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Handout on Advanced Nursing I for Nursing Students

Introduction to Advanced Nursing I

Advanced Nursing I builds upon the foundational skills and knowledge acquired in Basic Nursing. This course is designed to equip nursing students with more specialized skills in areas such as wound care, medication administration, intravenous therapy, and oxygen therapy. These advanced skills are essential for effective patient care in both hospital and community settings.

This handout aligns with the Ghana Nurses and Midwifery Council (NMC) Curriculum and is intended to provide nursing students with a detailed and practical guide to mastering advanced nursing procedures.


1. Wound Dressing

Wound care is one of the most essential tasks in nursing practice. Proper wound dressing not only promotes healing but also prevents infection and other complications. Nurses must be skilled in assessing different types of wounds and using the appropriate dressing techniques.


a. Setting Trays and Trolleys for Wound Dressing

Before performing a wound dressing, it is crucial to prepare the necessary equipment and ensure a sterile environment. This helps prevent contamination and promotes wound healing.

Equipment for Wound Dressing:
  • Sterile Dressing Pack: Contains sterile instruments, swabs, and dressings.
  • Gloves: Sterile and non-sterile gloves to prevent infection.
  • Normal Saline or Antiseptic Solution: Used to clean the wound.
  • Sterile Gauze: For covering the wound.
  • Bandages and Adhesive Tape: To secure the dressing.
Procedure:
  • Step 1: Wash hands thoroughly and wear sterile gloves.
  • Step 2: Arrange the dressing tray or trolley with all required materials, ensuring sterility is maintained.
  • Step 3: Position the patient comfortably and expose the wound area.

b. Wound Assessment and Documentation

Accurate wound assessment is vital for developing an appropriate care plan. Nurses must assess the wound regularly to monitor progress and detect any signs of infection or complications.

Wound Assessment Includes:
  • Type of Wound: Surgical, traumatic, pressure ulcer, etc.
  • Size: Measure the length, width, and depth of the wound.
  • Exudate: Type (serous, purulent, etc.) and amount of wound discharge.
  • Odor: Foul-smelling wounds may indicate infection.
  • Edges and Surrounding Skin: Check for signs of maceration, redness, or swelling.

Documentation:

  • Nurses must document their findings in the patient’s chart, noting the condition of the wound, dressing type used, and any changes in the wound’s appearance.

c. Taking a Wound Swab

A wound swab is often taken if there are signs of infection, such as increased exudate, redness, or fever. This helps identify the bacteria causing the infection and guides antibiotic treatment.

Procedure for Taking a Wound Swab:
  • Step 1: Clean the wound area with normal saline to remove any debris.
  • Step 2: Use a sterile swab to collect a sample from the wound bed, avoiding any necrotic tissue.
  • Step 3: Place the swab in a sterile container and send it to the laboratory for culture and sensitivity testing.

d. Stitching of Minor Wounds

Minor wounds that do not penetrate deeply into tissues may require suturing to promote healing and reduce the risk of infection.

Procedure:
  • Step 1: Clean the wound with antiseptic solution.
  • Step 2: Administer local anesthesia to numb the area.
  • Step 3: Use a sterile needle and suture material to close the wound. Ensure even stitching to promote good healing.
  • Step 4: Apply a sterile dressing over the stitched wound.

e. Simple, Minor, and Complicated Wound Dressing

  • Simple Wound Dressing: Used for clean wounds with minimal exudate. A basic sterile gauze dressing is usually sufficient.
  • Minor Wound Dressing: Involves wounds with slight contamination or minor lacerations that require regular cleaning and dressing changes.
  • Complicated Wound Dressing: Involves deep or infected wounds that may require wound irrigation, debridement, and specialized dressings such as hydrocolloid or foam dressings.

f. Removal of Stitches, Clips, and Drainage Tubes

  • Stitch Removal: Stitches are typically removed 7–14 days after the procedure, depending on the wound location and type. Use sterile scissors and tweezers to remove the sutures.
  • Clip Removal: Wound clips (staples) are removed using a specialized clip remover tool. Clean the area thoroughly before and after removal.
  • Drain Removal: Drainage tubes are used to remove excess fluid from a wound site. Once the drainage subsides, the tube is carefully removed, and the site is cleaned and redressed.
  • Wound Irrigation: This involves flushing the wound with a sterile solution to remove debris and bacteria, promoting a cleaner wound bed for healing.

