msn procedure adult Health nursing -1 content

Manual and procedure for adult health nursing

1. “Manual of Procedures for Adult Health Nursing I & II”
Meaning of IV Maintenance & Monitoring
IV maintenance and monitoring is the process of ensuring that an intravenous line remains
patent, safe, and effective throughout therapy. It includes checking the site, fluid, infusion
rate, and the patient’s response to prevent complications.
Purpose
To keep the IV line open and functioning.
To deliver prescribed fluids and medications safely.
To prevent and detect complications such as infiltration, phlebitis, or infection.
To monitor the patient’s overall response to IV therapy.
Equipment Purpose
IV fluid and infusion set To deliver prescribed fluids and medications.
Sterile gloves To maintain aseptic technique and prevent infection.
Antiseptic swabs/solution For cleaning the IV site and preventing contamination.
Syringe with saline flush To check and maintain cannula patency.
Adhesive tape/transparent dressingTo secure the IV cannula and prevent dislodgement.
IV stand To hang IV fluids at correct height for gravity flow.
Cotton balls/gauze with kidney trayFor cleaning, dressing changes, and site care.
Procedure
Step Rationale
Verify physician’s order for IV
fluid/medication
Ensures correct therapy is given.
Perform hand hygiene and wear glovesPrevents cross infection.
Inspect IV site for redness, swelling, leakage,
pain
Detects early signs of infiltration or phlebitis.
Check cannula patency (flush with saline if
needed)
Maintains free flow of IV fluid.
Confirm fluid type, label, and expiry datePrevents medication/fluid errors.
Ensure correct infusion rate (drip/min or
mL/hr)
Maintains prescribed therapy and prevents
overload.
Examine tubing and connections for
leakage/air
Prevents air embolism and contamination.
Monitor patient for signs of reaction or fluid
overload
Ensures patient safety and timely
intervention.
Change IV site/dressing as per protocolReduces infection risk.
Document procedure and observationsMaintains continuity and legal safety of care.

2. Meaning
Administration of IV medication is the process of delivering prescribed drugs directly into a
patient’s vein through an intravenous line or cannula. This route allows the medication to
enter the bloodstream immediately for rapid onset of action.
Purpose
To provide rapid therapeutic effect in emergency conditions (e.g., cardiac arrest,
seizures).
To deliver medications that are irritating to tissues and unsuitable for oral or
intramuscular routes.
To ensure accurate dosage reaches systemic circulation without absorption delay.
To administer medications to patients who are unable to take oral drugs.
To maintain steady blood levels of a drug by continuous infusion if required.

3. Meaning
Care of patients with a central line involves managing and maintaining a catheter that is
inserted into a large central vein (such as the subclavian, jugular, or femoral vein). This care
ensures that the line remains patent, sterile, and functional for administration of medications,
fluids, blood products, or parenteral nutrition over a prolonged period.
Purpose
To maintain central venous access for long-term therapy.
To deliver medications, IV fluids, blood products, or parenteral nutrition safely.
To monitor central venous pressure (CVP) if required.
To prevent complications such as infection, thrombosis, or catheter occlusion.
To ensure patient safety and effective therapy through proper line management.
Equipment Purpose
Sterile gloves Maintain asepsis and prevent infection.
Antiseptic solution (chlorhexidine/alcohol
swabs)
Clean insertion site and catheter hubs to
prevent contamination.
Sterile gauze or transparent dressing
Protect the insertion site and keep it dry and
sterile.
Saline flush (and heparin flush if prescribed)
Maintain patency of the catheter and prevent
clot formation.
Sterile syringes
For flushing the line and administering
medications.
IV extension set/tubing
Connect medications/fluids to the central
line safely.
Cap for central line port
Prevents microbial contamination when line
is not in use.
Kidney tray, cotton balls/gauze Assist in cleaning and dressing changes.
Sharps/biomedical waste container
Safe disposal of needles and contaminated
materials.
Procedure Step
Rationale
Perform hand hygiene and wear sterile glovesReduces risk of introducing infection.
Explain procedure to patient Reduces anxiety and ensures cooperation.
Inspect insertion site for redness, swelling,
discharge, or pain
Early detection of infection or phlebitis.
Check catheter dressing for moisture, looseness,
or contamination
Maintains sterility and securement of
catheter.
Clean catheter hub/port with antiseptic swab
before accessing
Prevents microbial contamination during
medication/fluids administration.
Flush line with sterile saline before and after
use
Maintains patency and prevents clot
formation.

4. Equipment Purpose
Replace dressing as per protocol using sterile
technique
Reduces infection risk and keeps catheter
stable.
Observe patient for complications (fever,
swelling, pain, difficulty breathing)
Early detection of systemic infection,
thrombosis, or air embolism.
Dispose of used materials in sharps/biomedical
waste container
Prevents cross-contamination and ensures
safety.
Document care, flushing, dressing changes, and
patient observations
Ensures continuity of care and legal record.
Thoracentesis is a medical procedure in which a needle or catheter is inserted into the
pleural space—the area between the lungs and the chest wall—to remove excess fluid or air.

5. The purpose of thoracentesis is twofold:
1.Diagnostic: To collect pleural fluid for laboratory analysis to detect infections,
malignancy, or other diseases affecting the lungs or pleura.
2.Therapeutic: To relieve symptoms such as shortness of breath, chest discomfort, or
pressure caused by fluid build-up (pleural effusion) or air (pneumothorax) in the
pleural space.
Equipment Purpose
Sterile thoracentesis tray
Contains all instruments required for the
procedure
Sterile gloves
Maintain aseptic technique and prevent
infection
Antiseptic solution (e.g., chlorhexidine)
Clean skin at insertion site to prevent
infection
Local anesthetic (e.g., lidocaine)
Numbs the area to minimize patient
discomfort
Syringe with needle or catheter To aspirate pleural fluid or air
Collection tubes For laboratory analysis of pleural fluid
Gauze and sterile dressing
Cover puncture site and prevent infection or
bleeding
Oxygen supply (if needed) Support patient in case of respiratory distress
Biohazard container
Safe disposal of sharps and contaminated
materials
Procedure Rationale
1. Verify patient identity, explain procedure,
obtain consent
Ensures safety and informed consent
2. Position patient upright, leaning slightly
forward, arms supported
Provides optimal access to pleural space and
reduces risk of lung injury
3. Perform hand hygiene and wear sterile
gloves
Prevents infection
4. Clean skin at insertion site with antisepticReduces risk of contamination and infection
5. Administer local anesthetic Minimizes pain during needle insertion
6. Insert needle/catheter into pleural space
carefully
Allows safe removal of fluid or air without
damaging lung tissue
7. Aspirate pleural fluid slowly into collection
tubes
Prevents sudden lung collapse and preserves
sample integrity
8. Remove needle/catheter and apply sterile
dressing
Prevents infection and bleeding at puncture
site
9. Monitor patient for complications
(pneumothorax, bleeding, dyspnea)
Early detection and management of adverse
events
10. Send fluid for laboratory analysis if
diagnosti
Enables accurate diagnosis and guides
treatment
Meaning:

6. Abdominal paracentesis is a medical procedure in which a needle or catheter is inserted into
the abdominal cavity to remove excess fluid (ascites). This can be done for diagnostic
purposes (to analyze the fluid) or therapeutic purposes (to relieve discomfort or breathing
difficulty).
Purpose:
1.Diagnostic: To collect ascitic fluid for laboratory analysis to detect infections,
malignancy, liver disease, or other causes of fluid accumulation.
2.Therapeutic: To relieve symptoms such as abdominal distension, pain, or respiratory
difficulty caused by large-volume ascites.
Equipment Purpose
Sterile paracentesis tray Contains all instruments needed for the procedure
Sterile gloves Maintain aseptic technique and prevent infection
Antiseptic solution (e.g.,
chlorhexidine)
Clean skin at puncture site to prevent infection
Local anesthetic (e.g., lidocaine)Numbs the area to minimize patient discomfort
Paracentesis needle or catheterTo aspirate ascitic fluid safely
Collection containers/tubes For diagnostic analysis of ascitic fluid
Gauze and sterile dressing Cover puncture site to prevent infection or bleeding
Ultrasound (optional) To locate fluid pocket and reduce complications
Biohazard container
Safe disposal of used needles and contaminated
materials
Procedure Rationale
1. Verify patient identity, explain procedure, and
obtain consent
Ensures patient safety and cooperation
2. Assess baseline vital signs and abdominal
girth
Provides reference for monitoring
therapeutic effect
3. Position patient in a supine or slightly upright
position
Optimizes access to fluid pocket and
comfort
4. Perform hand hygiene and wear sterile glovesPrevents infection
5. Clean skin at puncture site with antisepticReduces risk of infection
6. Administer local anesthetic at the puncture siteMinimizes pain during needle insertion
7. Insert needle/catheter into the abdominal
cavity carefully
Allows safe removal of ascitic fluid
without injuring organs
8. Aspirate fluid slowly into collection
containers
Prevents hypotension and preserves sample
integrity for analysis
9. Remove needle/catheter and apply sterile
dressing
Prevents infection and bleeding at the
puncture site
10. Monitor patient for complications
(hypotension, bleeding, infection)
Ensures early detection and management of
adverse events

7. Procedure Rationale
11. Label and send fluid for laboratory analysis
(if diagnostic)
Enables accurate diagnosis and guides
treatment
12. Document procedure, volume of fluid
removed, and patient response
Legal record and continuity of care
Administration of Oxygen Using Venturi Mask
Meaning:
It is a method of delivering a precise and controlled concentration of oxygen to a patient
using a Venturi mask, which mixes oxygen with room air through interchangeable color-
coded adapters to achieve a specific oxygen concentration. This method is often used when
accurate oxygen delivery is crucial, such as in patients with chronic obstructive pulmonary
disease (COPD).
Purpose:
1.Therapeutic: To provide supplemental oxygen to patients with low oxygen levels
(hypoxemia) and improve tissue oxygenation.
2.Controlled Oxygen Delivery: Ensures the patient receives a precise concentration of
oxygen, preventing complications such as hypercapnia in patients with COPD.
3.Relieve Symptoms: Helps reduce shortness of breath, fatigue, and other signs of
hypoxia.
Equipment Purpose
Venturi mask with color-coded adapters
Delivers precise oxygen concentration
based on patient needs
Oxygen source (cylinder or wall supply)Provides medical oxygen
Flow meter Controls and regulates oxygen flow rate
Connecting tubing Connects oxygen source to mask
Humidifier (if needed)
Prevents dryness of airway mucosa
during prolonged oxygen therapy
Pulse oximeter Monitors oxygen saturation in the patient
Goggles/face shield (optional)
Protects caregiver during procedure if
needed
Procedure Rationale
1. Verify patient identity, explain procedure,
obtain consent
Ensures patient cooperation and safety
2. Assess baseline respiratory rate, oxygen
saturation, and vital signs
Provides a reference for monitoring
therapy effectiveness
3. Select the appropriate Venturi mask adapter for
prescribed oxygen concentration
Ensures accurate oxygen delivery
4. Connect mask to oxygen source using tubingEnables oxygen flow to the patient
5. Set oxygen flow rate as per adapter instructions
on flow meter
Maintains prescribed oxygen
concentration
6. Place mask over patient’s nose and mouth, Prevents oxygen leakage and ensures

8. Equipment Purpose
ensuring a snug fit proper delivery
7. Monitor patient’s oxygen saturation and clinical
response
Detects hypoxia or hyperoxia, ensures
therapy effectiveness
8. Adjust flow rate or concentration if needed
based on physician orders
Maintains safe and effective oxygenation
9. Remove mask when therapy is complete, or
switch to other oxygen device if required
Ensures patient safety and comfort
10. Clean and disinfect mask and tubing after use
(if reusable)
Prevents infection and maintains hygiene
Meaning:
Nebulization is a medical procedure in which liquid medication is converted into a fine mist
or aerosol using a nebulizer, allowing the patient to inhale it directly into the lungs. This
method is commonly used to deliver bronchodilators, steroids, or other respiratory
medications.
Purpose:
1.Therapeutic: To treat respiratory conditions such as asthma, chronic obstructive
pulmonary disease (COPD), bronchitis, or other airway obstructions.
2.Direct Delivery: Ensures medication reaches the lower airways quickly and
effectively.
3.Symptom Relief: Helps relieve shortness of breath, wheezing, and chest tightness.
Equipment Purpose
Nebulizer machine
Converts liquid medication into aerosol for
inhalation
Medication (bronchodilator, steroid, or
saline)
Treats airway obstruction or inflammation
Nebulizer mask or mouthpiece Delivers aerosol to patient’s airways
Tubing Connects nebulizer to oxygen or air source
Oxygen or compressed air source Provides driving force for aerosol generation
Tissues or towel For patient comfort and cleanup
Pulse oximeter (optional) Monitors oxygen saturation during treatment
Procedure Rationale
1. Verify patient identity, explain procedure, and
obtain consent
Ensures patient cooperation and
safety
2. Wash hands and wear gloves
Maintains asepsis and prevents
infection
3. Assemble nebulizer machine and check for proper
functioning
Ensures equipment works effectively

9. Procedure Rationale
4. Pour prescribed medication into nebulizer cupDelivers correct dose
5. Connect tubing to oxygen or compressed air sourceProvides airflow to generate aerosol
6. Attach mask or mouthpiece and place on patient
Ensures proper delivery of
medication
7. Instruct patient to breathe slowly and deeply
Maximizes deposition of medication
in lungs
8. Run nebulizer until all medication is delivered
(usually 10–15 minutes)
Ensures full dose administration
9. Remove mask/mouthpiece and clean any spills
Maintains hygiene and patient
comfort
10. Monitor patient for response and adverse effects
Detects complications like tremors or
tachycardia
11. Document procedure, medication, duration, and
patient response
Legal record and continuity of care
Chest Physiotherapy (CPT)
Meaning:
Chest physiotherapy is a set of techniques used to improve respiratory function by clearing
mucus and secretions from the lungs and airways. It includes methods such as percussion,
vibration, postural drainage, deep breathing exercises, and coughing techniques. It is
commonly used for patients with respiratory conditions like pneumonia, chronic bronchitis,
cystic fibrosis, or after surgery.
Purpose:
1.Clear Airways: Helps remove mucus, secretions, or foreign material from the lungs
and bronchi.
2.Improve Lung Function: Enhances ventilation and oxygenation.
3.Prevent Complications: Reduces risk of infections, atelectasis, or pneumonia in
patients with impaired lung function.
4.Facilitate Recovery: Supports patients in maintaining normal respiratory function
after illness or surgery.
Equipment Purpose
Pillows or positioning aidsSupport patient in correct posture for drainage
Percussion cup or handsFor clapping to loosen secretions in lungs
Vibration device (optional)Helps mobilize mucus toward larger airways

10. Equipment Purpose
Suction apparatus Removes secretions if patient cannot cough effectively
Oxygen (if needed) Maintains oxygenation during therapy
Towel or cloth Protects patient’s skin and clothing during percussion
Incentive spirometerEncourages deep breathing and lung expansion
Chair or bed Provides safe and comfortable positioning for therapy
Procedure Rationale
1. Verify patient identity, explain procedure,
obtain consent
Ensures cooperation and safety
2. Wash hands and wear gloves Maintains asepsis and prevents infection
3. Assess patient’s respiratory status (rate, effort,
oxygen saturation)
Provides baseline and ensures safety
4. Position patient appropriately for postural
drainage
Allows gravity to aid in secretion drainage
5. Perform percussion on chest wall over affected
lung segments
Loosens mucus from smaller bronchi to
larger airways
6. Apply vibration during exhalation (if using
device)
Facilitates movement of secretions toward
trachea
7. Encourage patient to cough or perform assisted
coughing
Helps expectorate secretions effectively
8. Use suction if patient cannot clear secretionsPrevents airway obstruction and hypoxia
9. Encourage deep breathing exercises or
incentive spirometer use
Expands alveoli, prevents atelectasis
10. Monitor patient response throughout therapy
Detects complications like dizziness,
hypoxia, or fatigue
11. Document procedure, patient tolerance, and
outcomes
Legal record and continuity of care
Step Yes / No
Verified patient identity
Explained procedure to patient
Obtained patient consent
Washed hands and wore gloves
Assessed patient’s respiratory status
Positioned patient for postural drainage
Performed percussion over affected lung segments
Applied vibration during exhalation (if using)
Encouraged patient to cough/assist coughing
Used suction if required
Encouraged deep breathing/incentive spirometer use
Monitored patient response and oxygen saturation
Documented procedure and patient outcomes

11. Meaning:
Postural drainage is a technique of positioning a patient in specific postures so that gravity
helps drain mucus or secretions from different segments of the lungs into the larger airways,
where it can be coughed out or suctioned. It is commonly used in patients with respiratory
conditions like cystic fibrosis, chronic bronchitis, pneumonia, or after surgery.
Purpose:
1.Remove Secretions: Helps mobilize and clear mucus from the lungs and bronchi.
2.Improve Ventilation: Enhances airflow and oxygenation in affected lung areas.
3.Prevent Complications: Reduces the risk of infection, atelectasis, or pneumonia.
4.Facilitate Recovery: Supports respiratory function and overall lung health.
Equipment Purpose
Pillows or positioning aidsSupport patient in correct posture for drainage
Bed or treatment tableProvides safe and comfortable positioning
Towel or sheet Protects patient’s clothing and skin during therapy
Suction apparatus (if needed)Removes secretions if patient cannot expectorate effectively
Oxygen (if required) Maintains oxygenation during therapy
Incentive spirometer Encourages deep breathing and lung expansion
Timer Helps monitor duration of each position
Procedure Rationale
1. Verify patient identity, explain procedure, obtain
consent
Ensures cooperation and safety
2. Wash hands and wear gloves
Maintains asepsis and prevents
infection
3. Assess patient’s respiratory status (rate, effort,
oxygen saturation)
Provides baseline for monitoring
4. Position patient so that the targeted lung segment is
higher than the trachea
Uses gravity to drain secretions into
larger airways
5. Maintain each position for 5–15 minutes, depending
on tolerance
Allows effective drainage of mucus
6. Encourage patient to cough or perform huffing
technique
Facilitates expectoration of secretions
7. Use suction if patient is unable to clear secretions
Prevents airway obstruction and
hypoxia
8. Monitor patient for discomfort, dizziness, or
shortness of breath
Ensures safety and prevents
complications
9. Encourage deep breathing exercises or use incentive
spirometer after therapy
Re-expands alveoli and improves
ventilation
10. Document procedure, patient tolerance, and
response
Legal record and continuity of care

12. Meaning:
Oropharyngeal suctioning is a procedure in which a suction catheter is used to remove
secretions from the mouth and pharynx (throat). It is typically used for patients who are
unable to clear their own secretions due to illness, surgery, or decreased consciousness.
Purpose:
1.Maintain Airway Patency: Clears saliva, mucus, or other secretions to prevent
airway obstruction.
2.Prevent Aspiration: Reduces the risk of secretions entering the lungs, which can
cause pneumonia.
3.Improve Breathing and Oxygenation: Facilitates effective ventilation and oxygen
exchange.
4.Enhance Comfort: Relieves discomfort associated with excessive oral secretions.
Equipment Purpose
Suction machine
Provides negative pressure for removing
secretions
Suction catheter (yankauer or soft catheter)
Removes secretions from oropharynx
safely
Sterile gloves Maintains asepsis and prevents infection
Sterile water or saline (if needed) Helps clear thick secretions
Goggles/face shield and mask Protects caregiver from splashes
Tissues or towel
Cleans up secretions and protects
patient’s clothing
Oxygen source (if needed)
Maintains oxygenation during
suctioning
Procedure
Rationale
1. Verify patient identity, explain procedure, obtain
consent
Ensures patient cooperation and safety
2. Wash hands and wear protective equipment
(gloves, mask, goggles)
Prevents infection and protects caregiver
3. Assess patient’s respiratory status (rate, oxygen
saturation, effort)
Provides baseline for monitoring
4. Position patient sitting upright or in semi-
Fowler’s
Promotes drainage and reduces
aspiration risk
5. Connect suction catheter to suction machine and
adjust pressure
Ensures effective and safe suctioning
6. Insert catheter into oropharynx without applying
suction
Prevents trauma during insertion
7. Apply suction intermittently while withdrawing
catheter
Removes secretions safely without
damaging mucosa
8. Encourage patient to cough if consciousAssists natural clearance of secretions

