Principles and Practice of Nursing Shakuntla Sharma ‘Birpuri’
Page numbers followed by f refer to figure and t refer to table
Abdomen 118, 226, 420, 500
binder 301, 302, 302f
distention and constipation 464
examination in supine position 85f
girth 476
sonogram 414
Abduction and adduction of
hip 212f
shoulder 210f
wrist 211f
Abrasive wound 311
Accidental intravascular injection 220
Acetic acid 92
Acetone test 94
Acidosis 180
Acute illness 113
Adhesive straps 291, 292, 292f
blood transfusion 277
chemotherapy 456
infusion 268
subcutaneous infusion 275
Admission bed 35, 37, 43
Admitting and discharging patient 48
Aerosol mist 231
lock method 224, 224f
rings 140f
leak 341
obstruction 341
Albumin test 93
Alignment of cast structure 395f
Alkalinizers and acidifyers 269
Allergic reaction 220, 272, 280
Amino acids 136
Aneroid type sphygmomanometer 71f
Anorexia 114
Antenatal examination of abdomen 476f
Application of
cold sponge 191f
diathermy pads 199f
ultrasonic therapy 200f
adhesive straps 291
and removing
skeletal traction 387
skin traction 382
sutures 304
traction 378
binders 301
condom for drainage 177, 178f
counter-irritants 204
dressing 289
restraints 371
roller bandage 293
soothing applications 203
splints 375
sutures 304, 307, 310
tubular gauze bandage 295f
Arthritis 114
Asphyxia 70, 241
Aspiration 434
Assessing carotid pulse 325
in abdominal paracentesis 439
in biopsy and aspiration 433
in cast
application 391
removal 398
in dialysis 179
in endoscopy 427
in endotracheal intubation 326
in insertion and removal of chest tubes 350
in pericardiocentesis 444
in postural drainage 364
in thoracentesis 442
in tracheostomy 328
in venesection 283
patient to walk 155
Auscultation 56, 82
Baby sponge 511
brace 404, 404f, 405
rub 123
Bandage 293
enema 411
meal 411
swallow 411
Barrier nursing supplies 19
Bath tubs and washbasins 18
Bedpans and urine pots 18
Bedsore 124
solution 92
test 92, 94, 95
Biopsy 433, 434
forceps 429
Bivalved cast 392
instillation 243, 244, 246, 248, 248f
irrigation 262
Blanket bed 36, 45
tendencies 181, 206
time test 93, 95
Blistered nipples 515, 517
Blood 503
cells 503
collection 278
pressure 57, 70, 502
smear 91
specimen 86, 91
sugar tube 87
test 95
transfusion 277, 278
vessel tissues 220
volume expanders 269
Body cast 392
Bohler-Braun splint 376
Boiler 22
test 92, 93
of urine for albumin 94f
water 1
Bone marrow biopsy 434, 435
Bowel distension 181
Brachial pressure 73
Bradycardia 67
Breast 491, 502
bandage 299, 299f
binder 301, 302, 302f
biopsy/needle aspiration 434, 435
self examination 96
Breathing 53
Bronchography 412
Bronchoscopy 429431, 433
Bronchospasm 206
Buck's traction 380, 381f
Burn 316
bed 36, 38, 45
Calamine lotion/ointment 203, 204
Calculus 114
Calipers 376
Cancer of mouth, pharynx, esophagus 136
Candida albicans 515
Capping and masking 12, 15
Carbohydrates 136
bed 36, 37, 45, 45f
position 144f
temponade 341
Cardiopulmonary resuscitation 320
Caries 114
Cast removal 398, 399f
CBC tube 87
Cellulitis 313
Central venous pressure 335
biopsy 434
collars 377
traction 383, 386, 386f, 387, 390, 390f
mattress 46, 47
ostomy collection bag 367, 369, 370
compression 325f
restraint 371, 373, 373f
tube insertion and removal 350
tubes 353f
Choledochopancreatoenteroscopy 429
Circular bandage 295f
Circulatory adaptation 497
Circumduction of
hip 213f
shoulder 211f
Classification of
cold applications 188
enemas 160
hot applications 194
methods of sterilization/ disinfection 22
suppositories 165
Clavicle bandage 299, 300f
linen 36
wound 311, 314
genitals 119f
of ear with cotton buds 247f
of female urethral meatus 171f
of male urethral meatus 172f
bed 35, 36, 41, 42f
method 262, 264
of irrigation with infusion set 265f
Closure of fetal circulation 498
Clotting power 503
Coagulation time test 93, 95
Code of ethics for nurses 521
applications 187
bath 188, 189, 193
compress 187, 191
pack 188, 189, 192
sponge 187, 189, 191
test 92, 94, 95
sputum specimen 90f
urine from
catheter 89f
female infant 89f
urine in
kidney tray 89f
test tube and drainage bag 89f
Colon irrigation 257
Colostomy 368
irrigation 259
Colposcopy 430, 433
Combined traction 380
Combing hair 123
Computed tomography 417
Condom 177
catheter drainage 175
Confusion 107
Contact isolation 13
Contaminated wound 311
fever 75, 75f
finger bandage 300, 300f
mechanical ventilation 340
sutures 306f
Contused wound 312
Corrigans or water hammer 67
Corrugated drain 303
Coughing technique 214f
Cracked nipples 515, 517
Cranial sonography in infants 414
Culture tube 87
Cup-shaped hand 208f
Cusco’s/bivalve speculum 479
