Hematuria – Flushes out blood clots Chronic Debris Removal – Prevents buildup in long-term catheter use

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74. Contraindications Bladder Perforation or Injury Active Hemorrhage Severe Urethral Stricture Allergy to Irrigation Solution Severe UTI or Sepsis Precautions Aseptic Technique – Prevent infections Monitor Fluid Volume – Avoid overfilling Use Proper Equipment – Maintain sterility Ensure Patient Comfort – Minimize discomfort

75. Procedure Explain the procedure to the patient. Position the patient comfortably (usually lying on their back). Gather all necessary sterile equipment and set up a clean, sterile field . Perform hand hygiene before starting . Wear sterile gloves to prevent infection. Clean the catheter insertion site with an antiseptic solution (e.g., chlorhexidine or iodine ).

76. Cont.… Connect the sterile irrigation syringe or bag to the catheter’s irrigation port. Slowly introduce 30-60 mL of sterile solution into the bladder. Observe for any resistance, leakage, or patient discomfort . Allow the solution to drain out naturally. Check the drainage for blood clots, mucus, or debris . Repeat the process if necessary until the outflow is clear .

77. Cont.… Dispose of all used materials properly. Remove gloves and clean the patient if needed. Monitor the catheter and urine output for any complications.

78. Potential Complications UTI – Due to contamination Bladder Perforation – Excessive pressure Urethral Injury – Trauma from improper technique Obstruction – Remaining clots/debris Hematuria – Monitor for excessive bleeding

79. Assisting in Dialysis Procedures A procedure to remove waste, excess fluids, and toxins when kidneys fail. Two main types: Hemodialysis – Filters blood using a machine. Peritoneal Dialysis – Uses the abdomen as a filter.

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82. Cont.… Hemodialysis (HD) Blood is drawn, filtered through a dialyzer , and returned. Access through fistula, graft, or catheter . Performed in hospitals or dialysis centers . Peritoneal Dialysis (PD) Uses peritoneal membrane as a natural filter. Dialysis solution is infused and drained. Can be done at home .

83. Indications Indications End-Stage Renal Disease (ESRD) – Kidney failure. Acute Kidney Injury (AKI) – Sudden kidney failure. Fluid Overload – Severe swelling due to fluid retention. Electrolyte Imbalance – Dangerous potassium or sodium levels.

84. Contraindications Terminal illness – Limited benefit. Severe bleeding disorders – Risk of excessive bleeding. Non-compliance – Patients unable to follow dialysis regimen. Unstable heart conditions – Dialysis may worsen instability.

85. Precautions in Dialysis Infection Control – Strict aseptic technique. Monitor Vital Signs – BP, heart rate, oxygen levels. Check Dialysis Access – Watch for infection or clotting. Prevent Air Embolism – Avoid air bubbles in the circuit. Ensure Machine Functionality – Check alarms and performance.

86. Equipment for Dialysis Hemodialysis Machine – Pumps and filters blood. Dialyzer (Artificial Kidney) – Removes waste. Catheter or Fistula Needles – Blood access. Dialysis Solution – Used in peritoneal dialysis. BP Monitor, IV Fluids, Medications – Support patient stability.

87. Assisting in Hemodialysis Explain the procedure & position the patient. Set up dialysis machine & materials . Check fistula/catheter for infection or blockage . Monitor vital signs & fluid balance . Watch for complications (low BP, nausea). Ensure blood flows properly through the machine . Remove needles/catheter , apply dressing. Observe for bleeding or dizziness . Monitor urine output & vital signs

88. Assisting in Peritoneal Dialysis Explain the procedure to the patient. Position the patient comfortably. Prepare & warm dialysis solution. Use aseptic technique to connect catheter. Infuse & drain solution , monitoring for infection. Clean site & ensure patient comfort.

89. Dialysis Complications Infections (Peritonitis, catheter infections ). Low BP (Hypotension) – Rapid fluid loss. Blood Clots in Access Site – Can block dialysis. Electrolyte Imbalances – Can cause heart issues. Bleeding – From access site.