13. Equipment Purpose
9. Rinse catheter with sterile water/saline if neededPrevents blockage of catheter
10. Monitor patient for hypoxia, coughing, or
discomfort
Ensures safety and early detection of
complications
11. Dispose of used catheter and clean equipment
per protocol
Prevents cross-contamination
12. Document procedure, patient tolerance, and
outcomes
Legal record and continuity of care
Step Yes / No
Verified patient identity
Explained procedure to patient
Obtained patient consent
Washed hands and wore gloves, mask, goggles
Assessed patient’s respiratory status
Positioned patient upright or semi-Fowler’s
Connected suction catheter and adjusted pressure
Inserted catheter without applying suction initially
Applied suction intermittently while withdrawing catheter
Encouraged patient to cough (if conscious)
Rinsed catheter with sterile water/saline if needed
Monitored patient for hypoxia or discomfort
Disposed of catheter and cleaned equipment properly
Documented procedure and patient response
Meaning:
Chest drainage care involves managing a chest tube (thoracostomy tube) that is inserted into
the pleural space to remove air, blood, pus, or other fluids from the chest cavity. This helps
the lungs re-expand and restores normal intrathoracic pressure.
Purpose:
1.Remove Air or Fluid: Drains pleural effusion, hemothorax, pneumothorax, or
empyema.
2.Promote Lung Expansion: Restores normal lung inflation and improves
oxygenation.
3.Prevent Complications: Prevents infection, tube dislodgement, and blockage.
4.Monitor Patient Status: Assesses ongoing bleeding, air leak, or respiratory changes
for timely

14. Equipment Purpose
Chest drainage system (bottle or
digital)
Collects air, blood, or fluid from pleural space
Sterile gloves Maintains asepsis during dressing or handling
Antiseptic solution Cleans insertion site to prevent infection
Gauze and sterile dressing Protects tube insertion site and prevents contamination
Adhesive tape Secures chest tube to skin
Clamp (if needed)
Temporarily stops flow during emergencies or tube
change
Container for fluid measurementMonitors volume and character of drainage
Suction source (if prescribed)Enhances drainage and lung re-expansion
Drainage tubing Connects chest tube to collection system
Oxygen and resuscitation equipmentPrepared for patient emergencies
Procedure Rationale
1. Verify patient identity, explain procedure, obtain
consent
Ensures safety and cooperation
2. Wash hands and wear sterile gloves
Maintains asepsis and prevents
infection
3. Inspect chest tube insertion site and dressing
Detects signs of infection, bleeding, or
dislodgement
4. Ensure tubing is not kinked or clamped
unnecessarily
Maintains free flow of air or fluid
5. Check chest drainage system (water seal, suction
level)
Ensures proper function and prevents
backflow
6. Measure and record amount, color, and consistency
of drainage
Monitors patient condition and
identifies complications
7. Maintain tube below chest level Uses gravity to facilitate drainage
8. Encourage patient to cough, deep breathe, and
change position
Promotes lung expansion and prevents
atelectasis
9. Monitor patient for respiratory distress,
subcutaneous emphysema, or air leaks
Early detection of complications
10. Secure tube and dressing properly after inspection
Prevents accidental dislodgement and
infection
11. Document procedure, drainage, patient tolerance,
and vital signs
Legal record and continuity of care
Step Yes / No
Verified patient identity
Explained procedure to patient
Obtained patient consent
Washed hands and wore sterile gloves
Inspected insertion site and dressing
Ensured tubing is not kinked or clamped unnecessarily
Checked drainage system (water seal/suction)

15. Step Yes / No
Measured and recorded drainage (volume, color, consistency)
Maintained tube below chest level
Encouraged coughing, deep breathing, position change
Monitored for respiratory distress, air leak, or subcutaneous emphysema
Secured tube and dressing properly
Documented procedure, drainage, and patient response
High Protein Diet
Meaning:
A high protein diet is a dietary plan that includes an increased proportion of protein-rich
foods such as meat, fish, eggs, dairy products, legumes, nuts, and seeds. It is designed to
meet the body’s elevated protein requirements for growth, repair, and overall health.
Purpose:
1.Tissue Repair and Growth: Supports healing of wounds, recovery from surgery,
burns, or illness.
2.Muscle Maintenance: Helps build and maintain muscle mass, especially in patients
with malnutrition or chronic illness.
3.Immune Support: Enhances production of antibodies and other immune system
components.
4.Overall Nutrition: Ensures adequate protein intake for energy, enzyme, and hormone
production.
Food Item / Category Purpose
Eggs
Rich source of complete protein for tissue repair and
muscle building
Lean meat (chicken, turkey, lean
beef)
Provides high-quality protein and essential amino acids
Fish (salmon, tuna)
High protein and omega-3 fatty acids for healing and
immunity
Dairy products (milk, yogurt,
cheese)
Supplies protein and calcium for bone health
Legumes (lentils, beans,
chickpeas)
Plant-based protein for energy and repair
Nuts and seeds Provides protein, healthy fats, and micronutrients
Soy products (tofu, soy milk)Alternative protein source for vegetarians
Protein supplements (if
prescribed)
Helps meet increased protein requirements
Procedure / Meal Planning Rationale
Assess patient’s protein requirement based on age,
weight, and clinical condition
Ensures adequate intake for healing
and growth
Plan meals including protein sources at each meal Provides continuous supply of protein

16. Procedure / Meal Planning Rationale
(breakfast, lunch, dinner, snacks) for body needs
Include variety of protein sources (animal and plant-
based)
Ensures complete amino acid intake
and balanced nutrition
Encourage high-protein snacks like yogurt, nuts, or
boiled eggs
Supplements meals and prevents
protein deficit
Monitor patient tolerance and appetite
Adjusts diet to patient preferences and
clinical condition
Educate patient and family about protein-rich foodsPromotes adherence to dietary plan
Document dietary intake and patient response
Ensures continuity of care and
nutritional monitoring
Step Yes / No
Assessed patient’s protein requirement
Planned meals including protein at each meal
Included variety of protein sources (animal and plant)
Provided high-protein snacks
Monitored patient tolerance and appetite
Educated patient/family on protein-rich foods
Documented dietary intake and response
Diabetic Diet
Meaning:
A diabetic diet is a meal plan designed to help manage blood glucose levels in patients with
diabetes mellitus. It focuses on balanced intake of carbohydrates, proteins, and fats,
emphasizing foods that have a low glycemic index and are rich in fiber.
Purpose:
1.Control Blood Glucose: Helps maintain stable blood sugar levels and prevents
hyperglycemia or hypoglycemia.
2.Prevent Complications: Reduces risk of long-term complications like cardiovascular
disease, kidney damage, and neuropathy.
3.Maintain Healthy Weight: Supports weight management, which is crucial in
diabetes care.
4.Provide Balanced Nutrition: Ensures adequate intake of essential nutrients for
overall health and energy.
Food Item / Category Purpose
Whole grains (brown rice, oats, whole
wheat)
Provide complex carbohydrates for slow glucose
release
Vegetables (leafy greens, broccoli,
carrots)
High fiber, low-calorie foods that help regulate blood
sugar
Fruits (in moderation, low GI like
apples, berries)
Provide vitamins and minerals without causing rapid
glucose spikes

17. Food Item / Category Purpose
Lean proteins (chicken, fish, tofu,
legumes)
Support tissue repair and satiety without excessive fat
Low-fat dairy (milk, yogurt)
Provides calcium and protein with minimal added
sugars
Nuts and seeds
Healthy fats and protein to maintain energy and
reduce glycemic load
Healthy fats (olive oil, avocado)Support heart health and improve lipid profile
Water Maintains hydration and aids metabolic processes
Procedure / Meal Planning Rationale
Assess patient’s nutritional needs, weight, and
blood sugar levels
Ensures diet is tailored to individual
needs
Plan meals with balanced carbohydrates, proteins,
and fats
Maintains stable blood glucose and
prevents spikes
Include high-fiber foods in each meal Slows digestion and glucose absorption
Limit refined sugars, sweets, and high-GI foodsPrevents rapid increases in blood glucose
Encourage portion control and regular meal timing
Prevents hypoglycemia and maintains
energy levels
Educate patient/family on food choices and
carbohydrate counting
Promotes adherence and self-
management of diabetes
Monitor blood glucose response to dietAdjusts diet for optimal glycemic control
Document dietary intake and patient response
Ensures continuity of care and proper
monitoring
Step Yes / No
Assessed patient’s nutritional needs and blood glucose levels
Planned meals with balanced carbohydrates, proteins, and fats
Included high-fiber foods in each meal
Limited refined sugars and high-GI foods
Encouraged portion control and regular meal timing
Educated patient/family on diet and carbohydrate management
Monitored blood glucose response
Documented dietary intake and patient response

18. Meaning:
GRBS is a blood test that measures the blood glucose level at any random time, regardless
of when the patient last ate. It is a quick method to assess the current blood sugar level and
detect hyperglycemia or hypoglycemia.
Purpose:
1.Screening and Monitoring: Helps in detecting high or low blood sugar levels in
patients with diabetes or those at risk.
2.Immediate Assessment: Provides rapid information about current glucose status for
clinical decision-making.
3.Guide Treatment: Assists healthcare providers in adjusting medications, diet, or
insulin therapy.
4.Detect Complications: Helps in early identification of hyperglycemia-related
complications like diabetic ketoacidosis.
Equipment Purpose
Glucometer Measures blood glucose level accurately
Test strips React with blood to provide glucose reading
Lancet / lancing deviceUsed to prick the patient’s fingertip to obtain a blood sample
Alcohol swab Cleans the puncture site to prevent infection
Cotton / gauze Stops bleeding after sample collection
Gloves Maintains hygiene and prevents contamination
Logbook / record sheetDocuments blood glucose readings for monitoring
Sharps containerSafe disposal of lancet
Procedure Rationale
1. Verify patient identity and explain the
procedure
Ensures patient cooperation and safety
2. Wash hands and wear gloves Prevents infection and maintains asepsis
3. Prepare glucometer, test strip, lancet, and
cotton
Ensures all equipment is ready for accurate
measurement
4. Clean patient’s fingertip with alcohol swabReduces risk of infection
5. Prick fingertip with lancet to obtain bloodProvides sample for testing
6. Apply blood drop onto test strip inserted in
glucometer
Ensures correct measurement
7. Wait for glucometer reading Obtains current blood glucose level
8. Apply cotton to puncture site to stop
bleeding
Prevents bleeding or infection
9. Record reading in patient’s chart or logbookAllows monitoring and treatment decisions
10. Dispose of lancet in sharps containerPrevents needlestick injuries
11. Monitor patient for symptoms of
hypo/hyperglycemia
Ensures patient safety and timely
intervention

19. Step Yes / No
Verified patient identity
Explained procedure to patient
Washed hands and wore gloves
Prepared glucometer, test strip, lancet, and cotton
Cleaned fingertip with alcohol swab
Pricked fingertip to obtain blood
Applied blood to test strip in glucometer
Waited for and noted reading
Applied cotton to puncture site
Recorded reading in patient chart
Disposed of lancet safely
Monitored patient for hypo/hyperglycemia
Insulin Administration
Meaning:
Insulin administration is the process of injecting insulin into the body to regulate blood
glucose levels in patients with diabetes mellitus. Insulin is a hormone that helps the body use
glucose for energy and maintain normal blood sugar levels. It can be given via subcutaneous
injection, insulin pen, or insulin pump depending on the patient’s needs.
Purpose:
1.Control Blood Glucose: Helps maintain normal blood sugar levels in diabetic
patients.
2.Prevent Complications: Reduces the risk of hyperglycemia-related complications
like diabetic ketoacidosis, neuropathy, or cardiovascular disease.
3.Support Metabolic Function: Allows proper utilization of glucose for energy and
growth.
4.Therapeutic Management: Tailors insulin dosage to individual needs for optimal
glycemic control.
Equipment Purpose
Insulin (vial or prefilled pen)Provides prescribed insulin for blood glucose control
Syringe or insulin penDelivers accurate dose of insulin subcutaneously
Alcohol swab Cleans injection site to prevent infection
Cotton / gauze Stops bleeding after injection
Gloves Maintains hygiene and prevents contamination
Sharps container Safe disposal of needle after use
Logbook / patient chartDocuments insulin dose, time, and response

20. Procedure Rationale
1. Verify patient identity, explain procedure, and
check prescription
Ensures correct patient, dose, and
safety
2. Wash hands and wear gloves Prevents infection
3. Check insulin type, expiry, and appearanceEnsures correct insulin and safety
4. Prepare insulin dose using syringe or penDelivers accurate prescribed dose
5. Select and clean appropriate injection site
(abdomen, thigh, upper arm) with alcohol swab
Prevents infection and ensures proper
absorption
6. Pinch skin and insert needle at correct angle
(usually 90° for subcutaneous)
Ensures subcutaneous delivery and
avoids intramuscular injection
7. Inject insulin slowly and steadily
Reduces discomfort and ensures full
dose delivery
8. Withdraw needle and apply cotton/gauzePrevents bleeding and infection
9. Dispose of needle in sharps containerPrevents needle-stick injury
10. Rotate injection sites for subsequent doses
Prevents lipodystrophy and tissue
damage
11. Monitor patient for hypoglycemia or other
reactions
Ensures safety and early intervention if
needed
12. Document insulin type, dose, site, and patient
response
Legal record and continuity of care
Step Yes / No
Verified patient identity and checked prescription
Explained procedure to patient
Washed hands and wore gloves
Checked insulin type, expiry, and appearance
Prepared correct dose using syringe or pen
Selected and cleaned injection site
Inserted needle at correct angle
Injected insulin slowly and steadily
Applied cotton/gauze after withdrawal
Disposed of needle safely
Rotated injection site for subsequent doses
Monitored patient for hypoglycemia or reactions
Documented insulin type, dose, site, and response
Pre-Operative Care
Meaning:
Pre-operative care refers to the preparation of a patient before surgery to ensure they are

21. physically and psychologically ready for the procedure. It involves assessment, education,
and interventions to minimize risks and optimize surgical outcomes.
Purpose:
1.Physical Preparation: Ensures the patient’s body is ready for anesthesia and surgery,
reducing complications.
2.Psychological Preparation: Reduces anxiety and fear by educating and counseling
the patient.
3.Risk Assessment: Identifies underlying conditions (e.g., diabetes, hypertension) that
may affect surgery.
4.Safety and Compliance: Ensures informed consent, proper fasting, medication
management, and adherence to pre-op instructions.
5.Optimize Recovery: Helps improve post-operative outcomes and reduces hospital
stay.
Equipment Purpose
Patient chart / records
Review medical history, allergies, and previous
investigations
Vital signs monitor Assess baseline vital signs before surgery
Laboratory reports
Check for anemia, infection, electrolyte imbalance,
coagulation status
Antiseptic solution For pre-op skin cleaning if required
Personal protective equipment
(gloves, mask)
Maintain asepsis and protect patient and staff
Patient gown Ensures hygiene and facilitates surgical preparation
Informed consent form
Confirms patient understanding and agreement to
surgery
Educational materials Help explain procedure, post-op care, and expectations
Procedure Rationale
1. Verify patient identity and surgical scheduleEnsures correct patient and procedure
2. Explain procedure, expected outcomes, and
obtain informed consent
Reduces anxiety and ensures legal
compliance
3. Assess baseline vital signs, weight, and general
condition
Provides reference for perioperative
monitoring
4. Review medical history, allergies, and lab
reports
Identifies risks and contraindications
5. Educate patient about fasting, medications, and
hygiene
Prevents complications like aspiration or
drug interactions
6. Prepare skin (shaving, cleaning if required)Reduces risk of surgical site infection
7. Ensure patient has empty bladder and bowel if
required
Improves surgical field and comfort
8. Provide psychological support and answer
questions
Reduces fear and promotes cooperation
9. Ensure all pre-op investigations and Avoids delays and complications

22. Procedure Rationale
documentation are complete
10. Transport patient safely to operating room
Prevents injury and ensures continuity of
care
11. Document all pre-operative interventions and
patient status
Legal record and continuity of care
Step Yes / No
Verified patient identity and surgical schedule
Explained procedure and obtained informed consent
Assessed baseline vital signs, weight, and condition
Reviewed medical history, allergies, and lab reports
Educated patient about fasting, medications, and hygiene
Prepared skin as required (cleaning/shaving)
Ensured bladder and bowel readiness
Provided psychological support
Confirmed completion of all pre-op investigations and documentation
Transported patient safely to operating room
Documented pre-operative interventions and patient status
Immediate Post-Operative Care
Meaning:
Immediate post-operative care refers to the care provided to a patient immediately after
surgery, usually in the Post-Anesthesia Care Unit (PACU) or recovery room. It involves
close monitoring and interventions to ensure hemodynamic stability, airway patency, and
early detection of complications following anesthesia and surgery.
Purpose:
1.Monitor Vital Functions: Ensures airway, breathing, circulation, and neurological
status are stable after surgery.
2.Pain Management: Provides timely relief of post-operative pain.
3.Prevent Complications: Detects and prevents hemorrhage, respiratory distress,
shock, or adverse reactions to anesthesia.
4.Support Recovery: Assists in gradual return to consciousness and normal
physiological function.

23. 5.Patient Safety: Provides continuous observation until patient is stable enough to
transfer to the ward.
Equipment Purpose
Vital signs monitor
Continuous monitoring of blood pressure, heart rate,
respiratory rate, and oxygen saturation
Oxygen supply / mask Maintains oxygenation and supports breathing
Suction apparatus Clears airway secretions if necessary
IV fluids and infusion setMaintains hydration and medication administration
Emergency drugs (e.g., for
anaphylaxis, hypotension)
Immediate treatment of complications
Pain management supplies
(analgesics, PCA pump)
Provides relief of post-operative pain
Pulse oximeter Monitors oxygen saturation continuously
Bed with side rails Ensures patient safety during recovery
Documentation forms / chartsRecords observations and interventions
Procedure Rationale
1. Verify patient identity and surgical
procedure
Ensures correct patient and safe care
2. Assess airway, breathing, and circulation
immediately
Detects early complications such as airway
obstruction or shock
3. Monitor vital signs frequently (BP, pulse,
RR, SpO , temperature)
₂
Ensures hemodynamic stability and early
detection of complications
4. Assess level of consciousness and
neurological status
Detects post-anesthesia recovery and
complications
5. Administer oxygen if prescribedMaintains adequate oxygenation
6. Check surgical site for bleeding or drainage
Early detection of hemorrhage or wound
complications
7. Monitor urine output via catheter if presentAssesses renal function and fluid balance
8. Administer pain relief as prescribed
Ensures patient comfort and reduces stress
response
9. Maintain patient in safe position with side
rails
Prevents falls and injury
10. Communicate with patient and provide
reassurance
Reduces anxiety and promotes recovery
11. Document observations, interventions, and
patient response
Legal record and continuity of care
Step Yes / No
Verified patient identity and surgical procedure
Assessed airway, breathing, and circulation
Monitored vital signs frequently
Assessed level of consciousness and neurological status

24. Step Yes / No
Administered oxygen if prescribed
Checked surgical site for bleeding or drainage
Monitored urine output
Administered pain relief as prescribed
Maintained patient in safe position with side rails
Provided reassurance and communication
Documented observations, interventions, and patient response
Post-Operative Exercise
Meaning:
Post-operative exercises are planned physical activities performed after surgery to help
patients regain strength, improve circulation, and restore normal function. These
exercises include deep breathing, coughing, limb movements, and early ambulation
depending on the type of surgery and patient condition.
Purpose:
1.Prevent Complications: Reduces risk of deep vein thrombosis (DVT), pulmonary
embolism, pneumonia, and muscle atrophy.
2.Improve Circulation and Respiratory Function: Enhances blood flow and lung
expansion.
3.Restore Mobility: Helps patients regain muscle strength, joint flexibility, and
functional independence.
4.Promote Healing and Recovery: Supports faster recovery and reduces post-
operative fatigue.
5.Enhance Patient Confidence: Encourages active participation in recovery and
prevents prolonged bed rest complications.
Deep Breathing Exercises
Purpose: Improves lung expansion, prevents atelectasis, and clears secretions.
How to do: Patient inhales deeply through the nose, holds for 2–3 seconds, then exhales
slowly through the mouth. Repeat several times.
2. Coughing Exercises
Purpose: Helps clear secretions and maintain airway patency.
How to do: Patient takes a deep breath, holds it, then coughs forcefully 2–3 times. Support
incision site if needed.