Cystogram and cystourethrogram 412
Cystoscopy 429, 430, 433
Dead body care 52
Deep breathing
and coughing 460
technique 213f
Defibrillation 338
Degrees of temperature 63
Dehydration 74, 113
Deltoid muscle 222
Dialysis 179
Diathermy 194, 199
Digestion 502
Diphtheria 134
ECT 449, 451
intravenous push 458
Disinfection 12, 18
Dispersion of medicine 225f
Divergent spica 294, 297
aspect of hand 228, 228f
elevated position 137
Dorsiflexion and plantar flexion of
ankle 213f
wrist 211f
Dorsolateral aspect of arm 226
and single barrelled colostomy 259
lumen with round tip catheter 170f
and wet dressings 290
hot pack 195, 202
Drying wound with dry swab 315
Duckbill speculum 479
Dyspnea 69
bandage 298, 298f
instillation 243245, 247
irrigation 251
Echocardiography 414
and knee restraints 372
bandaging 297f
or knee restraint 374
inhaler method 230, 232, 232f
pad 194, 200
Electroconvulsive therapy 449, 450f
Electrode placement in convulsive therapy 450f
Electroencephalogram 425
Electrolytes 269
Electromyography 426
Emptying ostomy collection bag 368, 370
Emulsified fats 136
Encephalopathy 180
Endocarditis 114
Endometrial biopsy 434, 435
Endoscopic biopsy 434
intubation 326
tube passed through mouth 328f
Enema 159
can and rectal tube method 160, 163, 163f
funnel and rectal tube method 160, 164, 164f
syringe and rectal tube method 160, 164, 164f
Enteric isolation 14
Esophagogastroduodenoscopy 429, 433
Esophagoscopy 430f, 433
ESR tube 87
Ewald's tube 346, 346f
Excreta 18
Exercises for
abdomen 401
lower limbs 400
lungs 401
upper limbs 400
Existing intravenous line method 457
Extensive burns 136
and internal rotation of
hip 212f
shoulder 211f
radiation therapy 452
bandage 298, 298f
instillation 243, 244, 246
irrigation 250
Faulty sucking 518
Fecal impaction 167
Feeding 53
Female genitalia 85
catheter 180
pressure 73
Fever 74
Figure of eight 294
bandage 296f
for ankle 296
First degree bedsore 125
Fistula 313
needle 180
Fixed traction 379
Flail chest 341
Flat nipples 518
Flexion and extension of
elbow 211f
knee 213f
neck 210f
shoulder 210f
Folding layer of gauze 191f
Foley's catheter 176
Forceful ejection reflex 518
Formaldehyde 26
Four artery forceps 180
Fracture bed 36, 37, 43, 43f
Fresh wound 310, 315, 316
grip 477, 477f
height 476
Funnel method 257, 258
Gallow's traction 380, 380f
Gastric irrigation 255
Gastritis 114
Gastroduodenoscopy 430
bleeding 189
decompression 349
tube insertion and removal 345
Gastroscope with accessories 429
Gastrostomy feed 134, 135, 135f
dressing 289, 291f
wick 303
General guidelines for administering drugs 215, 218, 244
Genitalia 505
Genitals 502
Genupectoral 83, 146
position 84f
Gingivitis 114
Girdlestone mermaid night splint 376
back rub 123
bedpan 157
and urine pot 157
electroconvulsive therapy 449
enemas 159
intradermal injection 227
intramuscular injection 221
feed 136
injection 228
oral medication 215
ostomy care 367
oxygen inhalation 236
parenteral medication 218
perineal care 493
postoperative nursing care 462
preoperative nursing care 459
skin and cord care 510
steam inhalation 229
subcutaneous injection 225
tracheostomy care 333
tube feed 133
urine pot 157
Glass funnel 92
Glossitis 114
Gloving 13, 17
Glucose tolerance test 87, 91
muscle 221
site 223
Gowning 13, 16
Groin temperature 60
Gutter splint 377
Hair washing 122f
Hamilton-Russell's traction 381, 381f
Handling sterile/disinfected supplies 29
Handwashing 12, 15
Hard tissues 220
Hardwares 4, 6
Head bandage 298, 298f
and lung machine 189
position 137
cradle 199
lamp 194, 199
in action 199f
stroke 74
Heavy sedation 113
Heel bandaging 297f
Hematological values 503
Hematoma 271
Hemodialysis 180, 181, 184, 186
Hemoglobin 503
test 93, 95
Hemorrhage 313
Hemothorax 341
Heparin tube 87
fever 113
fowler position 366f
pyrexia 77, 189
tension 67
Hormonal action 60
airing 23, 27
applications 193
bath 195, 203
water bottle 194, 198
Hygiene 53
Hypercalcemia 281
Hyperextension of neck 210f
Hyperkalemia 180, 281
Hyperpnea 70
Hyperpyrexia 63, 77, 189
Hypertension 72, 180
Hyperthermia 63
Hyponatremia 181
Hypostatic pneumonia and atelectasis 464
Hypotension 72, 181
Hypothermia blanket 187, 189, 191
Hysterosalpingography 413
bag or collar 187, 190
poultice 187, 190
Ileostomy 368, 368f
Iliac site 435
Improvised dressing 289, 291
Infected wound 311
Infection 74, 313
Infestation isolation 14
Infrared or ultraviolet lamp 194, 199
Inhibited ejection reflex 518
Initiation of effective pulmonary circulation 497
cannula 330
tube 330
and removing gastrointestinal tubes 345
Foley's catheter 176f
nonretaining catheter 168
nozzle into vagina 267f