90. Performing Ear Irrigation Removal of excess earwax, debris, or foreign objects using water/saline. Improves hearing, relieves discomfort . Indications: ✅ Cerumen impaction ✅ Foreign body removal ✅ Infections (with caution) ✅ Pre-exam ear cleaning ✅ Hearing aid maintenance

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92. Cont.… Contraindications: ❌ Ear surgery history ❌ Perforated eardrum ❌ Active infections ❌ Recent trauma ❌ Sharp/live foreign objects

93. Precautions: 🔹 Use body-temperature water 🔹 Gentle pressure to avoid damage 🔹 Proper patient positioning 🔹 Stop if pain/dizziness occurs 🔹 Avoid excessive irrigation

94. Cont.… Equipment: Irrigation syringe/bulb Saline/warm water Towels/basin Otoscope ( optional) Cotton balls/gauze Protective gloves

95. Procedure Explain procedure & prepare equipment Position patient with head tilted Fill syringe & check solution temp Irrigate gently, allow drainage Repeat if needed (max 2-3 times ) Dry outer ear Check for discomfort Inspect ear (if needed ) Advise patient to keep ears dry Report complications

96. Performing Nasal Drop Installation Administering liquid medication to relieve congestion, allergies, infections. Indications: ✅ Nasal congestion ✅ Allergic rhinitis ✅ Dry nasal passages ✅ Nasal infections ✅ Sinusitis Contraindications: ❌ Nasal obstruction ❌ Allergy to medication ❌ Recent nasal surgery ❌ Severe infections

97. Cont.… Precautions: 🔹 Correct patient positioning 🔹 Avoid overuse of decongestants 🔹 Maintain hygiene (no contamination) 🔹 Ensure patient comfort Equipment : Nasal dropper/spray Tissues/cotton pads Gloves (optional) 🛏Towels/headrest

98. Procedure Explain procedure & prepare drops Position patient (head tilted back) Clean nostrils if needed Instill drops as prescribed Massage nose (if required ) Keep head tilted for 1-2 min Wipe excess medication Monitor for irritation or allergies Provide usage instructions Report side effects

99. Assisting in Lumbar Puncture (Spinal Tap) Procedure commonly known as a spinal tap, is a procedure to collect cerebrospinal fluid (CSF) from the subarachnoid space.

100. Indications for Lumbar Puncture Diagnosis of Infections (e.g., Meningitis, Encephalitis) Diagnosis of Neurological Disorders (e.g., Multiple Sclerosis, Guillain-Barre Syndrome) Measure Intracranial Pressure (ICP) Evaluation of Cerebral Hemorrhage Collection of CSF for Chemical or Cytological Analysis

101. Contraindications for Lumbar Puncture Increased Intracranial Pressure (ICP) Infection at the Puncture Site Severe Bleeding Disorders Spinal Deformities or Structural Abnormalities Patient Inability to Maintain Positio n

102. Precautions in Lumbar Puncture Patient Education: Explain procedure and importance of staying still Sterility: Maintain a strict sterile field Proper Positioning: Fetal or Sitting position Use of Local Anesthesia Post-Procedure Monitoring for complications

103. Equipment for Lumbar Puncture Sterile Needle (22-25 gauge) Sterile Drapes and Covers Antiseptic Solution (e.g., iodine, chlorhexidine ) Local Anesthetic (e.g., lidocaine ) Collection Tubes for CSF Syringe and Saline Solution Gloves, Mask, Gauze, and Bandages

104. Procedure for Assisting in Lumbar Puncture Explain procedure and reassure patient Position patient (Fetal or Sitting Position) Prepare the puncture site with antiseptic Assist with Local Anesthesia application Assist the provider with inserting the spinal needle Monitor patient comfort and stillness Help with CSF collection and labeling tubes Record CSF opening pressure if needed

105. Cont.… Assist with needle removal and apply bandage Monitor for complications (headache, bleeding, infection) Ensure hydration and comfort Provide post-procedure instructions (rest, avoid strenuous activity )

106. Complications of Lumbar Puncture Post-Lumbar Puncture Headache Infection Bleeding Nerve Damage Cerebral Herniation in high ICP cases

107. Crutch Walking is a method of ambulation used by individuals who cannot bear weight on one or both legs . Indications for Crutch Walking 1. Injuries: Fractures, sprains, post-surgery recovery. 2. Conditions causing weakness: Neurological disorders, arthritis. 3. Post-trauma or infections: Support healing by reducing weight-bearing stress.

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110. Contraindications for Crutch Walking Severe neurological impairment. Severe upper limb weakness. Poor balance or coordination.