25. 3. Limb Exercises
a) Active Limb Exercises – patient moves own limbs.
b) Passive Limb Exercises – caregiver moves patient’s limbs if patient cannot move
independently.
Purpose: Maintains joint flexibility, prevents stiffness, improves circulation, and reduces risk
of DVT.
Examples:
Ankle pumps
Knee bends
Shoulder rotations
Wrist and finger movements
4. Early Ambulation
Purpose: Promotes circulation, prevents DVT, enhances respiratory function, and restores
independence.
How to do: Patient sits at bedside, stands with support, and walks short distances as
tolerated.
5. Incentive Spirometer
Purpose: Prevents lung collapse, improves lung capacity, and encourages deep breathing.
How to do: Patient inhales slowly through the spirometer mouthpiece to raise the piston or
ball to a target level, holds for 2–3 seconds, then exhales. Repeat several times.
Pain Assessment
Meaning:
Pain assessment is the process of evaluating a patient’s pain in terms of its intensity, quality,
location, duration, and impact on daily activities. It involves asking questions, observing
behaviors, and sometimes using standardized pain scales.
Purpose:
1.To identify the presence and type of pain.
2.To understand the severity and effect of pain on the patient’s physical and emotional
well-being.
3.To guide appropriate pain management strategies.

26. 4.To monitor the effectiveness of treatment interventions.
Pain Management
Meaning:
Pain management refers to the interventions and strategies used to reduce or relieve pain.
This can include medications, physical therapies, psychological support, and other
complementary methods.
Purpose:
1.To provide relief from acute or chronic pain.
2.To improve the patient’s comfort, quality of life, and ability to perform daily
activities.
3.To prevent complications associated with unmanaged pain, such as sleep
disturbances, anxiety, or depression.
4.To support recovery and rehabilitation.
Procedure Rationale
1. Ask the patient to describe the pain (location,
type, intensity, duration).
Helps to identify the nature and severity
of pain accurately.
2. Observe the patient’s facial expressions, posture,
and body movements.
Non-verbal cues provide additional
information about pain level.
3. Use standardized pain assessment tools (e.g.,
Numeric Rating Scale, Visual Analogue Scale).
Provides objective measurement for
monitoring and comparison.
4. Assess the impact of pain on sleep, activity, and
mood.
Helps to understand the functional and
psychological effects of pain.
5. Record findings in the patient’s chart.
Ensures continuity of care and guides
treatment planning.
Procedure Rationale
1. Administer prescribed analgesics according to
dosage and schedule.
Reduces pain intensity and improves patient
comfort.
2. Apply non-pharmacological methods (e.g.,
relaxation, cold/heat therapy, massage).
Supports pain relief and may reduce
medication requirements.
3. Reassess pain at regular intervals after
interventions.
Evaluates effectiveness and allows
adjustment of treatment.
4. Educate patient about pain management
strategies.
Empowers patient to participate in care and
use self-management techniques.
5. Collaborate with healthcare team for
multimodal pain control.
Ensures comprehensive and individualized
care.

27. Colonoscopy
Meaning:
Colonoscopy is a medical procedure in which a long, flexible tube called a colonoscope is
inserted through the rectum to examine the inner lining of the large intestine (colon and
rectum). It allows direct visualization, biopsy, and sometimes removal of abnormal tissue.
Purpose:
1.To detect abnormalities such as polyps, tumors, inflammation, or bleeding in the
colon.
2.To diagnose causes of gastrointestinal symptoms like abdominal pain, chronic
diarrhea, constipation, or rectal bleeding.
3.To screen for colorectal cancer, especially in individuals over 50 or with risk factors.
4.To monitor previously detected colon conditions and assess treatment effectiveness.
Equipment Purpose
Colonoscope (flexible tube with camera and
light)
To visualize the inner lining of the colon and
rectum directly.
Light source and video monitor
Provides illumination and displays real-time
images for examination.
Sterile gloves and gown Maintain asepsis and prevent infection.
Sterile drapes Create a sterile field around the patient.
Antiseptic solution (e.g., chlorhexidine,
iodine)
Disinfect the perianal area or insertion site to
prevent infection.
Syringes and needles
For administering local anesthesia or sedation
if needed.
Sedative or analgesic medications
To reduce patient discomfort and anxiety
during the procedure.
Biopsy forceps / polyp removal tools
To take tissue samples or remove polyps
during the procedure.
Suction apparatus
Removes fluids, air, or stool for better
visualization.
Vital signs monitoring equipment (BP cuff,
pulse oximeter, thermometer)
Monitor patient’s condition during and after
the procedure.
Oxygen supply To maintain oxygenation during sedation.
Emergency equipment (resuscitation kit,
suction, oxygen)
To manage complications such as respiratory
distress or hypotension.
Specimen container with formalin
To store and preserve biopsied tissue or
polyps for laboratory analysis.
Labels and documentation forms
Properly label specimens and maintain
accurate records of the procedure.

28. Procedure Rationale
Explain the procedure to the patient and
obtain informed consent.
Ensures patient understanding, reduces anxiety,
and fulfills ethical/legal requirements.
Assess the patient’s medical history,
allergies, and current medications.
Identifies potential risks and prevents
complications during the procedure.
Prepare the bowel using prescribed
laxatives or enemas.
Ensures the colon is clean for clear visualization of
the mucosa.
Position the patient in left lateral (Sims)
position.
Provides optimal access and comfort for the
insertion of the colonoscope.
Monitor vital signs before and during the
procedure.
Detects early signs of complications such as
hypotension, hypoxia, or arrhythmia.
Insert the colonoscope carefully and
advance through the colon.
Allows direct visualization of the colon to detect
polyps, tumors, or inflammation.
Perform biopsies or remove polyps if
indicated.
Enables diagnosis and therapeutic intervention in
the same procedure.
Slowly withdraw the colonoscope while
inspecting the colon.
Ensures a complete examination of all colon
segments and reduces risk of injury.
Monitor the patient post-procedure until
sedation effects wear off.
Ensures patient safety and identifies any immediate
complications.
Provide post-procedure instructions
regarding diet, activity, and follow-up.
Promotes recovery and ensures the patient knows
warning signs that require medical attention.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
Meaning:
ERCP is a specialized medical procedure in which an endoscope (a flexible tube with a
camera) is passed through the mouth into the duodenum to examine the bile ducts, pancreatic
ducts, and gallbladder. A contrast dye is injected, and X-rays are taken to detect blockages,
stones, or other abnormalities.
Purpose:

29. 1.To diagnose conditions affecting the bile ducts, pancreatic ducts, or gallbladder, such
as stones, strictures, or tumors.
2.To treat certain conditions, such as removing bile duct stones or placing stents to
relieve obstructions.
3.To investigate unexplained jaundice, abdominal pain, or pancreatitis.
4.To monitor the effectiveness of prior treatments or surgical interventions in the biliary
or pancreatic system.
Procedure Rationale
Explain the procedure to the patient and
obtain informed consent.
Ensures patient understanding, reduces anxiety,
and meets ethical/legal requirements.
Assess patient’s medical history, allergies,
and current medications.
Identifies risks and prevents complications,
such as reactions to sedatives or contrast dye.
Ensure the patient is fasting for 6–8 hours
before the procedure.
Reduces risk of aspiration during sedation.
Administer sedation and monitor vital signs.
Ensures patient comfort and safety throughout
the procedure.
Position the patient in left lateral or prone
position.
Provides optimal access for endoscope
insertion and visualization.
Insert the endoscope through the mouth into
the duodenum.
Allows visualization of the duodenum and
access to bile and pancreatic ducts.
Inject contrast dye into the bile or pancreatic
ducts under X-ray guidance.
Highlights the ducts for accurate diagnosis of
stones, strictures, or obstructions.
Perform therapeutic interventions if
indicated (e.g., stone removal, stent
placement).
Treats the underlying problem during the same
procedure and reduces need for surgery.
Withdraw the endoscope slowly while
monitoring for complications.
Ensures safe removal and checks for immediate
issues such as bleeding or perforation.
Monitor the patient post-procedure until
sedation effects wear off.
Detects early complications such as
pancreatitis, bleeding, or infection.
Provide post-procedure instructions
regarding diet, activity, and warning signs.
Promotes recovery and ensures patient knows
when to seek medical attention.
Endoscopy
Meaning:
Endoscopy is a medical procedure in which a flexible tube with a camera and light (called an
endoscope) is inserted into the body to visually examine internal organs or cavities. Common
types include gastroscopy (stomach), colonoscopy (colon), bronchoscopy (lungs), and
others. It can also be used to take biopsies or perform minor therapeutic interventions.

30. Purpose:
1.To visually examine internal organs for abnormalities, such as inflammation, ulcers,
tumors, or bleeding.
2.To take tissue samples (biopsy) for diagnosis.
3.To perform minor therapeutic procedures, such as removing polyps, dilating
strictures, or controlling bleeding.
4.To monitor the progression or treatment of gastrointestinal, respiratory, or other organ
conditions.
5.To aid in diagnosis when imaging tests (X-ray, CT, MRI) are inconclusive.
Equipment Purpose
Endoscope (flexible tube with camera and
light)
To visualize internal organs and cavities
directly.
Light source and video monitor
Provides illumination and displays real-time
images for examination.
Sterile gloves and gown Maintain asepsis and prevent infection.
Sterile drapes Create a sterile field around the insertion site.
Antiseptic solution (e.g., chlorhexidine,
iodine)
Disinfect the insertion site or surrounding area
to prevent infection.
Syringes and needles For administering local anesthesia or sedation.
Local anesthetic (e.g., lidocaine)
Numbs the insertion site to reduce patient
discomfort.
Suction apparatus
Removes secretions or fluids during the
procedure for better visibility.
Biopsy forceps / polyp retrieval tools
To take tissue samples or remove polyps
during the procedure.
Vital signs monitoring equipment (BP cuff,
pulse oximeter, thermometer)
Monitor patient’s condition during and after
the procedure.
Oxygen supply To maintain oxygenation during sedation.
Emergency equipment (resuscitation kit,
suction, oxygen)
To manage complications such as respiratory
distress or adverse reactions.
Specimen container with formalin
To store and preserve biopsied tissue for
laboratory analysis.
Labels and documentation forms
Properly label specimens and maintain
accurate procedure records.

31. Procedure Rationale
Explain the procedure to the patient and
obtain informed consent.
Ensures patient understanding, reduces anxiety, and
meets ethical/legal requirements.
Assess the patient’s medical history,
allergies, and current medications.
Identifies potential risks and prevents complications
such as reactions to sedation or endoscopic
instruments.
Ensure the patient is fasting for 6–8
hours before the procedure.
Reduces risk of aspiration during sedation or
insertion of the endoscope.
Check baseline vital signs.
Provides reference for monitoring during and after
the procedure.
Prepare necessary equipment and
instruments.
Ensures readiness and prevents delays or
complications during the procedure.
Administer sedation and monitor vital
signs continuously.
Ensures patient comfort and safety throughout the
procedure.
Position the patient appropriately
(usually left lateral for upper GI
endoscopy).
Provides optimal access for endoscope insertion and
visualization.
Insert the endoscope carefully into the
target organ/cavity.
Allows direct visualization to detect abnormalities
such as ulcers, tumors, or inflammation.
Take biopsies or perform minor
therapeutic procedures if indicated.
Enables diagnosis and treatment during the same
procedure.
Withdraw the endoscope slowly while
inspecting the area.
Ensures complete examination and reduces risk of
injury.
Monitor the patient post-procedure until
sedation effects wear off.
Detects early complications such as bleeding,
perforation, or adverse reactions to sedation.
Provide post-procedure instructions
regarding diet, activity, and warning
signs.
Promotes recovery and ensures the patient knows
when to seek medical attention.
Document the procedure, interventions,
and patient’s response.
Ensures continuity of care and legal documentation.
Liver Biopsy
Meaning:
A liver biopsy is a medical procedure in which a small sample of liver tissue is removed,
usually with a needle, for microscopic examination. This helps to diagnose liver diseases,
assess the severity of liver damage, or guide treatment decisions.
Purpose:

32. 1.To diagnose liver conditions such as hepatitis, fatty liver disease, cirrhosis, or liver
tumors.
2.To assess the extent and severity of liver damage.
3.To monitor the effectiveness of ongoing treatment for liver disease.
4.To guide treatment planning and prognosis.
5.To differentiate between various liver disorders when other tests (blood tests,
imaging) are inconclusive.
Equipment Purpose
Biopsy needle (e.g., Tru-Cut, Menghini)
To obtain a sample of liver tissue for
histopathological examination.
Sterile gloves and gown Maintain asepsis and prevent infection.
Sterile drapes Create a sterile field around the biopsy site.
Antiseptic solution (e.g., chlorhexidine,
iodine)
Disinfect the biopsy site to prevent infection.
Syringes and needles To administer local anesthesia.
Local anesthetic (e.g., lidocaine)Numbs the biopsy site to minimize pain.
Gauze pads and sterile dressing
Apply pressure and cover the site after biopsy
to prevent bleeding.
Specimen container with formalin
Safely store and preserve the liver tissue for
laboratory analysis.
Vital signs monitoring equipment (BP cuff,
pulse oximeter, thermometer)
Monitor patient’s condition during and after
the procedure.
Emergency equipment (oxygen, suction,
resuscitation kit)
To manage complications such as bleeding or
respiratory distress.
Sharps disposal container
Safe disposal of needles and other sharp
instruments to prevent injury.
Labels and documentation forms
Properly label specimens and maintain
accurate records of the procedure.

33. Procedure Rationale
Explain the procedure to the patient and obtain
informed consent.
Ensures patient understanding, reduces
anxiety, and fulfills ethical/legal
requirements.
Assess patient’s medical history, allergies, and
current medications, especially anticoagulants.
Identifies risk factors for bleeding and other
complications.
Check baseline vital signs and coagulation
profile (PT, INR, platelet count).
Ensures patient safety and identifies
bleeding risks.
Position the patient supine with right arm above
the head.
Provides optimal access to the right lobe of
the liver.
Prepare and disinfect the biopsy site (usually
right upper quadrant).
Prevents infection at the puncture site.
Administer local anesthesia at the biopsy site.
Reduces pain and discomfort during needle
insertion.
Instruct the patient to hold breath during needle
insertion.
Minimizes movement and reduces the risk
of injury to surrounding organs.
Insert the biopsy needle and obtain liver tissue
sample.
Allows collection of adequate tissue for
microscopic examination and diagnosis.
Apply pressure and dressing to the biopsy site
after needle removal.
Prevents bleeding and promotes wound
healing.
Monitor vital signs and observe for
complications (bleeding, pain, hypotension)
post-procedure.
Early detection and management of
complications.
Advise the patient to rest for several hours and
avoid strenuous activity for 24–48 hours.
Reduces the risk of post-procedure
bleeding.
Provide post-procedure instructions and warning
signs to report (pain, fever, bleeding).
Ensures patient safety and timely
management of complications.
Document procedure, findings, and patient
response.
Maintains legal records and continuity of
care.

34. Nasogastric Aspiration
Meaning:
Nasogastric aspiration is the process of removing gastric contents through a nasogastric tube
(NG tube) inserted via the nose into the stomach. It can be used for diagnostic or therapeutic
purposes.
Purpose:
1.To decompress the stomach in cases of intestinal obstruction or ileus.
2.To remove toxic substances in cases of poisoning or overdose.
3.To obtain gastric contents for laboratory analysis (e.g., pH, culture).
4.To prevent vomiting and aspiration in critically ill patients.
5.To relieve gastric distension and discomfort.
Equipment Purpose
Nasogastric (NG) tube To access the stomach for aspiration of gastric contents.
Lubricant (water-soluble)
Reduces discomfort and facilitates smooth insertion of
the tube.
50–60 ml syringe To aspirate gastric contents or flush the tube.
pH paper or gastric test strips
To confirm correct placement of the NG tube in the
stomach.
Container / specimen cup To collect aspirated gastric contents for analysis.
Adhesive tape To secure the tube to the nose and prevent displacement.
Gloves (sterile or clean)To maintain asepsis and prevent infection.
Antiseptic solution To clean the insertion site and hands for infection control.
Towels or protective sheetTo protect clothing and bed from spills.
Vital signs monitoring equipment
(optional)
To monitor patient’s condition during the procedure,
especially if critically ill.
Documentation forms
To record the procedure, volume, and character of
aspirate.
Procedure Rationale
Explain the procedure to the patient and obtain consent.
Reduces anxiety and ensures patient
cooperation.
Wash hands and prepare equipment (NG tube, Maintains asepsis and ensures

35. Procedure Rationale
lubricant, syringe, gloves, pH paper, container).readiness.
Position the patient upright or in a high Fowler’s
position.
Facilitates insertion and prevents
aspiration.
Measure the NG tube from the tip of the nose to the
earlobe to the xiphoid process.
Ensures correct insertion length.
Lubricate the tip of the NG tube. Reduces discomfort during insertion.
Gently insert the NG tube through the nostril and
advance toward the stomach.
Allows safe passage without trauma.
Confirm placement by aspirating gastric contents and
checking pH (<5 is gastric).
Ensures correct tube placement and
prevents lung injury.
Attach syringe and aspirate gastric contents.
Removes stomach contents for
decompression or analysis.
Collect the aspirated contents in a container for
examination if needed.
Enables laboratory analysis for
diagnostic purposes.
Flush the NG tube with 20–30 ml of sterile water if
required.
Maintains patency of the tube.
Secure the tube to the patient’s nose and clothing with
tape.
Prevents displacement of the tube.
Monitor the patient for discomfort, vomiting, or
complications.
Ensures safety and early detection of
adverse effects.
Dispose of waste and document the procedure, volume,
and character of aspirate.
Ensures proper infection control and
record-keeping.
Gastrostomy/Jejunostomy Feeds
Meaning:
Gastrostomy feeding (G-tube) and Jejunostomy feeding (J-tube) involve delivering nutrition
directly into the stomach or jejunum (part of the small intestine) through a surgically or
endoscopically placed tube. These feeds are used when patients cannot take adequate
nutrition orally due to obstruction, dysphagia, or other medical conditions.
Purpose:
1.To provide adequate nutrition, fluids, and medications when oral intake is not
possible.
2.To maintain or improve nutritional status and prevent malnutrition.
3.To support recovery in patients with gastrointestinal, neurological, or critical
illnesses.
4.To allow long-term enteral feeding in patients with swallowing difficulties or chronic
illness.
5.To administer medications safely when oral route is not feasible.

36. Equipment Purpose
Feeding tube (G-tube or J-tube)
Provides direct access for nutrition and medication
administration.
Prescribed enteral feed (liquid
nutrition)
Supplies necessary nutrients, fluids, and calories.
20–60 ml syringe For delivering feeds and flushing the tube.
Feeding pump or gravity set (if
required)
Ensures controlled delivery of feeds.
Sterile or clean gloves Maintains asepsis during handling.
Water (sterile or boiled)
For flushing tube before and after feeding to maintain
patency.
Towels or protective sheetProtects clothing and bedding from spills.
pH paper or verification tools (if
required)
Confirms correct tube placement.
Tape or tube fixation deviceSecures the tube and prevents dislodgement.
Documentation forms
Records amount, type of feed, patient tolerance, and
tube condition.
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures patient
cooperation.
Wash hands and prepare equipment.
Maintains asepsis and readiness for
feeding.
Position the patient upright (30–45°) or as
prescribed.
Prevents aspiration during feeding.
Check tube placement by aspirating gastric/jejunal
contents or using prescribed verification method.
Ensures correct tube position and
prevents feeding into lungs.
Wash hands and wear gloves. Maintains infection control.
Flush the tube with 20–30 ml of sterile water before
feeding.
Clears the tube and maintains patency.
Administer prescribed feed slowly using syringe,
gravity, or feeding pump.
Prevents rapid infusion, reduces risk of
nausea, vomiting, or aspiration.
Flush the tube with water after feeding.Clears residual feed, prevents blockage.
Clamp or cap the tube as required.
Maintains tube hygiene and prevents
leakage.
Monitor the patient for discomfort, abdominal
distension, or vomiting.
Ensures safety and early detection of
complications.
Document the feed, amount, type, patient tolerance,
and tube status.
Ensures continuity of care and accurate
record-keeping.