rectal suppositories 164
self retaining catheter 173
Insertion of
catheter in
female patient 172f
male patient 172f
flatus tube 167f
medicine into vagina 248f
needle into muscle 224f
oropharyngeal nasopharyngeal airway 361f
rectal tube 163f
suction catheter 364
tube 135
Intake and output record 112t
Intermittent fever 75, 76f
Internal fixation 377
Intra-abdominal adhesions 181
Intradermal injection 227, 227f
Intragastric feed 134, 135, 136f
Intramuscular injection 221, 221f
chemotherapy 456
feed 136
infusion 229f, 268
injection 228
pyelography/IVP 412
Inverse fever 76, 77f
Inverted nipples 518
Irregular fever 76
colon 257
colostomy 259
ear 251
eye 250, 251f
nose 253
stomach 255
throat 254
urinary bladder 262
vagina 265
Jacket restraint 371, 373f
Jaw bandage 299, 299f
Jones-Thomas abduction frame 379, 379f
Jug method 230, 232, 232f
Keloids 313
Kidney tray 87, 429
Laboratory test 92
Lacerated wound 311
Laparoscopy 429, 430, 433
Large dusters 1, 518
Laryngoscopy 429, 430
flexion of neck 210f
grip 477
Left sidelying Trendelenburg 367f
brace 405, 405f
cast 392
Leukemia 74
Level of consciousness 56
moving 460
restraints 372
traction 383, 384, 386, 387, 389, 390
Lithotomy 84, 146
Liver biopsy 434, 435
and moderate pyrexia 77
pressure within infusion bottle 270
tension 67
garments 129
limb 288
lobes 366
Lubricating rectal thermometer 65f
Lvy's method 95
Lymphatic glands 420
aseptic practices 10
clean technique 10
isolation technique 11
neurological assessment record 107
nurse's notes/record 104
patient's records and reports 102
sterile technique 21
sterility 32
catheter 178f
genitalia 85
bedsore 124
gastrointestinal decompression 349
isolation unit 19
Manipulation 56, 82
brachial pressure 73f
central venous pressure 335
femoral pressure 73f
Mechanical ventilation 340
Meningitis 114
Mercury type sphygmomanometer 70f
Methods of ophthalmoscopy 432
Mitt restraint 372, 374
Mixed intention 312
Moderate pyrexia 63
Montgomery straps 293, 293f
Mouth gaurd 429
Mummy restraint 372, 375, 375f
Mycobacterium tuberculosis 26
Myelography 412
cannula 237, 242
catheter 237, 242
instillation 243245, 247
irrigation 253
Nasogastric feed 135, 135f
airway 360
airway suctioning 359
suctioning 359f
Nasopharynx suctioning 357
Nebulizer 234
Neck brace 405, 405f
biopsy/aspiration 434
displacement 270
position in tissue 226f
Nelson's inhaler method 229, 231, 232f
Nephritis 114
Nerve tissues 220
Nervous disease 74
Neurological assessment record 111t
Nightingale pledge 522
Nipples 502
Nitric acid test 94
Nonretaining catheter 168
Obturator or pilot tube 330
Occlusive method 318, 319
Occupied bed 35, 37, 42
nurse method 508
person CPR 322
tube method 257, 258
bed 35, 36, 39
heart surgery 189
method 262, 264, 319
of irrigation with asepto syringe 264f
Opening sterile package 30, 30f
Orogastric feed 133
airway 360f
suctioning 359f
Orthopnea 69
Osmotic diuresis 272
Osteoporosis 206
Otitis media 114
cannula 330
tube 330
cylinder with accessories 236f
inhalation 236
mask 237, 242
tent 237, 243
toxicity 241
Padded cast 392
Pale nipples 515, 517
Palmar flexion 211
Palpation 56, 82
Paralysis 113
Parotitis 114
Partial rebreathing and nonrebreathing masks 237
Parts of
syringe and hypodermic needle 221f
tracheostomy tube 330f
Passing flatus tube 166
Passive exercise 214
Pawlik's grip 477, 478f
corporis 120
pubis 120
grip 477, 478f
sonogram 414
traction 379, 383, 386, 387
Penetrating wound 311
Perforating wound 311
common laboratory tests 92
CPR 320
gastric analysis 437
massage 205
vaginal examination 479
Pericarditis 180
articles 4
wares 7
Peritoneal dialysis 179, 180, 182f, 185
Peritonitis 180, 181
Phlebitis 271
Pivot posture 149f
Placement of hands over chest 208f
Placing thermometer
in armpit 64f
in groin 64f
under tongue 64f
interrupted sutures 305f
abdomen 407
chest 407
examination 406
KUB 407
skeleton 407
Plantar flexion 213
bed 36, 37, 44
slabs 377
Positive pressure breathing 241
Postoperative nursing care 462
Postprocedural care 411
Postural drainage 364
liquid 31f
sterile liquids 31
Preoperative check list 462
Preparing hospital beds 35
Pressing supraorbital ridge with thumb 109f
Promote hemostasis 313
position 125, 145f
with thorax and abdomen 366f
Protect wound 314
Prothrombin time tube 87
Pugh's traction 379, 380f
edema 180, 341
ventilation 68
Pulses alternans 67
Purse string sutures 306f
Pyorrhea 114
Pyrogenic reaction 220, 272, 280
Qualities of nurse 521
Radial pulse 67
Radiotherapy 452
drip method 160, 164
suppository 164
temperature 60, 64
tube 166
Recurrent bandage 296f
and blue litmus 92
nipples 515
Reef knot 300