111. Precautions for Crutch Walking Proper fitting of crutches. Use of padding to prevent pressure sores. Maintaining correct posture. Avoiding overexertion and monitoring discomfort.

112. Equipment for Crutch Walking Crutches: Crutch tips for stability. Padding for comfort.

113. Procedure for Crutch Walking Explain the procedure Wash your hand Collect all necessary equipment Ensure crutch tips are 2 inches outside and 6 inches in front of the feet. Handgrips should allow a 20–30° elbow bend. There should be a 2-inch gap between the axilla and crutch pads Keep back straight and head up. Distribute weight on hands, not underarms, to prevent nerve damage. Ensure a safe Wear non-slip footwear for stability.

114. Cont.… Use the appropriate gait (two-point, three-point, four-point, swing-through ). Avoid leaning too much on the crutches for balance . Two-Point Gait: Move one crutch and the opposite leg together, then the other crutch and leg. Used for partial weight-bearing on both legs. Three-Point Gait: Move both crutches forward, then swing the unaffected leg forward. Used for non-weight-bearing on one leg. Four-Point Gait: Move one crutch, then the opposite leg, followed by the other crutch, then the other leg. Provides maximum stability, used for weak legs.

115. Cont.… Swing-Through Gait: Move both crutches forward, then swing both legs past the crutches. Used for patients with paralysis or severe leg weakness . Going Up Stairs: Lead with the unaffected leg, then bring the crutches and affected leg up. "Good leg goes up first." Going Down Stairs: Move crutches down first, then the affected leg, followed by the unaffected leg. "Bad leg goes down first."

116. Safety Considerations Use correct technique on stairs. Avoid twisting movements while turning. Rest frequently to prevent fatigue. Monitor for pressure sores and discomfort.

117. Complications of Crutch Walking Pressure sores from improper fitting. Overuse injuries (shoulder, wrist pain). Risk of falls due to imbalance. Poor posture leading to back or neck pain.

118. care for Traction T raction is a therapeutic technique used to manage fractures, dislocations, and deformities . It involves applying a pulling force to align bones, relieve pressure, and aid healing. Traction is applied using weights, pulleys, and ropes for continuous or intermittent force . Purpose : To maintain proper alignment of the affected limb, reduce pain, prevent complications, and promote healing.

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120. Indications for Traction Fractures : Long bone fractures, displaced fractures, pelvic fractures. Deformities : Congenital deformities, contractures. Joint Dislocations: Helps reposition displaced bones. Soft Tissue Injuries: Reduces tension in muscles, tendons, and ligaments. Pre-Operative Management: Reduces muscle spasms before surgery.

121. Types of Traction Skin Traction: Uses adhesive tapes or boots (e.g., Buck's traction). Skeletal Traction: Pins or wires inserted into bones (e.g., balanced suspension). Manual Traction: Applied by hand for emergencies. Cervical Traction: Used for neck injuries (e.g., head halter).

122. Contraindications for Traction Open fractures (risk of infection ). Severe skin conditions at the application site. Spinal injuries without imaging confirmation. Severe soft tissue damage.

123. Precautions During Traction Maintain proper alignment. Monitor circulation (color, temperature, numbness ). Check skin integrity to prevent pressure sores. Avoid excessive force to prevent muscle or nerve damage. Ensure patient comfort and reposition as needed.

124. Equipment for Traction Traction Weights (5-40 lbs ). Pulleys and Ropes. Skin & Skeletal Traction Devices. Padding for skin protection. Cervical traction devices (head halters, collars).

125. Procedure for Traction care Verify Physician’s Order: Confirm traction type, weight, and alignment. Explain to Patient: Ensure cooperation; advise not to adjust traction. Assess Patient: Check neurovascular status, skin integrity, and pressure points. Ensure Proper Alignment: Keep body straight; weights must hang freely. Skin Care: Clean skin under straps, change dressings, reposition as needed. Monitor for Complications: Watch for infection, DVT, and respiratory issues. Pain Management: Administer analgesics; use repositioning and relaxation techniques. Encourage Mobility: Assist with ROM exercises and self-care activities. Provide Support: Offer emotional support and engaging activities. Documentation: Record patient status, traction settings, skin checks, and pain management.

126. Complications of Traction Pressure sores. Nerve damage. Circulation impairment. Muscle atrophy.

127. End