37. Equipment Purpose
Feeding tube (G-tube or J-tube)
Provides direct access for nutrition and medication
administration.
Prescribed enteral feed (liquid
nutrition)
Supplies necessary nutrients, fluids, and calories.
20–60 ml syringe For delivering feeds and flushing the tube.
Feeding pump or gravity set (if
required)
Ensures controlled delivery of feeds.
Sterile or clean gloves Maintains asepsis during handling.
Water (sterile or boiled)
For flushing tube before and after feeding to maintain
patency.
Towels or protective sheetProtects clothing and bedding from spills.
pH paper or verification tools (if
required)
Confirms correct tube placement.
Tape or tube fixation deviceSecures the tube and prevents dislodgement.
Documentation forms
Records amount, type of feed, patient tolerance, and
tube condition.
leostomy / Colostomy Care
Meaning:
Ileostomy or colostomy care involves maintaining and managing a surgically created opening
(stoma) in the abdomen, which diverts intestinal contents into a stoma bag. This care includes
cleaning, changing the appliance, and monitoring for complications.
Purpose:
1.To maintain skin integrity around the stoma.
2.To prevent infection, leakage, and odor.
3.To ensure proper functioning of the stoma and appliance.
4.To educate and support patient self-care and independence.
5.To monitor for complications such as irritation, prolapse, or blockage.
Equipment for Ileostomy/Colostomy Care with Purpose
Equipment Purpose
Stoma bag / pouch Collects fecal output from the stoma.
Adhesive wafer / skin barrierProtects peristomal skin and secures pouch.
Warm water / mild soapCleans stoma and surrounding skin gently.
Soft washcloth or gauzeAssists in gentle cleaning without trauma.
Scissors To cut the adhesive wafer to fit stoma size.
Measuring guide / templateEnsures proper sizing of wafer to prevent leakage.
Disposable gloves Maintains asepsis during care.
Trash bag or containerFor disposal of used pouch and materials.
Barrier creams / ointmentsProtects peristomal skin from irritation or moisture.

38. Equipment Purpose
Towels / protective sheetProtects patient’s bed or clothing during procedure.
Documentation forms Records stoma condition, output, and care provided.
Procedure with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and promotes
cooperation.
Wash hands and wear gloves. Maintains asepsis and prevents infection.
Position the patient comfortably with protective
sheet.
Ensures easy access and prevents
contamination.
Remove the old pouch carefully. Prevents trauma to the skin and stoma.
Assess stoma and peristomal skin for color,
swelling, irritation, or infection.
Early detection of complications and
ensures stoma health.
Clean stoma and surrounding skin gently with
warm water or mild soap; pat dry.
Maintains hygiene, prevents infection, and
protects skin integrity.
Measure stoma size and cut new wafer
accordingly.
Ensures proper fit, prevents leakage and
skin irritation.
Apply barrier cream if needed.
Protects peristomal skin from moisture
and breakdown.
Place and secure new pouch/wafer over stoma.
Ensures collection of output and prevents
leakage.
Dispose of used materials properly.
Maintains cleanliness and infection
control.
Remove gloves, wash hands, and ensure patient
comfort.
Prevents cross-contamination and ensures
patient safety.
Document stoma condition, output characteristics,
and care provided.
Maintains continuity of care and legal
documentation.
Surgical Dressing
Meaning:
Surgical dressing is the sterile covering applied over a wound or surgical incision to protect it
from infection, absorb exudates, and promote healing. It can be primary (directly on the
wound) or secondary (over primary dressing for extra protection).
Purpose:
1.To protect the wound from infection, dust, and trauma.
2.To absorb exudates and maintain a moist wound environment.

39. 3.To promote healing by supporting tissue regeneration.
4.To provide pressure and support to prevent bleeding or hematoma formation.
5.To secure medications or antiseptics applied to the wound.
6.To monitor wound healing and detect early complications.
Equipment for Surgical Dressing with Purpose
Equipment Purpose
Sterile dressing pads / gauzeCovers the wound and absorbs exudates.
Sterile gloves Maintains asepsis and prevents contamination.
Sterile scissors Cuts dressing material to appropriate size.
Adhesive tape / bandage Secures the dressing in place.
Antiseptic solution (e.g., povidone-
iodine)
Cleans wound to prevent infection.
Sterile forceps / tweezers Handles dressing without contamination.
Protective sheet / towel Protects patient’s bed or clothing during procedure.
Saline solution Cleanses wound gently if needed.
Trash bag / container Proper disposal of used dressings and materials.
Documentation forms
Records wound condition, dressing type, and care
provided.
Procedure for Surgical Dressing with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures cooperation.
Wash hands and wear sterile gloves.Maintains asepsis and prevents infection.
Prepare all equipment and place on a sterile
field.
Ensures readiness and maintains sterility.
Remove old dressing carefully.
Prevents trauma to the wound and
surrounding skin.
Assess the wound for color, exudate, swelling,
odor, or signs of infection.
Early detection of complications and ensures
proper wound care.
Cleanse the wound with sterile saline or
antiseptic as prescribed.
Removes debris, bacteria, and prevents
infection.
Pat the wound dry gently with sterile gauze.
Prevents tissue maceration and prepares
wound for new dressing.
Apply sterile dressing of appropriate size over
the wound.
Protects wound, absorbs exudates, and
maintains healing environment.
Secure the dressing with adhesive tape or
bandage.
Keeps dressing in place and prevents
displacement or contamination.
Dispose of used materials properly.Maintains cleanliness and infection control.
Remove gloves and wash hands.
Prevents cross-contamination and maintains
hygiene.

40. Procedure Rationale
Document the wound condition, dressing type,
and any observations.
Ensures continuity of care and legal
documentation.
Surgical Dressing
Meaning:
Surgical dressing is the sterile covering applied over a wound or surgical incision to protect it
from infection, absorb exudates, and promote healing. It can be primary (directly on the
wound) or secondary (over primary dressing for extra protection).
Purpose:
1.To protect the wound from infection, dust, and trauma.
2.To absorb exudates and maintain a moist wound environment.
3.To promote healing by supporting tissue regeneration.
4.To provide pressure and support to prevent bleeding or hematoma formation.
5.To secure medications or antiseptics applied to the wound.
6.To monitor wound healing and detect early complications.
Equipment for Surgical Dressing with Purpose
Equipment Purpose
Sterile dressing pads / gauzeCovers the wound and absorbs exudates.
Sterile gloves Maintains asepsis and prevents contamination.
Sterile scissors Cuts dressing material to appropriate size.
Adhesive tape / bandage Secures the dressing in place.
Antiseptic solution (e.g., povidone-
iodine)
Cleans wound to prevent infection.
Sterile forceps / tweezers Handles dressing without contamination.
Protective sheet / towel Protects patient’s bed or clothing during procedure.
Saline solution Cleanses wound gently if needed.
Trash bag / container Proper disposal of used dressings and materials.
Documentation forms
Records wound condition, dressing type, and care
provided.
Procedure for Surgical Dressing with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures cooperation.

41. Procedure Rationale
Wash hands and wear sterile gloves.Maintains asepsis and prevents infection.
Prepare all equipment and place on a sterile
field.
Ensures readiness and maintains sterility.
Remove old dressing carefully.
Prevents trauma to the wound and
surrounding skin.
Assess the wound for color, exudate, swelling,
odor, or signs of infection.
Early detection of complications and ensures
proper wound care.
Cleanse the wound with sterile saline or
antiseptic as prescribed.
Removes debris, bacteria, and prevents
infection.
Pat the wound dry gently with sterile gauze.
Prevents tissue maceration and prepares
wound for new dressing.
Apply sterile dressing of appropriate size over
the wound.
Protects wound, absorbs exudates, and
maintains healing environment.
Secure the dressing with adhesive tape or
bandage.
Keeps dressing in place and prevents
displacement or contamination.
Dispose of used materials properly.Maintains cleanliness and infection control.
Remove gloves and wash hands.
Prevents cross-contamination and maintains
hygiene.
Document the wound condition, dressing type,
and any observations.
Ensures continuity of care and legal
documentation.
Suture Removal
Meaning:
Suture removal is the process of taking out stitches (sutures) from a healed wound after
sufficient healing has occurred, usually 7–14 days post-surgery, depending on the site and
type of wound.
Purpose:
1.To prevent infection by removing foreign material (sutures) once wound healing is
adequate.
2.To promote proper wound healing and prevent scarring.
3.To restore normal skin integrity and function.
4.To monitor the wound for complete healing and detect any complications.
Equipment for Suture Removal with Purpose

42. Equipment Purpose
Sterile scissors or suture removal
scissors
To cut the sutures safely without damaging skin.
Sterile forceps / tweezers To hold and gently lift the suture during removal.
Sterile gloves Maintain asepsis and prevent infection.
Antiseptic solution (e.g., povidone-
iodine)
Cleans wound site before and after removal.
Gauze pads
Cleans and absorbs any minor bleeding during
removal.
Adhesive strips or small bandageProtects wound after suture removal if needed.
Trash bag / sharps container Safe disposal of sutures and used materials.
Documentation forms
Records procedure, wound condition, and
observations.
Procedure for Suture Removal with Rationale
Procedure Rationale
Explain the procedure to the patient and
obtain consent.
Reduces anxiety and ensures patient
cooperation.
Wash hands and wear sterile gloves.Maintains asepsis and prevents infection.
Arrange equipment on a sterile field.Ensures readiness and maintains sterility.
Inspect the wound for healing, infection, or
dehiscence.
Ensures sutures are removed safely and only
after adequate healing.
Clean the wound gently with antiseptic
solution.
Reduces risk of infection during suture
removal.
Use forceps to grasp one end of the suture.
Provides control over the suture and prevents
skin injury.
Cut the suture close to the skin with scissors.Minimizes trauma to newly healed tissue.
Gently pull the suture out using forceps.
Removes suture safely without reopening the
wound.
Repeat for all remaining sutures.Ensures complete removal and wound integrity.
Apply gauze and antiseptic if needed.
Protects wound and absorbs any minor
bleeding.
Dispose of used sutures and materials
properly.
Maintains hygiene and prevents contamination.
Remove gloves, wash hands, and ensure
patient comfort.
Prevents cross-contamination and maintains
safety.
Document the procedure, wound condition,
and patient response.
Ensures continuity of care and legal
documentation.
Surgical Soak
Meaning:
Surgical soak (also called wound soak or dressing soak) is a procedure in which a sterile
dressing, gauze, or swab is soaked in a prescribed solution (e.g., antiseptic, saline) and

43. applied to a wound or surgical site. It is used to cleanse, soften crusts, or promote healing of
the wound.
Purpose:
1.To soften and remove dried exudate, blood, or debris from the wound.
2.To cleanse the wound and reduce microbial load, preventing infection.
3.To relieve pain, inflammation, or irritation at the wound site.
4.To promote proper wound healing and prepare the wound for further dressing.
5.To maintain a moist wound environment conducive to healing.
Equipment for Surgical Soak with Purpose
Equipment Purpose
Sterile gauze / swabs To apply the soaking solution to the wound.
Prescribed solution (e.g., saline,
antiseptic)
Cleanses wound, softens debris, and prevents
infection.
Sterile bowl or container Holds the solution for soaking gauze or swabs.
Sterile gloves Maintains asepsis and prevents contamination.
Forceps / tweezers
Handles gauze or swabs without touching with
hands.
Towels / protective sheet Protects patient’s bed or clothing from spills.
Trash bag / container Proper disposal of used gauze, swabs, and solution.
Documentation forms
Records procedure, wound condition, and
observations.
Procedure for Surgical Soak with Rationale
Procedure Rationale
Explain the procedure to the patient and
obtain consent.
Reduces anxiety and promotes cooperation.
Wash hands and wear sterile gloves.Maintains asepsis and prevents infection.
Prepare all equipment on a sterile field.Ensures readiness and maintains sterility.
Fill sterile bowl or container with prescribed
solution.
Provides a clean medium for soaking gauze or
swabs.
Soak sterile gauze or swabs in the solution.Prepares dressing for application to wound.
Apply soaked gauze gently to the wound,
ensuring complete coverage.
Softens debris, cleanses wound, and reduces
bacterial load.
Leave dressing in place for prescribed
duration.
Allows solution to act effectively on the wound.
Remove gauze carefully after soaking.Prevents trauma to wound or surrounding skin.
Assess wound for cleanliness, exudate,
odor, or infection.
Ensures wound is ready for next care step and
detects complications early.
Dispose of used materials properly.Maintains hygiene and infection control.

44. Procedure Rationale
Wash hands and ensure patient comfort.Prevents contamination and promotes safety.
Document procedure, wound condition, and
patient response.
Maintains continuity of care and legal
documentation.
Sitz Bath
Meaning:
A sitz bath is a therapeutic warm water bath in which only the hips, buttocks, and perineal
area are immersed. It is used to promote healing, hygiene, and comfort in the perineal or anal
region.
Purpose:
1.To cleanse the perineal, genital, or anal area.
2.To relieve pain, itching, or discomfort caused by infections, hemorrhoids, or surgical
wounds.
3.To reduce inflammation and promote circulation to the perineal area.
4.To aid in the healing of perineal tears, episiotomies, or post-anal surgery wounds.
5.To promote relaxation and patient comfort.
Equipment for Sitz Bath with Purpose
Equipment Purpose
Sitz bath basin or tub
Holds warm water and accommodates patient’s perineal
area.
Warm water (temperature 37–
40°C)
Provides therapeutic warmth to promote circulation and
comfort.
Soap or antiseptic (if prescribed)Cleanses the area and prevents infection.
Towels
Dries the area after bath and protects bed/clothing from
spills.
Protective sheet / waterproof padProtects bed or chair from water spillage.
Chair or toilet adapter (if
required)
Supports patient safely during sitz bath.
Gloves (if needed) Maintains hygiene while assisting patient.
Timer or watch
Ensures prescribed duration of bath (usually 10–20
minutes).
Documentation forms Records procedure, patient tolerance, and observations.
Procedure for Sitz Bath with Rationale

45. Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures cooperation.
Wash hands and wear gloves if assisting.
Maintains hygiene and prevents
contamination.
Prepare sitz bath basin, warm water, and
protective sheets.
Ensures comfort, cleanliness, and safety.
Position patient comfortably on the sitz bath or
toilet adapter.
Prevents falls and ensures proper immersion.
Immerse perineal area in warm water (37–
40°C).
Promotes circulation, reduces pain, and
relaxes muscles.
Add soap or antiseptic if prescribed.Cleanses area and reduces infection risk.
Allow patient to soak for 10–20 minutes.
Provides therapeutic effect for comfort and
healing.
Encourage relaxation and monitor patient
tolerance.
Ensures patient safety and prevents adverse
reactions.
Gently dry the area with a towel after the bath.
Prevents moisture-related skin irritation or
infection.
Clean and store equipment properly.
Maintains hygiene and prevents
contamination.
Wash hands and ensure patient comfort.Promotes safety and hygiene.
Document procedure, duration, and patient
response.
Ensures continuity of care and legal
documentation.
Care of Drain
Meaning:
Care of a drain involves managing a surgical drain placed in or near a surgical wound to
remove blood, pus, or other fluids. Proper care prevents infection, maintains patency, and
promotes healing. Common drains include Penrose, Jackson-Pratt (JP), Hemovac, or tube
drains.
Purpose:
1.To remove accumulated fluids, blood, or pus from a surgical site.
2.To prevent infection and abscess formation.
3.To promote wound healing by reducing pressure and edema.
4.To monitor the quantity, color, and type of drainage for clinical assessment.
5.To ensure proper functioning and prevent complications such as blockage or
dislodgement.
Equipment for Drain Care with Purpose

46. Equipment Purpose
Sterile gloves Maintains asepsis during handling of drain.
Sterile gauze or dressing Protects drain insertion site and absorbs exudate.
Antiseptic solution (e.g., povidone-
iodine)
Cleanses skin around drain to prevent infection.
Measuring container / graduated cylinderCollects and measures drainage volume accurately.
Tape / safety pin Secures drain to prevent accidental displacement.
Scissors Trims dressing or tape if needed.
Cotton swabs / forceps For gentle cleaning around the drain site.
Trash bag / container Safe disposal of used materials.
Documentation forms
Records drainage amount, type, and patient
response.
Procedure for Drain Care with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures
cooperation.
Wash hands and wear sterile gloves. Maintains asepsis and prevents infection.
Assess the drain site for redness, swelling,
discharge, or signs of infection.
Early detection of complications.
Check drain patency and ensure it is functioning
correctly.
Prevents fluid accumulation and
complications.
Measure and record the amount, color, and
consistency of drainage.
Monitors patient condition and aids in
clinical decisions.
Clean around the drain site with antiseptic solution
using sterile gauze.
Reduces microbial contamination and
prevents infection.
Replace or reinforce the dressing around the drain
as needed.
Maintains cleanliness and protects the
site.
Secure the drain tubing to prevent tension or
accidental removal.
Ensures safety and maintains proper
function.
Dispose of used materials properly.
Prevents contamination and maintains
hygiene.
Wash hands and ensure patient comfort.Promotes safety and hygiene.
Document drainage characteristics, dressing
change, and patient response.
Ensures continuity of care and legal
documentation.
Cardiac Monitoring
Meaning:
Cardiac monitoring is the continuous or intermittent observation of the heart’s electrical
activity using an electrocardiogram (ECG/EKG) to detect abnormalities in heart rate, rhythm,
and conduction. It is commonly used in critical care, post-operative, and emergency settings.
Purpose:

47. 1.To detect cardiac arrhythmias, ischemia, or myocardial infarction early.
2.To monitor patients after cardiac surgery, heart attack, or during critical illness.
3.To evaluate the effectiveness of cardiac medications or interventions.
4.To guide clinical decision-making in emergency or high-risk situations.
5.To ensure patient safety by enabling prompt response to cardiac events.
Equipment for Cardiac Monitoring with Purpose
Equipment Purpose
ECG monitor / cardiac monitor
Continuously displays heart rate, rhythm, and electrical
activity.
ECG electrodes Conduct electrical signals from skin to monitor.
Electrolyte gel / adhesive pads
Ensures good electrical contact between skin and
electrodes.
ECG cables / leads Transmit electrical signals to the monitor.
Alcohol swabs Clean skin for better electrode adhesion.
Razor (if needed) Remove hair at electrode site for proper adhesion.
Monitoring bed / chair Provides patient comfort during monitoring.
Documentation forms / monitor
printouts
Record ECG readings, trends, and events.
Defibrillator (as emergency backup)To manage life-threatening arrhythmias if detected.
Procedure for Cardiac Monitoring with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures cooperation.
Wash hands and prepare equipment. Maintains hygiene and ensures readiness.
Position patient comfortably in a supine or semi-
Fowler’s position.
Ensures accurate readings and patient
comfort.
Clean electrode sites with alcohol swabs; shave
hair if necessary.
Ensures good electrode adhesion and
accurate signals.
Attach ECG electrodes to designated chest sites.
Proper placement ensures accurate
monitoring of heart activity.
Connect ECG leads to the monitor and verify
correct waveform display.
Confirms proper functioning of the
monitoring system.
Adjust monitor settings according to patient
condition and physician orders.
Ensures accurate monitoring and detection
of abnormalities.