Reflex testing 56, 82
Reflexes 506
Relapsing fever 76
Remittent fever 75
Removal of
sutures 309f
tube 135
fecal impaction 167
of air from icebag 190f
sutures 304, 305, 309, 310
tube 348f
Renal biopsy 435
Resistive exercise 214
adaptation 497
insufficiency 181
isolation 13
spiral 294, 296
bandage 296f
Trendelenburg position 138, 146f
Rhinitis 114
middle lobe 365
sidelying Trendelenburg 367f
Rotation of neck 210f
Rothero's test 92, 94, 95
cleaning 11
method 224
test 92, 93, 95
Rubbing skin surfaces 61
Ryle's tube 346, 346f
Safe feeding 11
Safety belts 372, 372f
Sahil's acid hematin method 95
Sample of
graphic chart 59f
preoperative checklist 462t
binder 301, 301f, 302, 302f
binder for abdomen 302f
Second degree bedsore 125
Self-examination of breast 96
Self-retaining catheter 173
Semi-fowler position 366f
Semi-open method 319
Semirecumbent position 143f
Sengstaken-Blakemore tube 346, 346f
Serum hepatitis 272
Serving meal 131, 132
anemia 181
pain 206
Shape of catheter 169
Shaving of
abdomen 287f
lower limb 288f
rectoperineal area 287f
thoracoabdominal area 287f
upper limb 288f
abduction splint 377
bandaging 297f
Side lying position 125
Sim's position 83f, 144f
spiral bandage 296f
tube drain 303f
Single lumen 169
with mushroom tip catheter 170f
with round tip catheter 169f
Sinusitis 114
Site of insertion of catheter 169
Sitz bath 195
Skeletal traction 387, 389f
graft 288
traction 382, 385f
bed traction 379, 380
traction 379
Small nipples 517
bicarbonate 113
chloride 113
nitroprusside 92
Soft tissues 220
Soothing applications 203
Specimens of
cavity fluids 87
secretions 87, 92
Sphygmomanometer 70
Spica cast 392
Spinal braces 377
Spinous process site 435
lamp 92
swab 87
Splints for wrist and fingers 377
Sputum specimen 86, 90
Stage of
defervescence 75
fastigium 75
invasion 75
Stain remover 1
Starch poultice 203
inhalation 229
tent and kettle method 230, 232, 232f
dressing towel 169
gauze pieces 169
gloves 169
kidney tray 169
linen 36
lubricant 169
needle 86
precut tie of tracheostomy tube 335f
small bowl containing cotton swabs 6 to 8 169
sponge holding forceps 169
supplies 29, 333
technique 21
transfer forceps 22
tray or container 22
Stethoscope 70
and parts 70f
Stimulation of metabolism 60
Stomatitis 114
specimen 86, 90
test 93, 94, 94f
Stooping position 149f
Straight splint 376
Straining of stool 95
Strict isolation 13
infusion 275
injection 225
oropharynx/ nasopharynx 357
endotracheal/ tracheostomy tube 361
oropharyngeal/ nasopharyngeal airway 359
Sugar test 94
Sulfosalicylic acid 92
Superficial wound 311
position 125, 143f
Trendelenburg 367f
Supra pubic catheter drainage 175
bed 43, 43f
draping 33
gloving 33, 33f
gowning 33, 33f
handwashing 32, 32f
trauma and crushing injuries 74
Sweating 57
stage 75, 78
Swing crutch gait 401
Systolic and diastolic blood pressure 71t
Tachycardia 67
baby's weight 509
blood pressure 70
care of
breast 484
burn area 316
kitchen and pantry 8
patient's equipment 4
wound drain 303
height 79
pulse 65
respiration 68
temperature 60
vital signs 58
weight 80
T-binder 301, 302
for waist strap 302f
Temporary and permanent colostomy 259
Tension pneumothorax 341
Terminal cleaning 11
Test tubes 92, 93
Thermal adaptation 498
Thermometers 18
Thomas splint 376, 379, 379f
Thoracentesis 442
Thoracic sonogram 414
Three-augmented unipolar limb leads 423
Three-standard bipolar limb leads 423
Throat painting 243, 245, 247, 249
Thrombophlebitis and pulmonary embolism 464
Thyroid sonogram 414
Tongue depressor 429
TPR chart 59
Tracheostomy 328
suctioning 361
Treating pediculosis 123
Trendelenburg position 137, 145f
Triple lumen catheter 170f
Trunk restraints 371
T-tube drain 303f
feed 133
obstruction 270
Turning mattress 46, 46f
nurses method 508
persons CPR 325
tubes method 257,
Types of
application 61
pyrexia 63
thermometer 62f
Ultrasonic therapy 194, 199
Ultraviolet radiation 24
Unintentional wound 311
limb 288
lobes 365
culture specimen 89
in specimen bottle 88f
pot 158
retention 463, 464
routine specimen 88
specimen 86
test 93
Urinometer in jar of urine 93f
Use of urine pot 159f
cold applications 187
hanging scale 509
hot applications 193
metered dose inhaler 233
nebulizer 234
proportion method 531
sterile transfer/lifting forceps 30
ultraviolet lamp 199f
weighing machine 509
cleaner 1
drain 303, 303f
bleeding 478
examination 486
instillation 243245, 248, 249
Vastus lateralis
muscle 221
site 223
Vein spasm 270
Venesection 283
Ventilation 11, 12, 15
Ventral aspect of elbow or forearm 228
Venturi masks 237
Vermin and insects 1, 4
Vital signs 58
Vitamins 136
Vomiting 57, 463