2. Administration of Medicine

Administering medication is one of the primary responsibilities of nurses. It is essential that nurses understand the principles of safe medication administration, proper dosage calculations, and the different routes by which medications can be delivered.

See Also: Handout on Anatomy II for Nursing Students

a. Terms, Abbreviations, and Interpretation of Prescriptions

Nurses must be familiar with common medical abbreviations used in prescriptions, such as:

  • QID (quater in die): Four times daily.
  • BID (bis in die): Twice daily.
  • PRN (pro re nata): As needed.
  • STAT: Immediately.

Interpreting Prescriptions: Nurses must ensure they correctly interpret the doctor’s orders regarding medication type, dosage, frequency, and route of administration. Misinterpretation can lead to medication errors.


b. Dosage Calculation and Equipment Handling

Correct dosage calculation is critical, especially for medications administered intravenously or intramuscularly. Nurses must be proficient in calculating dosages based on the patient’s weight, age, and condition.

Dosage Calculation Formula:
  • Dosage = (Desired Dose ÷ Available Dose) × Quantity
Handling Equipment:
  • Nurses must ensure the sterile handling of syringes, needles, vials, and other equipment used in medication administration to prevent contamination.

c. Managing the Medicine Trolley/Cart

The medicine trolley or cart must be organized and kept sterile. It should contain all necessary medications, equipment, and supplies needed for administration. Nurses must also ensure that the trolley is secure and that medications are stored correctly, especially controlled substances.


d. Routes of Medicine Administration

There are several routes by which medications can be administered, each with specific techniques and purposes:

  • Oral: Tablets, capsules, and liquids are swallowed by the patient. This is the most common route for medication administration.
  • Topical: Ointments, creams, and patches are applied to the skin.
  • Subcutaneous: Medication is injected just beneath the skin (e.g., insulin).
  • Intradermal: Injections are given into the dermal layer of the skin, often used for allergy testing or TB tests.
  • Intramuscular (IM): Medication is injected directly into the muscle for rapid absorption (e.g., vaccines).
  • Intravenous (IV): Medication is delivered directly into the bloodstream for immediate effect.
  • Intrathecal and Intraosseous: Administered into the spinal canal or bone marrow in emergency cases.

e. Preparation and Administration of IV and IM Medications

  • Intravenous (IV): Nurses must ensure that IV medications are prepared under sterile conditions, the correct dosage is administered, and the infusion rate is carefully monitored to prevent complications such as phlebitis or infiltration.
  • Intramuscular (IM): Administered at sites like the deltoid or gluteal muscles, IM injections must be given at the correct angle (90 degrees) and depth to ensure absorption and avoid nerve damage.

f. Oxygen Therapy and Inhalational Agents

Oxygen therapy is administered to patients who are hypoxic or have respiratory disorders. Moist or dry inhalation agents are also used to deliver medications that relieve airway obstruction or treat lung infections.

Preparation:
  • Ensure the oxygen delivery system (nasal cannula, face mask) is correctly connected and that the oxygen flow rate is appropriately set.
Nursing Responsibilities:
  • Monitor the patient’s oxygen saturation levels using a pulse oximeter.
  • Educate patients on proper breathing techniques during oxygen therapy.

g. Dangerous Medicines Act (DDA) and Storage of Medicines

The Dangerous Drugs Act (DDA) governs the control and storage of narcotic and controlled medications. Nurses must ensure that such medications are securely locked away and accurately documented every time they are administered.


3. Intravenous Therapy and Blood Transfusions


a. Blood Transfusion and Total Parenteral Nutrition (TPN)

  • Blood Transfusion: Nurses must carefully monitor patients during blood transfusions for any adverse reactions, such as fever, chills, or anaphylaxis.
  • TPN: Used to provide nutrition to patients who cannot take food orally. It involves the infusion of nutrients directly into the bloodstream.

4. Administration of Oxygen

Oxygen therapy is critical in treating respiratory conditions. Nurses are responsible for administering oxygen safely and monitoring its effectiveness.

Key Considerations:
  • Ensure the correct flow rate (measured in liters per minute).
  • Monitor for signs of oxygen toxicity in patients receiving high concentrations for extended periods.

This Advanced Nursing I Handout, in line with the Ghana Nurses and Midwifery Council (NMC) Curriculum, covers essential skills such as wound dressing, medication administration, intravenous therapy, and oxygen therapy. Mastering these advanced techniques is critical for providing high-quality care to patients in various clinical settings.

This handout has also been optimized for search engines, ensuring that nursing students and professionals looking for NMC-aligned study materials can easily access it.

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