48. Procedure Rationale
Continuously observe monitor for heart rate,
rhythm, and alarms.
Enables early detection of arrhythmias or
cardiac events.
Document baseline readings, ongoing
observations, and any abnormalities.
Provides accurate record for treatment and
clinical decisions.
Respond promptly to alarms or abnormal
readings according to protocols.
Ensures patient safety and timely
intervention.
Clean equipment and electrodes as per protocol
after use.
Maintains hygiene and prevents cross-
contamination.
Recording and Interpreting ECG
Meaning:
Electrocardiography (ECG or EKG) is the process of recording the electrical activity of the
heart over a period of time using electrodes placed on the skin. Interpreting ECG involves
analyzing the waveforms to assess heart rate, rhythm, conduction, and detect abnormalities.
Purpose:
1.To diagnose cardiac arrhythmias, myocardial infarction, ischemia, or other heart
conditions.
2.To monitor the heart’s electrical activity in critically ill or post-operative patients.
3.To evaluate the effectiveness of cardiac medications or pacemakers.
4.To provide baseline and ongoing data for clinical decision-making.
5.To detect electrolyte imbalances or conduction abnormalities affecting cardiac
function.
Equipment for ECG Recording and Interpretation with Purpose
Equipment Purpose
ECG machine / monitor Records electrical activity of the heart.
ECG electrodes / adhesive padsConduct electrical signals from skin to the machine.
ECG cables / leads Transmit electrical signals from electrodes to the machine.
Alcohol swabs / skin prepCleans skin to improve electrode adhesion and signal quality.
Razor (if needed) Removes hair from electrode sites for proper contact.
ECG paper (if machine prints)Provides a physical record of the ECG waveform.
Stopwatch / timer Used in some machines for timed recordings.
Gloves (optional) Maintains hygiene during electrode placement.
Documentation forms To record interpretation, patient details, and observations.

49. Procedure for ECG Recording with Rationale
Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures cooperation.
Wash hands and prepare equipment. Maintains hygiene and ensures readiness.
Position patient supine, relaxed, and comfortable.
Reduces muscle artifact and ensures
accurate readings.
Clean electrode sites with alcohol swabs and
shave hair if necessary.
Ensures good electrode contact and
accurate signal transmission.
Attach electrodes to correct anatomical positions
(limb and chest leads).
Proper placement ensures reliable
recording of heart activity.
Connect ECG leads to the machine and check for
proper signal display.
Confirms functional setup and prevents
errors.
Instruct patient to remain still and breathe
normally during recording.
Minimizes artifacts and ensures accurate
waveform capture.
Record the ECG as per machine settings (standard
12-lead or as prescribed).
Provides comprehensive data on heart
rhythm and conduction.
Observe the ECG tracing for artifacts or abnormal
patterns.
Ensures data quality and identifies
potential issues promptly.
Interpret ECG waveforms for rate, rhythm,
intervals, and abnormalities.
Facilitates diagnosis and clinical decision-
making.
Document findings, including heart rate, rhythm,
and any abnormal observations.
Maintains legal and clinical records for
patient care.
Clean and store equipment properly after use.
Maintains hygiene and prevents
contamination.
Parameter Normal Finding Abnormal Finding / Notes
Heart Rate 60–100 bpm <60 = bradycardia, >100 = tachycardia
Heart Rhythm Regular Irregular → AF, AFib, ectopic beats
P Wave
Present, upright in lead II, one
per QRS
Absent → AF; abnormal shape → atrial
enlargement
PR Interval 0.12–0.20 sec
Short → WPW; Long → 1st-degree AV
block
QRS Complex 0.06–0.10 sec
Wide → bundle branch block,
ventricular rhythm
ST Segment Isoelectric (baseline)
Elevation → STEMI; Depression →
ischemia
T Wave Upright in most leads
Inverted → ischemia; Peaked →
hyperkalemia
QT Interval <0.44 sec
Prolonged → risk of ventricular
arrhythmias
Axis Normal: -30° to +90° Deviation → left/right axis deviation

50. Parameter Normal Finding Abnormal Finding / Notes
Overall
Abnormalities
None
Arrhythmias, conduction blocks,
ischemia, infarction
Administration of Cardiac Drugs
Meaning:
Administration of cardiac drugs involves giving medications that act on the heart and blood
vessels to manage cardiovascular conditions such as hypertension, heart failure, arrhythmias,
angina, or myocardial infarction. Drugs may include digoxin, beta-blockers, ACE
inhibitors, nitrates, diuretics, or antiarrhythmics.
Purpose:
1.To regulate heart rate and rhythm.
2.To improve cardiac output and myocardial contractility.
3.To reduce blood pressure and cardiac workload.
4.To prevent or treat heart failure, angina, or arrhythmias.
5.To prevent complications such as thromboembolism or myocardial ischemia.
Equipment for Administration of Cardiac Drugs with Purpose
Equipment Purpose
Prescribed cardiac medication Treats specific cardiovascular condition.
Oral syringes / medicine cups / spoonsFor accurate dosing of oral medications.
Injectable cardiac drugs (vials/ampules)For IV or IM administration if prescribed.
Syringes and needles For accurate parenteral administration.
Alcohol swabs To clean vial tops or injection sites.
Gloves Maintains hygiene and prevents contamination.
IV infusion set (if IV administration)Administers drugs safely into bloodstream.
Documentation forms / charts
Records drug administration, dose, and patient
response.
Emergency equipment (defibrillator,
resuscitation kit)
For immediate response in case of adverse
reaction.
Procedure for Administration of Cardiac Drugs with Rationale
Procedure Rationale
Check the physician’s prescription for drug, dose,
route, and timing.
Ensures correct drug administration
and prevents errors.
Explain the procedure to the patient.
Reduces anxiety and promotes
cooperation.
Wash hands and wear gloves if needed. Maintains hygiene and prevents

51. Procedure Rationale
contamination.
Verify five rights of medication: right patient, drug,
dose, route, time.
Ensures safe and accurate
administration.
Prepare medication (oral, IV, IM, or sublingual)
accurately.
Prevents dosing errors and ensures
effectiveness.
Administer drug using appropriate route.
Ensures proper absorption and
therapeutic effect.
Monitor patient for vital signs (BP, HR, rhythm)
before, during, and after administration.
Detects therapeutic response and
adverse effects.
Observe for side effects such as hypotension,
bradycardia, arrhythmias, or allergic reactions.
Ensures patient safety and prompt
intervention.
Dispose of syringes, vials, and other materials safely.Prevents contamination and injury.
Document drug name, dose, route, time, and patient
response.
Ensures legal and clinical record-
keeping.
Cardiac Catheterization Care
Meaning:
Cardiac catheterization is an invasive diagnostic and sometimes therapeutic procedure in
which a catheter is inserted into a blood vessel (usually femoral or radial artery) and guided
to the heart to assess cardiac function, coronary arteries, and pressure. Preparation and
aftercare involve ensuring patient safety, preventing complications, and promoting recovery.
Purpose:
Pre-procedure:
1.To prepare the patient physically and psychologically for the procedure.
2.To prevent infection and complications.
3.To ensure accurate assessment and successful catheterization.
Post-procedure:
1.To monitor for complications such as bleeding, hematoma, arrhythmias, or contrast
reactions.
2.To promote hemostasis at the puncture site.
3.To maintain patient comfort and facilitate recovery.
4.To provide patient education on activity restrictions and follow-up care.
Equipment for Cardiac Catheterization Care with Purpose

52. Equipment Purpose
Sterile gloves, gowns, masks
Maintain asepsis during procedure and
dressing changes.
Antiseptic solution (povidone-iodine)Clean skin and prevent infection.
Sterile drapes Provides a sterile field around insertion site.
Monitoring equipment (BP, ECG, SpO )
₂
Continuous monitoring of vital signs and
cardiac rhythm.
Oxygen supply
To manage hypoxia if required during or
after procedure.
IV fluids and infusion sets
Maintain hydration and administer
medications.
Pressure dressing / sandbag Ensures hemostasis at catheter insertion site.
Emergency resuscitation kit (defibrillator,
emergency drugs)
For immediate response to complications.
Documentation forms
Record procedure, observations, and patient
response.
Pain management medication (as prescribed)
Provides comfort and reduces stress post-
procedure.
Procedure for Preparation and Aftercare with Rationale
Procedure Rationale
Pre-procedure: Explain procedure, obtain
consent, and answer questions.
Reduces anxiety and ensures cooperation.
Assess patient history, allergies (especially
contrast dye), and baseline vitals.
Prevents adverse reactions and ensures safe
procedure.
Instruct patient to fast (usually 6–8 hours)
before procedure.
Reduces risk of aspiration during sedation.
Prepare insertion site (shave, clean with
antiseptic).
Prevents infection at puncture site.
Start IV line for fluids and emergency
medications.
Ensures readiness for immediate
interventions.
Ensure all monitoring equipment is connected
and functioning.
Continuous observation of cardiac and vital
parameters.
Post-procedure: Monitor vital signs, ECG,
and oxygen saturation closely.
Early detection of complications such as
arrhythmia, hypotension, or bleeding.
Inspect catheter insertion site for bleeding,
hematoma, or swelling.
Detects vascular complications early.
Apply pressure dressing and maintain limb
immobilization as prescribed.
Ensures hemostasis and prevents bleeding.
Encourage bed rest as ordered (usually 4–6
hours for femoral access).
Reduces risk of bleeding or hematoma
formation.
Administer prescribed medications (analgesics,
antiplatelets).
Relieves pain and prevents thrombotic
complications.
Educate patient on activity restrictions, wound
care, and follow-up appointments.
Promotes recovery and prevents
complications at home.

53. Procedure Rationale
Document procedure, vital signs, insertion site
status, and patient response.
Ensures legal and clinical record-keeping.
Basic Cardiac Life Support (BCLS)
Meaning:
BCLS is a life-saving emergency procedure provided to a person suffering from cardiac
arrest, respiratory arrest, or airway obstruction. It involves performing cardiopulmonary
resuscitation (CPR) and other essential interventions to maintain circulation and oxygenation
until advanced care is available.
Purpose:
1.To maintain blood circulation and oxygenation to vital organs, especially the brain
and heart.
2.To prevent irreversible organ damage during cardiac or respiratory arrest.
3.To improve survival rate in cardiac emergencies.
4.To provide immediate care until advanced cardiac life support (ACLS) is available.
Equipment for BCLS with Purpose
Equipment Purpose
BCLS mannequin (for training)Used for skill practice and demonstration.
Barrier device / pocket mask
Protects rescuer while providing mouth-to-mouth
ventilation.
Bag-valve-mask (BVM)
Provides ventilation to patient in case of respiratory
arrest.
Gloves Maintains hygiene and prevents infection.
AED (Automated External
Defibrillator)
Delivers shock to restore normal heart rhythm during
cardiac arrest.
Oxygen cylinder and tubingSupplies supplemental oxygen during resuscitation.
Suction apparatus Clears airway obstruction if needed.
Stopwatch / timer Ensures proper timing of compressions and ventilations.
Documentation forms Records procedure and patient response.
Procedure for BCLS with Rationale
Procedure Rationale
Ensure the scene is safe for rescuer and patient.
Prevents injury to rescuer and
patient.
Check patient responsiveness and breathing.Determines need for BCLS.
Call for help / activate emergency response.Ensures timely availability of

54. Procedure Rationale
advanced support.
Position patient supine on firm surface.
Facilitates effective chest
compressions and ventilation.
Open airway using head tilt-chin lift or jaw thrust (if
cervical injury suspected).
Ensures airway patency.
Check breathing for no more than 10 seconds.
Rapid assessment to decide on
rescue measures.
Begin chest compressions (30:2 ratio for adults) – 100–
120 compressions/min, depth 5–6 cm.
Maintains circulation to vital
organs.
Provide rescue breaths using barrier device or BVM.
Supplies oxygen to lungs and
bloodstream.
Use AED as soon as available – follow prompts.
Restores normal cardiac rhythm in
shockable arrhythmias.
Continue cycles of compressions and ventilation until
patient responds or advanced help arrives.
Sustains circulation and
oxygenation.
Monitor vital signs and patient response continuously.
Detects return of spontaneous
circulation (ROSC).
Document the procedure, timing, and outcomes.
Ensures legal and clinical record-
keeping.
lood Grouping and Crossmatching
Meaning:
Blood grouping is the process of determining a person’s blood type (ABO and Rh system).
Crossmatching is the compatibility test between donor and recipient blood before transfusion
to prevent hemolytic reactions.
Purpose:
1.To identify the patient’s blood group (ABO and Rh factor).
2.To ensure safe blood transfusion by matching donor and recipient blood.
3.To prevent transfusion reactions like hemolysis, fever, or shock.
4.To assist in emergency transfusions and surgical procedures requiring blood.
5.To maintain proper records for future transfusions.
Equipment for Blood Grouping and Crossmatching with Purpose

55. Equipment Purpose
Sterile lancet or needle To collect blood sample safely.
Test tubes For mixing blood with reagents.
Blood grouping reagents (Anti-A, Anti-B,
Anti-D)
To identify ABO and Rh blood group.
Normal saline Dilutes blood and prevents clotting.
Glass slides (for slide method) To observe agglutination reactions.
Centrifuge (for crossmatching)
Separates blood components for compatibility
testing.
Pipettes / dropper Accurate mixing of blood and reagents.
Gloves Maintains hygiene and prevents contamination.
Microscope (optional) Helps in detailed observation of agglutination.
Documentation forms Records blood group and crossmatch results.
Procedure for Blood Grouping with Rationale
Procedure Rationale
Explain the procedure and obtain consent.
Reduces patient anxiety and ensures
cooperation.
Wash hands and wear gloves.
Maintains asepsis and prevents
contamination.
Collect blood sample using sterile technique.
Prevents infection and ensures accurate
results.
Place drops of blood on a slide or in test tubes.Provides sample for testing.
Add Anti-A, Anti-B, and Anti-D (Rh) reagents to
respective samples.
Detects agglutination indicating blood
group and Rh factor.
Mix gently and observe for agglutination.
Agglutination confirms presence of
specific antigens.
Record ABO and Rh blood group.
Ensures correct identification for
transfusion purposes.
Procedure for Crossmatching with Rationale
Procedure Rationale
Mix donor red cells with recipient serum in
a test tube or microplate.
Detects compatibility before transfusion.
Incubate at room temperature or as per
protocol.
Allows reaction between donor antigens and
recipient antibodies.
Centrifuge sample if using tube method.
Enhances separation and visibility of
agglutination.
Observe for agglutination or hemolysis.
Agglutination indicates incompatibility; no
reaction indicates compatibility.
Record crossmatch results and label
compatible units.
Prevents transfusion reactions and ensures
patient safety.
Dispose of used materials safely.Maintains hygiene and prevents contamination.

56. Blood Sugar Measurement
Meaning:
Blood sugar measurement (also called blood glucose monitoring) is the process of
determining the amount of glucose in a patient’s blood, which is essential for diagnosing and
managing diabetes mellitus.
Purpose:
1.To monitor blood glucose levels in diabetic and critically ill patients.
2.To detect hyperglycemia or hypoglycemia and prevent complications.
3.To guide insulin or oral hypoglycemic therapy.
4.To evaluate effectiveness of dietary management and lifestyle modifications.
5.To provide baseline data for medical and nursing care planning.
Equipment for Blood Sugar Measurement with Purpose
Equipment Purpose
Glucometer Measures blood glucose level accurately.
Test strips (compatible with glucometer)Reacts with blood sample to give glucose reading.
Lancet / finger-prick device Obtains a small blood sample safely.
Alcohol swabs Cleans finger before pricking to prevent infection.
Cotton or gauze Stops bleeding after sample collection.
Gloves Maintains hygiene and prevents contamination.
Logbook / documentation forms Records blood sugar readings and trends.
Procedure for Blood Sugar Measurement with Rationale
Procedure Rationale
Explain the procedure to the patient.Reduces anxiety and ensures cooperation.
Wash hands and wear gloves.
Maintains hygiene and prevents
contamination.
Clean fingertip with alcohol swab and allow to
dry.
Prevents infection and ensures accurate
reading.
Use lancet to prick the side of the fingertip.Obtains capillary blood safely.
Wipe away the first drop of blood (optional, as per
protocol).
Removes tissue fluid that may affect
accuracy.
Apply second drop of blood to glucometer test
strip.
Ensures proper sample for accurate
measurement.
Wait for glucometer reading and record value.
Provides immediate feedback for patient
care.

57. Procedure Rationale
Apply cotton or gauze to stop bleeding.Prevents infection and promotes comfort.
Dispose of lancet and used strip in sharps
container.
Maintains safety and hygiene.
Document blood sugar value, time, and patient
response.
Ensures continuity of care and guides
therapy.
Serum Electrolytes
Meaning:
Serum electrolytes measurement is the laboratory assessment of essential ions in the blood,
including sodium (Na ), potassium (K ), chloride (Cl ), calcium (Ca² ), magnesium
⁺ ⁺ ⁻ ⁺
(Mg² ), and bicarbonate (HCO )
⁺ ₃⁻
. It helps evaluate fluid balance, kidney function, and
metabolic status.
Purpose:
1.To detect electrolyte imbalances such as hyponatremia, hyperkalemia, or
hypocalcemia.
2.To monitor patients with kidney disease, heart failure, dehydration, or endocrine
disorders.
3.To guide intravenous fluid therapy and electrolyte replacement.
4.To assess response to medications (e.g., diuretics, ACE inhibitors).
5.To prevent complications like cardiac arrhythmias, neuromuscular dysfunction, or
metabolic acidosis/alkalosis.
Equipment for Serum Electrolytes Measurement with Purpose
Equipment Purpose
Sterile gloves
Maintains asepsis during sample
collection.
Tourniquet Helps locate vein for venipuncture.
Alcohol swabs
Cleans puncture site to prevent
infection.
Sterile syringe / vacutainer Collects blood sample accurately.
Blood collection tube (usually with clot activator or
plain tube)
Collects blood for serum separation.
Centrifuge (lab use) Separates serum from blood cells.
Laboratory analyzer / electrolyte analyzerMeasures serum electrolyte levels.
Cotton / gauze
Applies pressure to puncture site post-
collection.
Sharps disposal container Safe disposal of needles and syringes.
Documentation forms Records procedure and results.
Procedure for Serum Electrolytes Measurement with Rationale

58. Procedure Rationale
Explain the procedure to the patient.Reduces anxiety and ensures cooperation.
Wash hands and wear sterile gloves.
Maintains hygiene and prevents
contamination.
Apply tourniquet and select vein for
venipuncture.
Ensures proper blood sample collection.
Clean puncture site with alcohol swab and allow
to dry.
Prevents infection at puncture site.
Collect blood sample using sterile syringe or
vacutainer.
Ensures sufficient and uncontaminated
sample.
Release tourniquet and apply cotton or gauze to
puncture site.
Prevents bleeding and hematoma
formation.
Label the blood sample properly.
Ensures accurate identification and
prevents mix-up.
Transport sample to laboratory promptly.
Maintains sample integrity and accuracy of
results.
Laboratory separates serum and analyzes
electrolytes.
Determines accurate electrolyte
concentrations.
Document the procedure, sample time, and
results.
Ensures continuity of care and legal record.
ABG Analysis and Interpretation
Meaning:
ABG analysis measures the levels of oxygen (PaO ), carbon dioxide (PaCO ), blood pH,
₂ ₂
bicarbonate (HCO ), and oxygen saturation (SaO ) in arterial blood. It is used to evaluate
₃⁻ ₂
respiratory, metabolic, and acid-base status.
Purpose:
1.To assess oxygenation and ventilation status.
2.To determine acid-base balance and detect respiratory or metabolic disorders.
3.To monitor critically ill patients or those on ventilatory support.
4.To guide oxygen therapy, ventilator settings, and medical interventions.
5.To evaluate the effectiveness of treatment in respiratory or metabolic conditions.