Vomitus specimen 86, 91
Waist restraint 371, 373, 374f
hair 123
hands 11
Waterseal drainage system 354
Weak sucking 518
Wet and dry colostomy 259
White nipples 515, 517
Wound hemorrhage 464
Wrist or ankle restraint 374
Xylocaine 429
jelly 429
Z-track method 225
Chapter Notes

Save Clear

Caring the Patient's Unit and EquipmentChapter 1

Patient's Unit
It means a room or cubicle (accommodating one or more, i.e. 4 to 6 patients depending upon its capacity) having attached toilet and bathroom or a ward (accommodating 20 to 40 patients) having common toilet and bathroom where the patient is kept during his/her stay in the hospital for the purpose of treatment and care.
  1. To keep the unit clean, tidy and attractive.
  2. To keep all breeding places especially corners and ledges free from micro-organisms.
  3. To maintain esthetic sense.
The following supplies should be made available to the concerned workers for the care of following:
  1. Broom.
  2. Large dusters—two.
  3. Buckets—two.
  4. Soap/any other floor detergent and water.
  5. Vacuum cleaner.
  6. Stain remover, abrasive and wax, if needed.
  1. Carbolic solution in a basin.
  2. Duster—1.
  3. Soap and water, if needed.
  1. Detergent, brush and water.
  2. Spot removing agent, i.e. hydrochloric acid, if required.
Vermin and Insects
  1. Boiling water.
  2. Insecticides and fumigation supplies if needed.
  1. The patient's unit and equipment should be kept clean, tidy and attractive and in functioning condition. This responsibility is vested with the head nurse or delegated to the housekeeper managing the housekeeping department.
  2. Although the sweeping, mopping and cleaning activities have to be performed by the workers meant for them but the head nurse if made responsible, may need to supervise these activities.
  3. Observe the following principles of cleaning:2
    1. Clean and dust before the ward routine starts.
    2. Collect all the cleansing equipment before hand.
    3. Sweep before making beds.
    4. Dust after sweeping with a clean and damp duster as under:
      • From above downward and high place to low place
      • With firm and even strokes
      • In such a way as to prevent the dust flying from place to place
      • All the places paying special attention to all the corners and ledges with the least disturbance of the patient.
    5. When cleaning, consider the following points:
      • Make use of soap and water as soap emulsifies the fat and lowers the surface tension of water and the water acts as good solvent.
      • Make use of abrasives, brushes and other friction methods for mechanical cleaning.
    6. Remove the stains immediately with a stain remover if necessary, wash off the stain remover with clean water and dry immediately.
    7. Select the simple but suitable method for cleaning and sterilizing the suitable equipment.
    8. Clean, dry and arrange all the cleansing material which is in functioning condition before replacing in store, so that it can be easily located when required.
    9. Discard the cleansing material which is not in functioning condition as per hospital policy.
  4. Follow the frequency of cleaning as under:
    1. Daily
      • Sweep and mop the floors twice a day and dust the unit once a day
      • Remove, clean, dry and replace the toilet accessories in the toilet cabinet
      • Keep the locker neat and tidy and it should contain only the equipment needed for the patient
      • Place the furniture in order
      • Empty the bins two times or more as necessary.
    2. Weekly
      • Dust the walls, windows, doors, roof and ceiling fans
      • Wash and carbolize the furniture
      • Wash floors thoroughly
      • Clean and tidy the lockers and cupboards
      • Get the repairs and replacements done, if any.
    3. Annually
      • Get the white wash, paint and polish done
      • Get the repairs and replacements done.
  5. The flies, mosquitoes, bedbugs, cockroaches and rats are dangerous carriers of disease and therefore, all available measures should be used to prevent and control them.
Method of Care
The concerned workers should involve as follows:
  1. Sweep and mop the floors at least twice a day.
  2. Use two buckets of water, one is to wash out the duster while first wiping and the other to rinse the duster for second wiping of the floor. Make use of vacuum cleaner.
  3. Clean the cement, marble or tile floors with soap or any other floor detergent. Make use of an abrasive for tile floors and marble 3floors. Rinse thoroughly with clean water and dry.
  4. Polish the marble floors with wax if necessary to keep them glazing.
  5. Keep the unit well-ventilated and do not close the top ventilating windows unless there is storm or heavy wind.
  6. Dust the walls and roof from time to time in order to remove cobwebs.
  7. Clean the cement, tile and marble walls in the same way as floors. White wash the white washed walls. Rinse and dry the painted walls.
  8. Clean the windows and doors regularly.
It may be made of wood, iron, steel or plastic. The common furniture used in the patient's unit is as under:
  1. Bedsteads
    1. Remove dust every day while making the bed.
    2. Carbolize or wash with soap and water or any other detergent and dry well after the discharge of the patient.
  2. Lockers
    1. Avoid leaving unwanted food, dirty glasses and papers, etc. on the lockers.
    2. Arrange and dust every morning and evening when tiding the ward.
    3. Clean in the manner as bedsteads.
  3. Bed-cradles, back-rests and over bed tables Treat as bedsteads.
  4. Chairs and stools
    Treat as bedsteads.
  5. Cupboards
    1. Keep clean and tidy.
    2. Line the shelves with paper.
    3. Arrange the supplies after drying absolutely.
    4. Use naphthalene balls to protect the moths in the cupboards.
E.g. Iron furniture is cleaned with a dry duster to prevent rusting.
  1. Bathing rooms
    1. Scrub and wash the floors everyday.
    2. Avoid stagnation of water on the floors.
    3. Dispose of the hair, small bits of cotton and dressing material in proper dust bins as these may block the drainage system.
  2. Lavatories
    1. See that the flushing system is in working order.
    2. Avoid throwing things like bits of cotton, pads and dressings into them as these may block them.
    3. Make the arragement, when there is no water.
    4. Clean them with cleaning powder using a brush.
    5. Pay special attention to the drains.
    6. Pour boiling water or phenyl down them everyday.
    7. Remove the spots which cannot be easily removed with fine sand mixed with cleaning powder or washing soda. Use hydrochloric acid, harpic or saunifres to remove the spots which are very hard to remove otherwise.
    8. Scrub and wash the floors daily.
    9. Teach the patients and relatives regarding the proper use of lavatory.
  3. Washbasins
    1. Clean them twice a day with cleaning powder using a brush.
    2. Remove the spots with some spot removing agent mentioned above.
    3. Avoid throwing bits of cotton, dressings, food particles and other wastage into them and provide a waste bucket nearby for the purpose.
    4. Pour boiling water down the wash basin drains everyday.4
  4. Cabinet for sanitary wares
    1. Keep the racks clean, neat and tidy.
    2. Store the sanitary wares in racks neat and tidy and ready for use.
Vermin and Insects
  1. Clean the patient's unit regularly and thoroughly.
  2. Eliminate all the breeding places.
  3. Keep garbage well covered and dispose of all refuse as soon as possible.
  4. Store food properly.
  5. Use fly screens on windows and doors.
  6. Use boiling water, insecticides and fumigation as necessary.
Cleansing Material
These are soap, vim, washing soda, many other detergents, rags, abrasives, brushes, brooms and the liquids used for cleaning purposes. Harpic, sanifresh and hydrochloric acid are used to remove the stains in the lavatories, wash basins, etc.
  1. Use the cleansing material with utmost economy. Avoid leaving the soap lying in water. Use vim, washing soda and other cleansing material with care. Wash and dry rags, abrasives, brushes and brooms. Avoid keeping brooms standing on their heads as it spoils the bristles. Use sanifresh and acids only when other methods fail to remove stains.
  2. Properly arrange all the cleansing material when stored so that it can be conveniently located when required.
Patient's Equipment
It means various types of articles which are used for (and by) the patient during his/her stay in the hospital for carrying out his/her treatment and care such has bedding, linen, rubber, plastic enamel, steel and glass articles and dressing material.
  1. To keep the equipment ready for use at all times.
  2. To prolong the durability of the equipment.
Bedding and Linen
Refer procedure “Making Beds”.
Rubber and Plasticwares
  1. Running water.
  2. Soapy solution in a basin.
  3. Disinfectant solution in a basin.
  4. Applicator and powder.
  1. Soap.
  2. Brush.
  3. Disinfectant solution in a basin/tub.
Perishable Articles
  1. Newspaper, soap/glass detergent as needed.
  2. Dry duster and rag.
  3. Turpentine/kerosene oil/alcohol/ether, if needed.
Dressing Material
Surgical dressing material as needed.
Cleansing Material
Inventory and Stores
List of equipment with specifications used in the patient's unit.5
  1. The mattresses and pillows may be made of foam, coir or dunlop.
  2. Sheets, drawsheets, covers (mattress, pillow, blanket and quilt), counterpans, towels, shirts and pyjamas may be made of cotton material which is easily washable, from the linen. See that:
    1. The sheets are long and wide enough for the type of bed used.
    2. The drawsheets are slightly thicker, more absorbent and made of warmer cotton material than the bedsheets.
    3. The covers are long enough to cover the mattresses, pillows, blankets and quilts.
    4. Every care is taken for these articles and these are used only for the purpose for which these are intended.
  3. Cupboard used for storing the rubber and plastic goods should be provided with holes at the sides to ensure a steady current of air circulating into all these goods.
  4. Avoid the use of heat, acids, alkalies, other chemicals, abrasives and brushes on the equipment to which these are harmful.