59. Equipment for ABG Analysis with Purpose
Equipment Purpose
ABG syringe with heparinTo collect arterial blood without clotting.
Alcohol swabs / antisepticCleans skin at puncture site to prevent infection.
Sterile gloves Maintains asepsis during the procedure.
Gauze / cotton Applies pressure after puncture to prevent hematoma.
Tourniquet (optional)Helps locate the artery if needed.
Ice container Preserves sample integrity if delay before analysis.
ABG analyzer / lab machineMeasures pH, PaO , PaCO , HCO , SaO accurately.
₂ ₂ ₃ ₂ ⁻
Sharps disposal containerSafe disposal of needles and syringes.
Documentation forms Records procedure, results, and interpretation.
Procedure for ABG Collection with Rationale
Procedure Rationale
Explain procedure to patient and obtain consent.
Reduces anxiety and ensures
cooperation.
Wash hands and wear sterile gloves.
Maintains asepsis and prevents
contamination.
Identify and palpate the artery (radial, brachial, or
femoral).
Ensures accurate and safe arterial
puncture.
Clean puncture site with antiseptic. Prevents infection at the puncture site.
Optional: apply local anesthetic if needed.Reduces patient discomfort.
Insert ABG needle at 30–45° angle into artery and
aspirate blood.
Obtains arterial blood accurately.
Remove needle and apply pressure with gauze for
5–10 minutes.
Prevents bleeding and hematoma
formation.
Expel air bubbles from the sample, cap syringe,
and place in ice if delay.
Maintains sample integrity for accurate
analysis.
Transport immediately to laboratory for analysis.Minimizes changes in gas levels and pH.
Analyze sample using ABG analyzer.
Determines pH, PaO , PaCO , HCO ,
₂ ₂ ₃ ⁻
and SaO values.
₂
Document procedure, results, and patient response.
Ensures continuity of care and legal
record.
ABG Interpretation (Basic Guide)
ParameterNormal Range Clinical Significance
pH 7.35–7.45 <7.35 = acidosis; >7.45 = alkalosis
PaCO
₂
35–45 mmHg>45 = respiratory acidosis; <35 = respiratory alkalosis
HCO
₃⁻
22–26 mEq/L<22 = metabolic acidosis; >26 = metabolic alkalosis
PaO
₂
80–100 mmHg<80 = hypoxemia; >100 = hyperoxia

60. ParameterNormal Range Clinical Significance
SaO
₂
95–100% <95% indicates inadequate oxygenation
Interpretation Steps:
1.Check pH → Determine acidosis or alkalosis.
2.Check PaCO
₂
→ If abnormal, indicates respiratory component.
3.Check HCO
₃⁻
→ If abnormal, indicates metabolic component.
4.Determine compensation → Partial, full, or none.
5.Assess oxygenation → PaO and SaO values.
₂ ₂
Blood Transfusion
Meaning:
Blood transfusion is the process of transferring whole blood or blood components (e.g.,
packed red cells, platelets, plasma) from a compatible donor to a recipient to replace lost
blood or treat deficiencies.
Purpose:
1.To restore blood volume after hemorrhage or trauma.
2.To correct anemia or low hemoglobin levels.
3.To replace clotting factors in patients with bleeding disorders.
4.To improve oxygen-carrying capacity of blood.
5.To manage patients with thrombocytopenia, coagulopathy, or certain medical
conditions.
Equipment for Blood Transfusion with Purpose
Equipment Purpose
Blood bag (whole blood or components)Provides donor blood for transfusion.
IV cannula / catheter Provides access for blood administration.
Blood administration set with filterEnsures safe and controlled transfusion.
IV fluids (normal saline)
Maintains patency of IV line; avoids mixing
with blood.
Alcohol swabs / antiseptic Cleans puncture site and maintains asepsis.
Gloves Protects nurse and maintains hygiene.
Blood warmer (if needed) Prevents hypothermia during rapid transfusion.
Monitor (BP, pulse, SpO , temperature)
₂
Monitors patient for reactions and vital signs.
Emergency resuscitation kit (adrenaline,
antihistamines, oxygen)
To manage transfusion reactions.
Documentation forms
Records donor/recipient details, blood type, and
transfusion outcomes.
Procedure for Blood Transfusion with Rationale

61. Procedure Rationale
Explain the procedure to the patient and obtain
consent.
Reduces anxiety and ensures
cooperation.
Verify blood prescription, patient identity, blood
group, and compatibility.
Prevents hemolytic transfusion
reactions.
Check vital signs before starting transfusion.
Provides baseline for detecting
adverse reactions.
Prepare IV access with appropriate cannula.
Ensures safe and effective
transfusion.
Clean puncture site with antiseptic and apply sterile
technique.
Prevents infection.
Inspect blood bag for clots, leaks, or discoloration.
Ensures safety and quality of blood
product.
Connect blood bag to administration set and start
transfusion slowly (usually 15–30 minutes initially).
Early detection of transfusion
reactions.
Monitor patient closely for signs of reaction: fever,
chills, rash, dyspnea, hypotension.
Ensures patient safety and prompt
intervention.
Gradually increase transfusion rate as tolerated.Maintains patient safety and comfort.
Record vital signs every 15–30 minutes during
transfusion.
Detects complications early.
Upon completion, flush IV line with normal saline if
ordered.
Ensures complete delivery of blood
and prevents line occlusion.
Dispose of blood bag and administration set according
to protocol.
Maintains safety and prevents
contamination.
Document transfusion details: blood type, volume,
start/end time, patient response, and any reactions.
Ensures legal and clinical record.
Bone Marrow Aspiration
Meaning:
Bone marrow aspiration is a procedure in which a sample of liquid bone marrow is
withdrawn, usually from the posterior iliac crest, for diagnostic purposes. Assisting involves
preparing the patient, supporting the physician, and ensuring aseptic technique.
Purpose:
1.To diagnose hematological disorders such as leukemia, anemia, lymphoma, or
multiple myeloma.
2.To monitor response to treatment in hematological diseases.
3.To evaluate bone marrow cellularity and morphology.
4.To detect infections or metastatic cancer involving bone marrow.
5.To collect samples for cytogenetic or molecular analysis.
Equipment for Bone Marrow Aspiration with Purpose

62. Equipment Purpose
Sterile gloves, gown, mask Maintains asepsis and prevents contamination.
Antiseptic solution (povidone-iodine)Cleans skin to prevent infection.
Sterile drapes Provides a sterile field around the site.
Local anesthetic (e.g., lidocaine)Numbs the site for patient comfort.
Syringe (usually 10–20 mL) with aspiration
needle (e.g., Jamshidi)
Withdraws bone marrow sample.
Specimen containers/slides
Collects and preserves the bone marrow
sample for analysis.
Sterile gauze / cotton Controls bleeding post-procedure.
Adhesive bandage Covers puncture site after procedure.
Sharps disposal container Safe disposal of needles and syringes.
Documentation forms
Records procedure details, patient response,
and sample information.
Procedure for Assisting Bone Marrow Aspiration with Rationale
Procedure Rationale
Explain procedure to the patient and obtain informed
consent.
Reduces anxiety and ensures
cooperation.
Wash hands and wear sterile gloves, gown, and mask.
Maintains asepsis and prevents
infection.
Position patient prone or lateral with access to posterior
iliac crest.
Provides optimal access and patient
comfort.
Clean aspiration site with antiseptic solution and drape
sterile field.
Prevents infection at puncture site.
Assist physician with preparation and administration of
local anesthetic.
Ensures patient comfort and
effective anesthesia.
Hand sterile syringe and aspiration needle to physician.
Supports smooth and safe
procedure.
Collect bone marrow aspirate in appropriate
container/slides.
Ensures sample integrity for
laboratory analysis.
Apply sterile gauze and pressure to site after needle
removal.
Prevents bleeding and hematoma
formation.
Apply adhesive bandage over site.
Protects puncture site and promotes
healing.
Observe patient for immediate complications (bleeding,
pain, dizziness).
Ensures patient safety and allows
prompt intervention.
Dispose of sharps and used materials safely.
Maintains hygiene and prevents
injury.
Document procedure details: site, sample obtained,
patient response, and any complications.
Ensures continuity of care and
legal record-keeping.
Anti-Embolism Stockings (TED Hose)

63. Meaning:
Anti-embolism stockings (TED hose) are elastic stockings designed to apply graduated
pressure on the lower limbs to prevent venous stasis and reduce the risk of deep vein
thrombosis (DVT) and pulmonary embolism (PE) in immobile or post-operative patients.
Purpose:
1.To prevent venous stasis and pooling of blood in the lower extremities.
2.To reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism.
3.To improve venous return and circulation in immobilized or post-surgical patients.
4.To prevent edema in the lower limbs.
5.To promote comfort and enhance recovery during hospitalization.
Equipment for Application of TED Hose with Purpose
Equipment Purpose
Anti-embolism stockings (TED
hose)
Provides graduated compression to prevent DVT.
Gloves (optional) Maintains hygiene while handling stockings.
Tape measure (optional)Ensures correct size selection.
Documentation forms Records application, removal, and patient response.
Lotion (optional)
Prevents skin dryness, but not applied immediately before
wearing stockings.
Procedure for Application of TED Hose with Rationale
Procedure Rationale
Explain procedure to the patient.
Reduces anxiety and ensures
cooperation.
Wash hands and wear gloves if required.
Maintains hygiene and prevents
contamination.
Measure patient’s leg length and circumference to
select correct size.
Ensures proper fit and effective
compression.
Position patient supine with legs slightly elevated if
possible.
Facilitates easier application and
prevents discomfort.
Turn stocking inside out up to the heel.
Simplifies application and ensures
correct orientation.
Place foot into stocking, ensuring heel is properly
positioned.
Prevents pressure points and ensures
comfort.
Gently pull the stocking up over the calf and thigh
(for knee- or thigh-length stockings).
Provides even, graduated compression
from ankle to thigh.
Smooth out wrinkles and folds in the stocking.
Prevents skin irritation, pressure sores,
and impaired circulation.
Ensure toes are not constricted (if open-toe design).
Allows monitoring of circulation and
prevents ischemia.

64. Procedure Rationale
Document application time, size used, and patient
tolerance.
Ensures continuity of care and
monitoring.
Remove stockings at prescribed intervals (usually
once per shift) for skin inspection and hygiene.
Prevents skin breakdown and allows
circulation assessment.
Sequential Compression Device (SCD)
Meaning:
A Sequential Compression Device is a medical device that intermittently inflates cuffs around
the patient’s legs to apply pressure, mimicking muscle contractions. It promotes venous
return and prevents venous stasis in immobile or post-operative patients.
Purpose:
1.To prevent deep vein thrombosis (DVT) and pulmonary embolism in high-risk
patients.
2.To improve venous blood flow in the lower extremities.
3.To reduce edema in immobilized or post-operative patients.
4.To complement pharmacological prophylaxis against thromboembolism.
5.To promote overall circulatory health in patients unable to ambulate.
Equipment for SCD Application and Maintenance with Purpose
Equipment Purpose
Sequential Compression Device (machine with
sleeves/cuffs)
Provides intermittent pneumatic compression
to lower limbs.
Power source / batteries Ensures device operates continuously.
Gloves (optional) Maintains hygiene during application.
Documentation forms
Records application, duration, and patient
tolerance.
Skin barrier or padding (optional)Prevents skin irritation under cuffs.
Procedure for Application and Maintenance of SCD with Rationale
Procedure Rationale
Explain procedure to the patient.
Reduces anxiety and ensures
cooperation.
Wash hands and wear gloves if required.
Maintains hygiene and prevents
contamination.
Assess patient’s lower extremities for edema, skin Ensures safe application and prevents

65. Procedure Rationale
integrity, wounds, or peripheral vascular disease.injury.
Select correct sleeve size based on leg measurements.
Ensures effective compression and
patient comfort.
Apply sleeves over the legs, securing straps without
excessive tightness.
Ensures proper function and prevents
circulation compromise.
Connect sleeves to the SCD machine and power
source.
Prepares device for operation.
Set prescribed pressure and inflation/deflation cycle
according to physician or protocol.
Provides safe and effective
prophylaxis.
Ensure patient comfort and check that device inflates
and deflates properly.
Confirms functionality and prevents
complications.
Encourage patient to remain in position during
therapy.
Maximizes efficacy of venous return.
Periodically inspect skin and limb circulation during
therapy.
Detects early signs of pressure injury
or impaired circulation.
Document application time, duration, settings, and
patient tolerance.
Ensures continuity of care and legal
record.
Remove device at prescribed intervals for skin
inspection and hygiene.
Prevents skin breakdown and allows
assessment of limb condition.
Application of Topical Medication
Meaning:
Topical medications are drugs applied directly to the skin, mucous membranes, or body
cavities to produce local effects or systemic absorption. Application involves spreading,
painting, or placing the medication on the targeted area.
Purpose:
1.To treat localized skin conditions (e.g., rashes, infections, wounds).
2.To provide pain relief or anti-inflammatory effects locally.
3.To deliver medication for systemic absorption via skin or mucous membranes (e.g.,
nitroglycerin ointment).
4.To prevent infection or promote healing in wounds, burns, or ulcers.
5.To administer medications in a convenient and controlled manner.
Equipment for Topical Medication Application with Purpose
Equipment Purpose
Prescribed topical medication (ointment, cream,
lotion, gel, powder)
Provides therapeutic effect on targeted
area.
Gloves
Maintains hygiene and prevents
contamination.
Applicator (spatula, tongue depressor, cotton
swab)
Ensures accurate and hygienic application.

66. Equipment Purpose
Gauze or cotton pads
Assists in spreading medication or
covering the area.
Clean water or antiseptic solution (if required)Cleans area before application.
Protective dressing (if prescribed)
Maintains medication in place and protects
the area.
Documentation forms
Records medication type, dose, site, and
patient response.
Procedure for Topical Medication Application with Rationale
Procedure Rationale
Explain procedure to the patient. Reduces anxiety and ensures cooperation.
Wash hands thoroughly and wear gloves.
Maintains asepsis and prevents
contamination.
Clean the affected area gently if required.
Removes debris or secretions for better
medication absorption.
Apply the prescribed amount of medication using
applicator or gloved fingers.
Ensures accurate dosing and prevents
contamination.
Spread evenly over the affected area as directed.Maximizes therapeutic effect.
Cover area with sterile dressing if ordered.
Protects the site and enhances medication
absorption.
Remove gloves and dispose of used applicator,
gauze, or cotton properly.
Maintains hygiene and prevents
contamination.
Instruct patient to avoid touching or washing the
area immediately.
Ensures proper absorption and
effectiveness of medication.
Document medication name, dose, site of
application, time, and patient response.
Ensures continuity of care and legal
record.
Intradermal Injection – Skin Allergy Testing
Meaning:
Intradermal injection for skin allergy testing involves injecting a small amount of allergen
into the dermis to assess for hypersensitivity reactions. It is commonly used to identify
allergens causing allergic conditions such as asthma, rhinitis, or dermatitis.
Purpose:
1.To identify specific allergens responsible for allergic reactions.
2.To guide diagnosis and management of allergic conditions.
3.To evaluate patient sensitivity before immunotherapy or desensitization.
4.To prevent systemic allergic reactions by using small, controlled doses.
5.To provide information for personalized patient treatment plans.

67. Equipment for Intradermal Skin Allergy Testing with Purpose
Equipment Purpose
Sterile gloves Maintains asepsis during procedure.
Alcohol swab Cleans skin to prevent infection.
Sterile syringe (usually 1 mL) and fine-gauge
needle (26–30G)
Delivers precise small volume intradermally.
Allergen extracts Substance being tested for hypersensitivity.
Cotton / gauze
For cleaning and blotting any excess
allergen.
Marker pen Marks injection sites on the skin.
Ruler or measuring scale Measures size of reaction (wheal and flare).
Documentation forms Records test results and patient response.
Emergency kit (epinephrine, antihistamines,
oxygen)
For immediate management of systemic
allergic reactions.
Procedure for Intradermal Skin Allergy Testing with Rationale
Procedure Rationale
Explain procedure and obtain informed consent.
Reduces anxiety and ensures
cooperation.
Wash hands and wear sterile gloves.
Maintains hygiene and prevents
contamination.
Clean the skin (usually forearm or upper back) with
alcohol swab.
Prevents infection at injection site.
Mark test sites with a pen, spacing each injection
appropriately.
Ensures accurate identification of
each allergen.
Draw small amount of allergen into syringe.Ensures correct dosing for testing.
Insert needle bevel up into the dermis at 10–15° angle
and inject 0.02–0.05 mL allergen to form a small bleb.
Proper intradermal technique
ensures accurate reaction.
Repeat for all allergens being tested.
Tests multiple allergens in a
controlled manner.
Observe patient for immediate systemic reactions.
Ensures early detection and
management of adverse reactions.
After 15–20 minutes, measure the size of wheal and
flare at each site.
Quantifies allergic response for
accurate diagnosis.
Document allergens tested, reaction size, and patient
response.
Provides record for diagnosis and
treatment planning.
Dispose of needles and used materials safely.
Maintains hygiene and prevents
injury.

68. Medicated Bath
Meaning:
A medicated bath is a therapeutic bath in which specific medications or antiseptic solutions
(e.g., potassium permanganate, chlorhexidine, or oatmeal) are added to water to treat skin
conditions, relieve itching, or prevent infection.
Purpose:
1.To cleanse and disinfect the skin in patients with infections or wounds.
2.To relieve pruritus (itching) associated with dermatological conditions.
3.To soften skin and remove crusts, scales, or exudates.
4.To provide comfort and relaxation to the patient.
5.To prevent secondary infection and promote skin healing.
Equipment for Medicated Bath with Purpose
Equipment Purpose
Medicated solution / prescribed antiseptic (e.g.,
potassium permanganate)
Provides therapeutic effect on skin.
Bath tub / basin
Holds water and medicated solution for
bathing.
Gloves
Maintains hygiene and prevents
contamination.
Towels Dries patient gently after bath.
Washcloth / sponge
Cleans body while applying medicated
solution.
Measuring cup / spoon
Ensures correct concentration of
medicated solution.
Gown / clean clothes For patient to wear after bath.
Documentation forms
Records procedure and patient
response.
Procedure for Medicated Bath with Rationale
Procedure Rationale
Explain procedure to the patient.
Reduces anxiety and ensures
cooperation.
Wash hands and wear gloves.
Maintains hygiene and prevents
contamination.
Prepare medicated solution as prescribed, ensuring Ensures safety and therapeutic

69. Procedure Rationale
correct concentration. effectiveness.
Fill bath tub or basin with warm water at safe
temperature.
Promotes comfort and prevents burns.
Assist patient into bath safely.
Prevents falls and ensures patient
safety.
Apply medicated solution to affected areas using
sponge or washcloth.
Ensures proper therapeutic contact
with skin.
Allow patient to soak for prescribed duration (usually
10–20 minutes).
Ensures adequate exposure for
therapeutic effect.
Assist patient to get out of bath safely.Prevents falls and injury.
Pat patient dry gently with towel; do not rub.
Prevents skin irritation and preserves
moisture.
Dress patient in clean clothes or gown. Maintains hygiene and comfort.
Dispose of used water and clean bath equipment.
Prevents contamination and maintains
hygiene.
Document procedure, solution used, duration, and
patient response.
Ensures continuity of care and legal
record.
Intradermal Injection – BCG / Tuberculin (Mantoux) Test
Meaning:
The Mantoux test is an intradermal injection of purified protein derivative (PPD) of
Mycobacterium tuberculosis to assess cell-mediated immunity and detect latent or active
tuberculosis infection. BCG vaccination is given intradermally to provide immunity against
tuberculosis.
Purpose:
1.To screen for latent or active tuberculosis infection (Mantoux test).
2.To provide immunization against tuberculosis (BCG vaccine).
3.To assess an individual’s immune response to Mycobacterium tuberculosis.
4.To guide diagnosis, treatment, and public health interventions.
5.To prevent the spread of tuberculosis in the community.
Equipment for Intradermal Injection – BCG / Mantoux Test with Purpose
Equipment Purpose
Sterile gloves Maintains asepsis during injection.
Alcohol swab Cleans the skin to prevent infection.
Sterile syringe (1 mL) and fine-gauge needle
(26–27G)
Ensures accurate intradermal injection.
Tuberculin PPD or BCG vaccine Provides diagnostic or immunization agent.
Cotton or gauze Stops bleeding or removes excess vaccine.

70. Equipment Purpose
Marker pen Marks injection site for reading the reaction.
Ruler or caliper Measures induration at test site.
Documentation forms
Records injection, batch, site, and patient
response.
Emergency kit (epinephrine, antihistamines,
oxygen)
For management of rare allergic reactions.
Procedure for Intradermal Injection – BCG / Mantoux Test with Rationale
Procedure Rationale
Explain the procedure to the patient or guardian
and obtain consent.
Reduces anxiety and ensures cooperation.
Wash hands and wear sterile gloves.
Maintains hygiene and prevents
contamination.
Select injection site (usually the inner surface of
the forearm for Mantoux, upper arm for BCG).
Provides standard site for accurate
reading and immunity.
Clean skin with alcohol swab and allow to dry.Prevents infection at the injection site.
Draw 0.1 mL PPD (Mantoux) or BCG vaccine into
syringe.
Ensures proper dosing.
Insert needle bevel up at 5–15° angle intradermally
and inject slowly to form a small bleb (6–10 mm).
Proper intradermal placement ensures
accurate test result or vaccine efficacy.
Remove needle and do not rub the site.
Prevents vaccine loss or interference with
test reaction.
Mark the site for Mantoux reading after 48–72
hours.
Ensures accurate measurement of
induration.
Observe patient for immediate adverse reactions.
Ensures early detection and management
of complications.
Dispose of needle and syringe safely in sharps
container.
Maintains hygiene and prevents injury.
Document date, site, batch number, and patient
information.
Ensures legal and clinical record.
For Mantoux test, read the test after 48–72 hours
by measuring induration (not redness).
Determines positive or negative reaction
accurately.
Barrier Nursing

71. Meaning:
Barrier nursing is a method of nursing care used for patients with highly infectious diseases.
It involves using protective measures to prevent the spread of infection from patient to
healthcare workers, other patients, or the environment.
Purpose:
1.To prevent transmission of infectious agents from the patient to others.
2.To protect healthcare workers from contracting infections.
3.To contain contagious diseases within a specific area.
4.To maintain aseptic technique and reduce cross-infection.
Equipment for Barrier Nursing with Purpose
Equipment Purpose
Gloves Prevent contact with infectious material.
Gown / Apron Protects clothing and skin from contamination.
Mask Prevents inhalation of infectious droplets.
Cap / Hair cover Reduces contamination from hair.
Goggles / Face shield Protects eyes from splashes or droplets.
Disinfectants (e.g., 70% alcohol, bleach)Cleans contaminated surfaces and equipment.
Dedicated patient equipment (thermometer,
BP cuff)
Prevents cross-infection between patients.
Waste disposal bags
Proper segregation and disposal of infectious
material.
Procedure for Barrier Nursing with Rationale
Procedure Rationale
Explain procedure to patient and visitors.
Ensures cooperation and reduces
anxiety.
Wash hands thoroughly. Reduces risk of transmitting infection.
Wear PPE (gloves, gown, mask, cap, goggles).Provides personal protection.
Use dedicated patient equipment and avoid sharing.Prevents cross-contamination.
Limit visitors and maintain isolation precautions.Reduces risk of infection spread.
Dispose of contaminated materials in proper
biohazard bags.
Ensures safe handling and
environmental safety.
Clean and disinfect surfaces regularly.
Prevents indirect transmission of
pathogens.
Remove PPE carefully after patient contact and
perform hand hygiene.
Prevents self-contamination.
Reverse Barrier Nursing (Protective Isolation)
Meaning:
Reverse barrier nursing is a method used to protect immunocompromised patients (e.g.,

72. chemotherapy, bone marrow transplant, neutropenia) from acquiring infections from
healthcare workers, visitors, or the environment.
Purpose:
1.To prevent infection in patients with weakened immunity.
2.To maintain a sterile or low-microbial environment.
3.To protect vulnerable patients from community-acquired or nosocomial infections.
4.To reduce morbidity and mortality associated with opportunistic infections.
Equipment for Reverse Barrier Nursing with Purpose
Equipment Purpose
Sterile gloves Protects patient from contamination.
Sterile gown Prevents transmission of microbes from nurse.
Mask
Prevents droplet-borne pathogens from reaching
patient.
Cap / Hair cover Reduces risk of hair-borne contamination.
HEPA-filtered room or laminar airflow (if
available)
Reduces airborne pathogens.
Sterile supplies and dedicated equipmentEnsures patient safety.
Hand hygiene supplies (soap, sanitizer)Maintains aseptic technique.
Visitors gowning kits
Protects patient from infections carried by
visitors.
Procedure for Reverse Barrier Nursing with Rationale
Procedure Rationale
Explain procedure to patient and family.Reduces anxiety and ensures cooperation.
Perform thorough hand hygiene before entering
patient room.
Prevents transfer of microorganisms.
Wear sterile gown, gloves, mask, and cap.Protects patient from external pathogens.
Use sterile or dedicated equipment for patient care.Reduces risk of introducing infection.
Maintain a clean, disinfected, and controlled
environment.
Minimizes exposure to pathogens.
Restrict visitors and enforce proper protective
attire.
Prevents infection from external sources.
Monitor patient for signs of infection regularly.Allows early detection and intervention.
Remove PPE properly and perform hand hygiene
after care.
Prevents contamination of self and
environment.
Hand Hygiene

73. Meaning:
Hand hygiene is the practice of cleaning hands using soap and water or alcohol-based hand
rubs to prevent the spread of microorganisms.
Purpose:
1.Prevent transmission of infections to patients and healthcare workers.
2.Reduce healthcare-associated infections (HAIs).
3.Maintain asepsis during patient care.
Equipment:
Soap and water
Alcohol-based hand rub
Clean towels or disposable paper towels
Procedure with Rationale:
Procedure Rationale
Wet hands with clean water. Prepares for effective cleaning.
Apply soap and lather for at least 20 seconds.
Removes dirt, microorganisms, and
transient flora.
Rub all surfaces including back of hands, between
fingers, and under nails.
Ensures complete decontamination.
Rinse hands thoroughly with water. Removes soap and loosened microbes.
Dry hands with clean towel or air dryer.
Prevents recontamination and skin
irritation.
2. Use of Personal Protective Equipment (PPE)
Meaning:
PPE includes clothing or equipment worn to minimize exposure to hazards such as infectious
agents.
Purpose:
1.Protect healthcare workers from infectious materials.
2.Prevent cross-contamination between patients.
3.Reduce exposure to blood, body fluids, and airborne pathogens.
Equipment:
Gloves
Gown / Apron
Mask / Respirator
Face shield / Goggles
Cap / Shoe covers (if needed)

74. Procedure with Rationale:
Procedure Rationale
Select appropriate PPE for the procedure. Ensures adequate protection.
Perform hand hygiene before donning PPE.
Prevents contamination under
PPE.
Don PPE in correct order (gown → mask → goggles →
gloves).
Ensures complete coverage.
Remove PPE carefully after procedure. Prevents self-contamination.
Dispose or disinfect PPE as per protocol. Maintains hygiene and safety.
3. Needlestick and Sharp Injury Prevention
Meaning:
Precautions to avoid injuries from needles or sharp instruments to prevent transmission of
bloodborne pathogens.
Purpose:
1.Prevent exposure to HIV, Hepatitis B, and Hepatitis C.
2.Reduce risk of occupational infections.
3.Ensure safe handling of sharps in clinical settings.
Equipment:
Needles and syringes
Sharps container
Gloves
Safety-engineered devices (if available)
Procedure with Rationale:
Procedure Rationale
Use safety-engineered needles when
available.
Reduces risk of injury.
Avoid recapping needles. Prevents accidental puncture.
Dispose needles immediately into sharps
container.
Prevents injury and contamination.
Wear gloves during procedures. Provides barrier protection.
Report and manage any needlestick injury
promptly.
Ensures timely prophylaxis and reduces
infection risk.
4. Cleaning and Disinfection

75. Meaning:
Process of removing dirt, debris, and microorganisms from surfaces and equipment to prevent
infection.
Purpose:
1.Maintain a clean environment in healthcare settings.
2.Prevent healthcare-associated infections.
3.Ensure safe reuse of medical equipment after proper sterilization or disinfection.
Equipment:
Detergents and disinfectants (e.g., bleach, alcohol)
Cleaning cloths / mops
Gloves and PPE
Sterilizers / Autoclave for instruments
Procedure with Rationale:
Procedure Rationale
Wear appropriate PPE before cleaning. Protects staff from exposure.
Remove visible dirt from surfaces first.
Allows disinfectants to work
effectively.
Apply disinfectant according to recommended
concentration and contact time.
Ensures microbial killing.
Rinse and dry surfaces if required.
Prevents chemical residues and
corrosion.
Dispose of cleaning materials safely. Prevents cross-contamination.
5. Respiratory Hygiene / Cough Etiquette
Meaning:
Practices to prevent transmission of pathogens through droplets from coughing or sneezing.
Purpose:
1.Prevent spread of respiratory infections like influenza or COVID-19.
2.Protect patients and healthcare workers from airborne pathogens.
3.Promote general hygiene in healthcare settings.
Equipment:
Tissues
Masks
Hand sanitizer
Procedure with Rationale:

76. Procedure Rationale
Cover mouth and nose with tissue or elbow when
coughing/sneezing.
Prevents droplet spread.
Dispose tissue immediately in a closed bin.Reduces contamination of surfaces.
Perform hand hygiene after coughing/sneezing.
Removes any pathogens transferred
to hands.
Provide masks to patients with respiratory symptoms.Limits spread to others.
6. Waste Disposal and Safe Injection Practices
Meaning:
Safe handling, segregation, and disposal of healthcare waste and safe use of injections to
prevent infection.
Purpose:
1.Prevent exposure to infectious materials.
2.Protect healthcare workers, patients, and community from contamination.
3.Reduce environmental hazards from biomedical waste.
Equipment:
Color-coded waste bags / containers
Sharps container
Gloves and PPE
Needles, syringes, and safety-engineered devices
Procedure with Rationale:
Procedure Rationale
Segregate waste into color-coded containers.Ensures proper disposal and compliance.
Dispose sharps immediately in puncture-proof
sharps container.
Prevents injuries and infections.
Use single-use needles and syringes; avoid reuse.
Prevents transmission of bloodborne
infections.
Wear gloves when handling waste. Protects staff from contamination.
Transport and treat waste according to biomedical
waste guidelines.
Ensures environmental safety and legal
compliance.
Preparation of Patient for Myelogram / CT / MRI
Meaning:
Preparation of the patient for diagnostic imaging studies such as Myelogram, CT scan, or
MRI involves steps taken to ensure safety, comfort, and accuracy of the imaging procedure.
This may include patient education, fasting, positioning, and screening for contraindications.
Purpose:

77. 1.To obtain accurate and diagnostic-quality imaging.
2.To ensure patient safety during the procedure.
3.To reduce patient anxiety and discomfort.
4.To prevent complications related to contrast media or procedural requirements.
5.To identify contraindications such as allergies, implants, or pregnancy.
Equipment for Preparation with Purpose
Equipment Purpose
Patient gown / hospital clothingProvides comfort and allows easy access for imaging.
IV line and cannula Administers contrast media if required.
Contrast media (for
myelogram/CT)
Enhances visualization of structures.
Vital signs monitoring equipmentEnsures patient stability before and during procedure.
Consent forms Confirms patient understanding and legal authorization.
Screening checklist / questionnaire
Identifies contraindications (allergies, implants,
pacemakers, pregnancy).
Towels / pillows Provides patient comfort and proper positioning.
Emergency drugs (e.g., for contrast
allergy)
Manages adverse reactions promptly.
Procedure for Preparation of Patient with Rationale
Procedure Rationale
Explain the procedure, purpose, and possible
sensations to the patient.
Reduces anxiety and improves
cooperation.
Obtain informed consent for the procedure and
contrast media use.
Ensures legal and ethical compliance.
Assess patient history for allergies, kidney function,
pregnancy, implants, or claustrophobia.
Identifies contraindications to prevent
complications.
Advise patient to fast if required (usually 4–6 hours
for myelogram/contrast studies).
Prevents nausea, vomiting, or aspiration.
Remove all metallic objects (jewelry, hairpins,
watches, hearing aids).
Prevents interference with imaging,
especially MRI.
Establish IV access if contrast is required.
Allows safe administration of contrast
media.
Position the patient as per procedural requirements
(prone, supine, or lateral).
Ensures proper imaging of target area.
Monitor vital signs before the procedure.
Ensures patient stability and identifies
pre-existing abnormalities.
Provide pillows or support for comfort and to
reduce movement during imaging.
Reduces motion artifacts and improves
image quality.
Ensure emergency drugs and equipment are ready.
Allows immediate intervention in case
of allergic or adverse reaction.
Document preparation steps, patient education, Ensures continuity of care and legal

78. Procedure Rationale
consent, and any pre-existing conditions.documentation.
Application & Removal of POP / Cast
Meaning:
Plaster of Paris (POP) cast is an orthopedic appliance applied to immobilize fractured bones,
joints, or soft tissues to ensure proper healing. Assisting involves preparing the patient,
supporting the nurse or physician during application or removal, and ensuring patient safety
and comfort.
Purpose:
1.To immobilize fractured bones or injured joints for proper alignment and healing.
2.To relieve pain and prevent further injury.
3.To support soft tissues and prevent deformity.
4.To facilitate rehabilitation and return of function after healing.
5.To ensure patient safety and comfort during the procedure.
Equipment for Application & Removal of POP / Cast with Purpose
Equipment Purpose
POP plaster rolls Provides rigid immobilization of fractured area.
Stockinette Provides a protective layer between skin and cast.
Soft padding / cotton paddingProtects skin and bony prominences from pressure sores.
Bucket of warm water Activates the POP plaster for molding.
Scissors / POP saw Removes cast safely without injuring patient.
Gloves Maintains hygiene during handling.
Towels / sheets Protects patient clothing and bed.
Basin Holds water and POP materials.
Documentation forms Records procedure, limb involved, and patient response.
Procedure for Application & Removal of POP / Cast with Rationale
Procedure Rationale
Explain procedure to the patient.
Reduces anxiety and ensures
cooperation.
Wash hands and wear gloves.
Maintains hygiene and prevents
contamination.
Prepare the patient comfortably in proper position.
Ensures correct alignment and
patient comfort.
Measure and cut stockinette and padding to fit the limb.
Protects skin and bony prominences
from pressure.

79. Procedure Rationale
Soak POP plaster rolls in warm water and remove
excess water.
Activates plaster and prevents
dripping.
Apply stockinette, then padding, and finally plaster
evenly around limb.
Provides adequate immobilization
while protecting skin.
Mold plaster carefully to maintain proper bone/joint
alignment.
Ensures fracture healing in correct
position.
Allow plaster to set and harden. Provides stable immobilization.
Instruct patient on cast care, avoiding inserting objects
inside cast, and signs of complications (pain,
numbness, swelling).
Prevents skin injury, pressure sores,
and complications.
For removal, position patient comfortably and use POP
saw/scissors with care.
Ensures safe removal without injury.
Check skin integrity and circulation after removal.
Detects pressure sores, skin
breakdown, or neurovascular
compromise.
Dispose of used materials properly. Maintains hygiene and safety.
Document limb involved, procedure, patient tolerance,
and any complications.
Ensures legal and clinical record.
Skin Traction / Skeletal Traction
Meaning:
Traction is a method of applying a pulling force to a part of the body to maintain alignment,
reduce pain, immobilize fractures, or correct deformities. Skin traction involves pulling
through adhesive or bandage applied to the skin, whereas skeletal traction uses pins or wires
inserted into the bone.
Purpose:
1.To immobilize fractured bones and maintain proper alignment.
2.To relieve pain and muscle spasm.
3.To reduce and correct fractures or deformities.
4.To prevent further injury during healing.
5.To facilitate proper circulation and nerve function while immobilized.
Equipment for Skin/Skeletal Traction with Purpose
Equipment Purpose
Traction apparatus (ropes, pulleys, weights,
spreader bars)
Provides continuous pulling force for
alignment.
Adhesive bandages or traction boots (for skin Transmit pulling force to skin safely.

80. Equipment Purpose
traction)
Skeletal traction pins/wires (for skeletal
traction)
Provides direct traction force on the bone.
Weights (pre-measured) Apply correct pulling force.
Pillows / positioning devices Support and maintain proper limb position.
Gloves and sterile dressing supplies
Maintain asepsis for skeletal traction pin
sites.
Monitoring equipment (BP, pulse, SpO )
₂
Detects complications early.
Bed / frame capable of traction setupProvides stable platform for traction therapy.
Documentation forms
Records procedure, traction type, and patient
response.
Procedure for Preparation, Assisting, and Aftercare with Rationale
Procedure Rationale
Explain procedure, purpose, and duration to patient.
Reduces anxiety and improves
cooperation.
Wash hands and wear gloves.
Maintains hygiene and prevents
infection.
Prepare equipment: traction apparatus, weights, ropes,
and supports.
Ensures smooth and safe procedure.
Assess limb for circulation, skin integrity, and
sensation before applying traction.
Establishes baseline and prevents
complications.
Position patient comfortably in bed with pillows to
support limb.
Reduces pressure points and
prevents discomfort.
Apply traction (skin or skeletal) as prescribed by
physician.
Ensures proper alignment and
therapeutic effect.
Attach weights carefully ensuring ropes are free of
knots and pulleys move freely.
Maintains consistent force and
prevents injury.
Monitor patient’s vital signs, limb color, temperature,
and neurovascular status.
Early detection of circulation or
nerve compromise.
Provide regular skin care for areas under traction
(especially for skin traction).
Prevents skin breakdown, pressure
sores, and irritation.
Maintain pin site care for skeletal traction (sterile
dressing, cleaning).
Prevents infection and promotes
healing.
Encourage patient to perform breathing exercises and
gentle movements of non-immobilized joints.
Prevents complications like
pneumonia, DVT, and stiffness.
Educate patient and caregivers on precautions (avoid
removing weights, limb position).
Ensures safety and effectiveness of
traction.
Record procedure details, traction type, weight used,
patient tolerance, and any complications.
Ensures legal and clinical
documentation.
Care of Orthotics

81. Meaning:
Orthotics are devices applied externally to support, align, prevent, or correct deformities of
the musculoskeletal system. Care of orthotics involves cleaning, inspection, and ensuring
proper fit to maintain function and prevent complications.
Purpose:
1.To maintain proper alignment and support of affected body parts.
2.To prevent skin breakdown, irritation, or pressure sores.
3.To ensure the orthotic device functions effectively.
4.To promote patient comfort and compliance with therapy.
5.To prolong the life of the orthotic device.
Equipment for Care of Orthotics with Purpose
Equipment Purpose
Mild soap and water Cleans the orthotic surface without damaging it.
Soft cloth / sponge Gentle cleaning to prevent scratches or damage.
Gloves Maintains hygiene while handling orthotics.
Lotion or barrier cream (if prescribed)Protects skin from irritation under orthotic.
Screwdriver / adjustment tools (if
applicable)
Adjusts orthotic for proper fit.
Documentation forms
Records maintenance, adjustments, and patient
response.
Procedure for Care of Orthotics with Rationale
Procedure Rationale
Explain procedure to the patient.
Reduces anxiety and ensures
cooperation.
Wash hands and wear gloves.
Maintains hygiene and prevents
contamination.
Remove orthotic carefully from patient. Prevents injury or discomfort.
Inspect orthotic for cracks, wear, or loose parts.
Ensures device is safe and functions
properly.
Clean orthotic with mild soap and water, then dry
thoroughly.
Removes dirt and bacteria,
preventing skin irritation.
Inspect patient’s skin under orthotic for redness, sores,
or irritation.
Early detection of skin breakdown or
pressure points.
Apply barrier cream if prescribed. Protects skin and prevents irritation.
Reapply orthotic ensuring proper fit and alignment.
Maintains therapeutic effect and
comfort.
Instruct patient on correct usage, wearing schedule, and
signs of complications.
Promotes adherence and prevents
misuse.
Document maintenance, patient skin condition, Ensures legal and clinical record for

82. Procedure Rationale
adjustments made, and patient tolerance. continuity of care.
Muscle Strengthening Exercises
Meaning:
Muscle strengthening exercises are physical activities designed to improve the strength,
endurance, and functional capacity of specific muscles or muscle groups. These exercises are
commonly used in rehabilitation, fitness programs, or for patients recovering from illness or
injury.
Purpose:
1.To increase muscle strength and endurance.
2.To improve joint stability and mobility.
3.To enhance functional independence in daily activities.
4.To prevent muscle atrophy in immobilized or bedridden patients.
5.To improve circulation and overall physical fitness.
Equipment for Muscle Strengthening Exercises with Purpose
Equipment Purpose
Resistance bands / therabandsProvides adjustable resistance to strengthen muscles.
Dumbbells / weights
Adds external load for progressive muscle
strengthening.
Exercise mat Provides comfort and support during floor exercises.
Chair / stool Provides support for seated exercises or balance.
Pulley systems (for upper limb
exercises)
Facilitates controlled resistance training.
Gloves (optional) Protects hands during resistance exercises.
Stopwatch / timer Helps monitor exercise duration and rest intervals.
Documentation forms
Records exercise type, repetitions, sets, and patient
response.
Procedure for Muscle Strengthening Exercises with Rationale
Procedure Rationale
Explain the exercise routine and purpose to the
patient.
Ensures patient cooperation and
understanding.
Assess patient’s baseline strength, range of motion,
and limitations.
Ensures exercises are safe and tailored
to patient ability.
Warm-up muscles with light activity for 5–10
minutes.
Prepares muscles, reduces risk of
injury.