  5. Remove the stains immediately with a stain remover if necessary, wash off the stain remover with the clean water and dry.
  6. Select the simple but suitable method for cleaning and sterilizing the suitable equipment.
Nursing Activity
Take care of equipment as under.
Bedding and Linen
  1. Mattresses
    1. Provide even and comfortable mattresses.
    2. Dust daily with damp duster.
    3. Cover with cotton covers.
    4. Brush or wash and disinfect or sterilize according to the type of mattress.
    5. Lay a canvas sheet or beddari on the bed under the mattress.
  2. Pillows
    Follow the above steps except the last one.
  3. Blankets
    1. Protect by using a cotton sheet next to the patient and a counterpane on the top of the blankets or cotton covers.
    2. Avoid frequent washing, as these get deteriorated very quickly.
    3. Wash yearly or when have been used by an infectious patient.
    4. When not in use, wrap in plastic envelopes or put in a cupboard preferably of tin lined.
    5. Put some naphthalene balls in between the layers of blankets to protect from moths.
  4. Quilts
    1. Protect by using cotton covers.
    2. Further care is the same as for blankets.
  5. Linen
    1. Change frequently and do not allow to become more dirty.
    2. Carefully check, when received from laundry and mend before using again.
    3. Count when sending to the laundry and on receiving from the laundry.
    4. Carefully check the linen missing.
    5. Remove the dirty and soiled linen from the unit immediately.
    6. Place the soiled linen in a tub containing disinfectant solution.
    7. Immediately attend the soiled and stained linen.
Rubber and Plasticwares
  1. Tubes: These are feeding, aspiration, rectal tubes, catheters and many others.6
    1. Straighten the tubes.
    2. Thoroughly flush the used tube under running water holding the eye upwards and allowing the water to run through it.
    3. Flush with soapy solution if grease or oil has been used.
    4. Use applicator if necessary to clear ‘eye’.
    5. Wrap in a clean cloth, boil each one separately for 5 minutes, dry by hanging on a hook under shade, powder and store. All these measures help to preserve the texture of the tube material.
    6. Send feeding tubes and catheters for autoclaving if facilities are available, otherwise reboil for five minutes before using again.
  2. Ice caps, collars, air-rings and hot water bottles:
    1. When not in use, wash with mild soapy solution, rinse and hang upside down to drain.
    2. Fill in little air when dried to prevent the two surfaces coming in contact.
    3. Place stopper tightly and store.
    4. Report if any cracks are seen.
  3. Gloves
    1. Store new gloves in their original envelopes, taking care to avoid any kinking of the gloves placed inside them.
    2. Thoroughly wash the used gloves both inside and outside, check punctures by filling air or water, wrap in cloth, boil for five minutes if required for immediate use in the ward.
    3. For surgical purposes, dry, powder with chalk or talcum, both inside and outside, then put together in pairs in a wrapper and send for autoclaving.
  4. Sheets
    1. Soak soiled sheets in cold water containing some disinfectant, then wash with soapy solution, rinse and hang on a rail in shade in order to dry them.
    2. When not in use, powder, roll, never fold and store.
  5. Bedpans and urine pots
    1. Do not throw cotton sponges, wipette, rags, applicators and sanitary pads into the bedpan. If thrown by mistake, remove before emptying the bedpan.
    2. Carry the bedpan after use to the sluice room.
    3. Measure the contents, if necessary with measuring container kept in the sluice room.
    4. Empty bedpan into the lavatory pan, rinse with cold water under force.
    5. Clean with soap or detergent using a brush, rinse thoroughly, dry and replace in bedpan rack kept in the toilet cabinet.
    6. Disinfect or sterilize the bedpans at least once in a week by soaking in a solution, e.g. lysol 1:40 for one hour or carbolic or phenol 1:40 for two hours.
    7. Treat the urine pots in the same manner.
  1. Enamel wares
    1. Sputum mugs and kidney trays
      • Empty and treat as bedpans
      • Render the infectious contents such as sputum of tuberculosis patient harm less by boiling or using chemicals before emptying or dispose of by burning
      • Add a small quantity of disinfectant such as carbolic or phenol 1:20 into the sputum mug before giving to the 7patient to prevent sputum sticking to the sides.
    2. Others
      • These are basins, mugs, buckets, tubs, trays, jugs and others
      • Clean with vim after use, rinse, dry and replace
      • Never scrape with anything sharp.
    3. Bedpans and urine pots
      • Refer point 5 above
      • The enamel bedpans and urine pots can also be disinfected or sterilized by placing in a mixture of washing soda and boiling water, bedpan sterilizer or sun.
  2. Steel wares
    1. Articles
      Clean with soap or detergent, rinse and dry completely ensuring no water marks on them to prevent rusting when stored.
    2. Instruments
      • Open them, place in a deep basin containing cold water and rinse thoroughly to remove organic material. Do not use hot water as it coagulates the organic matter and tends to make it stick to the instruments.
      • Scrub those with serrations and lock using a brush, wash in a hot mild soapy or any steel detergent solution, rinse and dry. Soap or detergent has an emulsifying action, reduces surface tension to facilitate the removal of dirt and rinsing helps to remove the dirt away.
      • Do not handle unnecessarily.
      • Place heavy instruments at the bottom of the tray and the light and delicate at the top.