83. Procedure Rationale
Demonstrate correct technique for each exercise.
Ensures proper form, effectiveness,
and prevents strain.
Perform exercises as prescribed (number of sets and
repetitions).
Provides controlled and progressive
strengthening.
Use resistance bands, weights, or body weight
appropriately.
Offers progressive overload for muscle
adaptation.
Monitor patient for signs of pain, fatigue, or
discomfort.
Prevents overexertion and injury.
Encourage breathing and proper posture during
exercises.
Maintains oxygenation and prevents
compensatory movements.
Cool down with gentle stretching after exercises.
Reduces muscle soreness and improves
flexibility.
Document exercises performed, patient tolerance,
improvements, and any adverse reactions.
Ensures continuity of care and
monitoring of progress.
Crutch Walking
Meaning:
Crutch walking is a mobility technique used to help patients with lower limb injuries,
weakness, or post-operative conditions walk safely while maintaining weight-bearing
restrictions.
Purpose:
1.To provide support and stability while walking with lower limb injury or weakness.
2.To promote mobility and independence in patients with impaired lower limb function.
3.To prevent falls and reduce strain on injured limbs.
4.To maintain balance and proper posture during ambulation.
5.To assist in rehabilitation and recovery of lower limb function.
Equipment for Crutch Walking with Purpose
Equipment Purpose
Crutches (axillary or forearm type)
Provides support and helps in partial or non-weight-
bearing walking.
Non-slip footwear Prevents slips and enhances stability.
Hand gloves (optional) Prevents friction or skin irritation from crutches.
Walker or gait belt (if needed for
supervision)
Provides additional safety and support during training.
Documentation forms Records patient teaching, progress, and tolerance.
Procedure for Crutch Walking with Rationale

84. Procedure Rationale
Explain the purpose and method of crutch walking to
the patient.
Reduces anxiety and ensures
cooperation.
Measure and adjust crutch height (top 2–3 fingers
below axilla; elbow slightly bent).
Ensures proper fit, comfort, and
prevents nerve injury.
Instruct patient to wear non-slip footwear.Reduces risk of falls.
Demonstrate proper crutch gait: two-point, three-point,
or four-point as prescribed.
Ensures safe and effective
ambulation according to weight-
bearing status.
Teach patient to bear weight on hands and arms, not
axilla.
Prevents axillary nerve injury.
Instruct patient on proper stepping sequence (e.g., for
non-weight-bearing: crutches → injured leg → healthy
leg).
Maintains balance and protects
injured limb.
Encourage upright posture with head up and eyes
forward.
Prevents falls and promotes proper
gait mechanics.
Supervise patient during initial ambulation.Ensures safety and correct technique.
Monitor for fatigue, pain, or skin irritation under
crutch pads.
Prevents injury and allows early
intervention.
Document crutch walking technique taught, patient
tolerance, gait pattern, and any complications.
Ensures continuity of care and
progress tracking.
Rehabilitation
Meaning:
Rehabilitation is a comprehensive process aimed at restoring a patient’s physical,
psychological, and social abilities after illness, injury, or surgery. It focuses on improving
functional independence, quality of life, and participation in daily activities.
Purpose:
1.To restore functional ability and independence.
2.To prevent complications such as muscle atrophy, joint stiffness, or contractures.
3.To promote physical, emotional, and social well-being.
4.To support reintegration into home, work, or community.
5.To enhance quality of life and prevent recurrence or deterioration.
Equipment for Rehabilitation with Purpose
Equipment Purpose
Exercise mats Provides comfort and safety for floor exercises.
Resistance bands / therabandsStrengthens muscles and improves flexibility.
Weights / dumbbells Enhances muscle strengthening and endurance.
Crutches, walkers, or canesSupports mobility during ambulation training.
Pulley systems / exercise
machines
Assists in range of motion and strengthening exercises.

85. Equipment Purpose
Orthotics / braces
Provides support and corrects alignment during
rehabilitation.
Pillows / bolsters Maintains proper positioning during exercises.
Documentation forms
Records type of rehabilitation, patient progress, and
response.
Procedure for Rehabilitation with Rationale
Procedure Rationale
Assess patient’s baseline physical and functional
status.
Provides information to tailor
rehabilitation program safely.
Explain rehabilitation goals and activities to the
patient.
Encourages cooperation and
motivation.
Plan individualized rehabilitation program based on
patient needs and condition.
Ensures safe and effective intervention.
Begin with warm-up exercises and gentle
movements.
Prepares muscles, improves circulation,
and prevents injury.
Implement muscle strengthening, range-of-motion,
balance, and mobility exercises.
Restores function, strength, and
coordination.
Provide assistive devices (crutches, walkers) if
needed for ambulation.
Ensures safety and promotes
independence.
Monitor patient for pain, fatigue, or adverse reactions
during exercises.
Prevents complications and ensures
tolerance.
Encourage patient participation and provide positive
reinforcement.
Improves motivation and compliance.
Cool down and provide rest periods after exercises.
Reduces risk of muscle strain and
promotes recovery.
Document rehabilitation activities, patient response,
progress, and any complications.
Ensures continuity of care and
evaluation of effectiveness.
Positioning and Draping in Operation Theater
Meaning:
Positioning in the operation theater involves placing the patient in a specific posture that
provides optimal surgical access while maintaining physiological stability. Draping is the
process of covering the patient with sterile cloths to create a sterile field around the surgical
site.
Purpose:
1.To provide adequate surgical exposure and access to the operative site.
2.To maintain patient safety and prevent injury (nerve, pressure sores).
3.To maintain a sterile field and prevent surgical site infection.
4.To ensure patient comfort and proper physiological function during surgery.

86. 5.To support anesthetic management and monitoring.
Equipment for Positioning and Draping with Purpose
Equipment Purpose
Operating table with adjustable featuresAllows optimal positioning and surgical access.
Positioning aids: pillows, pads, gel pads,
foam supports
Prevents pressure sores, nerve injuries, and
maintains alignment.
Straps / belts / safety supportsPrevents patient falls or unintended movement.
Sterile drapes (cloth or disposable)Maintains a sterile field around surgical site.
Towels
Provides additional coverage and padding if
needed.
Gloves (sterile and non-sterile)Maintains asepsis during draping and handling.
Surgical instruments tray Positioned within sterile field for easy access.
Documentation forms
Records patient position, procedure, and any
complications.
Procedure for Positioning and Draping with Rationale
Procedure Rationale
Explain procedure to patient (if conscious pre-
anesthesia).
Reduces anxiety and improves
cooperation.
Wash hands and wear appropriate gloves (sterile
for draping).
Maintains hygiene and prevents
contamination.
Assess patient’s physical condition, pre-existing
injuries, and areas at risk for pressure sores.
Ensures safe positioning and prevents
complications.
Position patient according to surgical site (supine,
prone, lateral, lithotomy, etc.).
Provides optimal surgical access while
maintaining physiological stability.
Place padding under pressure points (heels,
elbows, sacrum, head).
Prevents pressure sores and nerve injuries.
Secure patient with straps or supports if needed.
Prevents accidental movement or falls
during surgery.
Cover patient with sterile drapes, exposing only
surgical site.
Maintains a sterile field and reduces risk
of infection.
Arrange surgical instruments and equipment
within sterile field.
Facilitates smooth surgical procedure and
efficiency.
Monitor patient’s vital signs and position
continuously during surgery.
Prevents physiological compromise and
ensures safety.
Document patient position, type of draping, and
any intraoperative complications.
Ensures continuity of care and legal
documentation.

87. Preparation of Operation Table
Meaning:
Preparation of the operation table involves arranging and setting up the surgical table and its
accessories to ensure patient safety, optimal positioning, and maintenance of a sterile
environment during surgery.
Purpose:
1.To provide a stable and adjustable surface for safe patient positioning.
2.To allow proper access to the surgical site for the surgical team.
3.To maintain patient comfort and prevent pressure injuries during surgery.
4.To support anesthetic procedures and monitoring devices.
5.To ensure asepsis and readiness for the surgical procedure.
Equipment for Preparation of Operation Table with Purpose
Equipment Purpose
Operating table with adjustable features
Provides stable and customizable positioning for
patient and surgery.
Positioning aids: pillows, gel pads,
foam supports
Prevents pressure sores, nerve injuries, and
maintains alignment.
Arm boards / leg supports / stirrupsMaintains proper positioning of limbs for surgery.
Safety straps or belts
Prevents patient from falling or shifting during
surgery.
Sterile drapes Maintains sterile field when patient is on the table.
Towels / underpads Provides comfort and absorbs any fluids.
Gloves (sterile and non-sterile)Maintains asepsis during table preparation.
Instrument trays nearby
Ensures accessibility of necessary surgical
instruments.
Documentation forms
Records table setup, patient positioning, and any
special precautions.
Procedure for Preparation of Operation Table with Rationale
Procedure Rationale
Wash hands and wear appropriate gloves.
Maintains asepsis and prevents
contamination.
Inspect the operation table for cleanliness, stability,
and proper function.
Ensures patient safety and smooth
procedure.
Adjust table height and tilt according to planned
surgical procedure.
Provides optimal surgical access and
comfort.
Place positioning aids (pillows, gel pads) on table to
protect pressure points.
Prevents pressure sores and nerve
injuries.
Arrange arm boards, leg supports, and stirrups as Maintains proper limb positioning for

88. Procedure Rationale
required. surgical access.
Apply safety straps or belts to secure patient during
surgery.
Prevents accidental movement or
falls.
Cover table with sterile drapes, leaving space for
surgical field.
Maintains sterile environment.
Ensure all surgical instruments and monitoring
devices are accessible.
Facilitates efficient and safe surgery.
Verify proper functioning of anesthesia and
monitoring attachments on table.
Ensures patient safety during
anesthesia.
Document preparation steps, special positioning
requirements, and any precautions.
Ensures legal and clinical record for
continuity of care.
Setup of Trolley with Instruments in Operation Theater
Meaning:
The setup of a surgical trolley involves arranging surgical instruments, equipment, and
supplies in a systematic and sterile manner to facilitate easy access during surgery. Proper
setup ensures efficiency, safety, and maintenance of a sterile field.
Purpose:
1.To provide the surgical team with easy access to instruments during the procedure.
2.To maintain asepsis and prevent contamination of instruments.
3.To reduce surgical delays by organizing instruments systematically.
4.To enhance efficiency and workflow in the operation theater.
5.To ensure patient safety by avoiding mishandling or missing instruments.
Equipment for Setup of Trolley with Instruments with Purpose
Equipment Purpose
Sterile surgical trolley
Holds instruments and supplies within the
sterile field.
Sterile drapes / covers Maintains asepsis on the trolley surface.
Surgical instruments (scalpels, scissors, forceps,
clamps, needle holders, etc.)
Used for performing surgical procedures.
Instrument trays or basins
Organizes instruments and prevents mixing
or contamination.
Sterile gloves
Maintains asepsis while handling
instruments.
Indicator tape or labels
Identifies instruments and maintains
organization.
Towels or mats
Provides clean surface under instruments if
required.

89. Equipment Purpose
Documentation forms
Records setup, instruments arranged, and
any special requirements.
Procedure for Setup of Trolley with Instruments with Rationale
Procedure Rationale
Wash hands and wear sterile gloves before
handling instruments.
Maintains asepsis and prevents
contamination.
Cover the trolley with sterile drapes to create a
sterile field.
Ensures instruments remain sterile
throughout the procedure.
Arrange instruments according to type,
frequency of use, and surgeon preference.
Facilitates easy access and smooth
workflow during surgery.
Place sharp instruments (scalpels, needles) in
separate designated areas.
Prevents accidental injury and maintains
safety.
Place instrument trays or basins to organize
instruments systematically.
Prevents mixing and confusion during
surgery.
Ensure all instruments are sterile, intact, and
functional before placement.
Prevents use of contaminated or
malfunctioning instruments.
Label or arrange instruments in sequence of use
if required.
Enhances efficiency and reduces errors.
Keep additional instruments or backup trays
ready nearby.
Ensures preparedness for unexpected
requirements.
Maintain the sterile field by avoiding contact
with non-sterile surfaces.
Prevents contamination and surgical site
infection.
Document the instrument setup, any special
arrangements, and verification of sterility.
Provides legal and clinical record for
accountability and continuity of care.
Assisting in Major and Minor Operations
Meaning:
Assisting in surgery involves helping the surgical team (surgeon, anesthetist, scrub nurse)
before, during, and after surgical procedures to ensure patient safety, maintain asepsis, and
facilitate smooth operation. Major operations are extensive surgeries requiring significant
tissue manipulation and anesthesia, whereas minor operations are simpler procedures, often
under local anesthesia.
Purpose:
1.To maintain aseptic technique and prevent infection.
2.To ensure patient safety and comfort throughout the procedure.
3.To provide necessary instruments and supplies promptly to the surgical team.
4.To support the surgeon in performing the procedure efficiently.
5.To facilitate postoperative care and documentation.

90. Equipment for Assisting in Major and Minor Operations with Purpose
Equipment Purpose
Sterile gloves, gowns, and masks
Maintains asepsis and prevents
contamination.
Surgical instruments (scalpels, scissors, forceps,
clamps, needle holders)
Enables surgical procedures.
Trolley with instruments
Organizes and provides easy access to
instruments.
Sterile drapes
Maintains sterile field around operative
site.
Sutures, needles, and sterile gauze Used for wound closure and hemostasis.
Suction apparatus and cautery
Assists in clearing surgical site and
controlling bleeding.
Anesthesia equipment (for major operations)Ensures patient is safely anesthetized.
Towels, bowls, and basins
Used for cleaning, washing, and holding
instruments.
Documentation forms
Records procedure details, instruments
used, and patient status.
Procedure for Assisting in Major and Minor Operations with Rationale
Procedure Rationale
Explain procedure to patient (preoperative) and
obtain consent.
Reduces anxiety and ensures cooperation.
Perform hand hygiene and wear sterile gloves,
gown, and mask.
Maintains asepsis.
Prepare the operation table, instruments trolley,
and sterile field.
Ensures efficiency and readiness for
surgery.
Assist in positioning and draping the patient.
Provides optimal surgical access and
maintains sterile environment.
Check all surgical instruments, sutures, and
equipment are available and functional.
Prevents delays and errors during surgery.
Hand instruments to the surgeon as needed,
following sterile technique.
Facilitates smooth and efficient
procedure.
Suction or irrigate operative site when required.
Maintains clear view and reduces risk of
infection.
Monitor patient’s vital signs and comfort (if
applicable).
Ensures patient safety and early detection
of complications.
Assist in wound closure, dressing, and transferring
patient postoperatively.
Provides safe completion of procedure
and comfort to patient.
Dispose of used instruments, gloves, and waste
according to protocol.
Maintains hygiene and prevents
contamination.
Document procedure, instruments used, and Ensures legal and clinical record.

91. Procedure Rationale
patient condition.
Disinfection and Sterilization of Equipment in Operation Theater
Meaning:
Disinfection is the process of eliminating or reducing pathogenic microorganisms on
inanimate objects to a level that is not harmful. Sterilization is the process of destroying all
forms of microbial life, including spores, on surgical instruments and equipment. Both are
essential to prevent surgical site infections and maintain asepsis in the operation theater.
Purpose:
1.To prevent surgical site infections (SSIs) and cross-contamination.
2.To maintain a sterile environment for safe surgery.
3.To ensure instruments are safe and ready for repeated use.
4.To comply with infection control protocols and hospital standards.
5.To protect patients and healthcare personnel from infectious hazards.
Equipment for Disinfection and Sterilization with Purpose
Equipment Purpose
Autoclave / steam sterilizer
Sterilizes surgical instruments using steam
under pressure.
Dry heat sterilizer
Sterilizes heat-resistant instruments using high
temperature.
Chemical disinfectants (e.g., glutaraldehyde,
hydrogen peroxide)
Disinfects instruments sensitive to heat.
Sterile trays and pouches Maintains sterility after sterilization.
Instrument brushes / cleaning solutionsRemoves blood and debris before sterilization.
Gloves and protective equipment
Protects staff during cleaning and handling of
contaminated instruments.
Timer and sterilization indicators
Confirms correct sterilization cycles and
effectiveness.
Storage cabinets for sterile instrumentsMaintains sterility until use.
Documentation forms Records sterilization procedures and instrument

92. Equipment Purpose
readiness.
Procedure for Disinfection and Sterilization with Rationale
Procedure Rationale
Wear protective gloves and gown.
Prevents contamination and protects
staff.
Pre-clean instruments by removing blood, tissue, and
debris using brushes and cleaning solutions.
Ensures proper sterilization by
removing organic matter.
Rinse instruments thoroughly and dry them before
sterilization.
Prevents corrosion and ensures
effective sterilization.
Select appropriate sterilization method (autoclave, dry
heat, or chemical) based on instrument type.
Ensures safe and effective
sterilization.
Arrange instruments properly in trays or pouches to
allow penetration of steam or sterilant.
Ensures all surfaces are sterilized.
Run sterilization cycle according to recommended
temperature, pressure, and duration.
Ensures complete destruction of
microorganisms and spores.
Use chemical or biological indicators to confirm
sterilization.
Provides verification of sterilization
effectiveness.
Store sterilized instruments in dry, sterile storage until
use.
Maintains sterility and prevents
contamination.
Disinfect surfaces and trolleys in the operation theater
with approved disinfectants.
Maintains asepsis in the surgical
environment.
Document sterilization date, method, instruments, and
verification results.
Ensures legal and clinical record and
traceability.
Intraoperative Monitoring
Meaning:
Intraoperative monitoring involves continuous assessment of a patient’s physiological status
during surgery to ensure safety and detect complications early. This includes monitoring vital
signs, oxygenation, anesthesia depth, and other critical parameters.
Purpose:
1.To ensure patient safety during surgery.
2.To detect early signs of complications such as hypotension, hypoxia, or arrhythmias.
3.To guide anesthesia management and adjust medications accordingly.

93. 4.To maintain optimal oxygenation, perfusion, and vital organ function.
5.To provide real-time data for prompt intervention and decision-making.
Equipment for Intraoperative Monitoring with Purpose
Equipment Purpose
ECG monitor Monitors heart rate, rhythm, and detects arrhythmias.
Pulse oximeter Measures oxygen saturation in blood.
Blood pressure monitor (manual or
automated)
Monitors blood pressure to detect hypotension or
hypertension.
Capnograph
Monitors end-tidal CO during anesthesia for
₂
ventilation assessment.
Temperature probe Monitors patient body temperature.
Respiratory rate monitor Assesses ventilation adequacy.
Anesthesia machine Delivers and monitors anesthetic agents and gases.
Urinary catheter (if indicated)
Monitors urine output for renal function and fluid
balance.
Defibrillator Provides emergency cardiac resuscitation if needed.
Documentation forms
Records vital signs, anesthesia parameters, and
interventions.
Procedure for Intraoperative Monitoring with Rationale
Procedure Rationale
Verify all monitoring equipment is functional before
patient entry.
Ensures accurate readings and
patient safety.
Attach ECG leads, pulse oximeter, blood pressure cuff,
and other monitors as per protocol.
Provides continuous physiological
monitoring.
Monitor vital signs continuously: heart rate, blood
pressure, respiratory rate, oxygen saturation,
temperature.
Detects early changes requiring
intervention.
Monitor anesthesia depth and agent delivery through
anesthesia machine.
Ensures adequate anesthesia
without overdose or underdose.
Assess capnography and oxygen saturation to maintain
adequate ventilation and oxygenation.
Prevents hypoxia, hypercapnia, or
respiratory complications.
Record urine output if catheterized.
Monitors renal function and fluid
balance.
Communicate any abnormal findings immediately to the
surgeon and anesthetist.
Facilitates timely interventions to
prevent complications.
Maintain sterile handling of monitoring equipment as per
OR protocol.
Prevents infection and maintains
aseptic environment.
Document intraoperative monitoring parameters,
interventions, and patient response.
Ensures legal, clinical record and
continuity of care.