      • Carefully clean the sharp instruments such as knives and scissors, avoiding contact with hard surface. If knives have detachable blades, remove and attach with the help of special forceps when it is to be used.
      • Sterilize by autoclaving or boiling and sharp instruments by chemicals.
      • Use each instrument for the purpose it is meant specifically and avoid its rough use.
  3. Dustbins
    1. Use three bins, each covered with a lid, one for left over food, other one for things like egg shells, tins, tea leaves, skin of fruits, etc. and the third one for dirty dressing material.
    2. Clean with soap or detergent and warm water, disinfect and dry after emptying.
    3. Put the refuse into an incinerator or bury it.
    4. Teach the patient and relatives regarding the purpose and the use of dustbins.
Perishable Wares
  1. Glass wares
    1. Mirrors, windows and door panes
      • Clean regularly.
      • Wash with soap or detergent or any glass detergent, rinse and dry with a clean dry duster or with dry old newspaper which is used wet at first and then dry one.
      • Very dirty panes with paint adhering, are cleaned with a rag dipped in turpentine, kerosene oil, alcohol or ether. This also prevents flies settling on the windows.
    2. Thermometers—see guidelines points 12 and 13 on .
    3. Syringes and needles—The glass syringes are nondisposable and are replaced almost in all institutions by 8disposable syringes. The advantage of disposable syringes is that these help in safe administration. The glass syringes are still some times used, hence these are sterilized and reused.
      • Flush those which need to be reused with cold water, wash with mild soapy or glass detergent solution and rinse thoroughly.
      • Open the blocked needles with stylets. Separate the barrels and pistons and keep together when cleaning and sterilizing to prevent interchanging. Warm the stuck needles and syringes to separate them. Dipping in the weak solution of nitric acid, hydrochloric acid or potassium dichromate also helps.
      • Take care to avoid needle point coming in contact with any hard surface as it becomes blunt.
      • Sterilize by autoclaving as these are best sterilized by this method but when required for immediate use sterilize by boiling.
      • When boiling separate the barrel, piston and needle of each syringe to prevent their breakage as a result of expansion of glass by heat. Then wrap the barrel and piston, each separately and keep together along with the needle of each syringe in boiler to prevent their interchanging.
    4. Others
      • Rinse and flush those that need flushing under force, just after use. Clean with soap or detergent using soft rag, rinse, dry and replace.
      • Sterilize by boiling after adequately padding them to prevent breakage.
  2. Earthen wares—Crockeries and cutleries
    • Clean as the glass articles.
Dressing Material
These are cotton, gauze, bandages and lint, etc.
  1. Prepare surgical dressing in sufficient quantities for each particular dressing but any surplus cotton, lint, gauze must be put aside for resterilization.
  2. Cotton pads which are not soiled but are not suitable to be used again, can be made into swabs and sterilized and used for dressing.
  3. Use lint and bandages for cleaning purposes.
  4. Burn the used dressing material.
Inventory and Stores
The inventory which needs daily check is the equipment such as thermometers, instruments, syringes and needles, sphygmomanometer, torch, flash lights, oxygen and emergency drugs, etc.
  1. Daily check to see that these are not missing, are in working order or need any repair or replacement.
  2. Weekly, biweekly or monthly checks are made for the furniture and occasionally required equipment.
  3. Keep the stores clean. Keep things stored in cupboards, tidy and well arranged. Keep new and old things apart.
  4. Check the stores from time to time atleast every month.
  5. Condemn the old things from time to time as per hospital policy.
  6. The nurse is the custodian of the hospital and should do all whatever in her power to maintain it in an efficient manner.
Kitchen and Pantry
Kitchen is the room or area in hospital where the food is prepared and cooked for the 9patient and pantry is the area or cupboard in which crockery, cutlery and other kitchen utensils are kept.
  1. To keep the kitchen and pantry clean, tidy and attractive.
  2. To keep the utensiles ready for use.
  3. To provide safe food supply to the patients.
The following supplies should be made available to the concerned workers for the care of:
  1. Kitchen equipment—Detergent, brush, dusters, rags.
  2. Floors—Refer supplies for the care of unit.
  3. Sinks—Detergents, rags, brushes and spot removing agent, if required.
Method of Care
The concerned workers should involve as follows:
Kitchen, Pantry and Equipment
  1. Keep them clean. Wipe the floor after each use. Treat the sinks in the same way as wash basins.
  2. Keep the utensils used for infectious disease patients strictly apart and labelled. If get mixed up with other equipment, boil and disinfect all the equipment.
  3. People employed in kitchen should have short nails, put on apron and tie, their hair neatly covering with a net.
  4. Keep food in the covered containers.
  5. Dispose of all garbages properly.
  1. Defrost and wash thoroughly at regular intervals.
  2. Before cleaning turn to ‘U’ for defrost. Remove all the foods, utensils and medicines, etc.
  3. Remove shelves and wash them with soap and water, rinse, dry and replace.
  4. Remove ice trays from ice compartment, wash and dry the ice compartment.
  5. Wash and dry the inside of the door.
  6. Replace foods, only those which are in good condition.
  7. Replace utensils after wiping the outside.
  8. Replace the medicines which can only be used.
  9. Wash and dry the outside of the refrigerator.
  10. Clean the ice trays, fill with clean water putting cube compartments in and keep in the ice compartment.