Handout on Basic Nursing for Beginner Nursing Students

Handout on Basic Nursing for Beginner Nursing Students

Introduction to Basic Nursing

Nursing is a profession that focuses on the care of individuals, whether they are ill, injured, or in good health, and it emphasizes the promotion of health, prevention of illness, and the care of the dying. This course will cover the fundamental skills and knowledge you need as future nurses to provide safe and compassionate care. We will focus on the essential principles of body mechanics, hygiene, asepsis (infection control), homeostasis, and patient support, including both physical and emotional aspects of care.

As a nurse, you will not only address patients’ physical needs but also their psychological, social, and spiritual well-being. These comprehensive skills will allow you to meet the diverse needs of patients throughout their healthcare journey.

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1. Body Mechanics in Nursing Care

Body mechanics refers to the way you move your body to prevent injury to yourself or others. Nurses often lift or move patients, which can be physically demanding and carries the risk of strain or injury. Proper body mechanics reduce the risk of injury and make the work more efficient.

1.1 Principles of Body Mechanics

The principles of body mechanics ensure that nurses use their bodies efficiently while avoiding injury. Here are some fundamental principles with additional detail:

• Bend at the knees, not the waist: This allows you to use the strong muscles of your legs instead of the weaker muscles of your back. When you bend from your waist, your spine takes the strain, which can lead to back injuries over time. Always squat by bending your knees and keeping your back straight.
• Use your legs to lift: Your leg muscles are the largest and strongest in your body. By lifting with your legs, you engage these powerful muscles, reducing the strain on your back. For example, when helping a patient out of bed, make sure you squat and push up using your leg muscles.
• Keep objects (or patients) close to your body: The further away the object, the more strain is placed on your muscles, especially the arms and back. By keeping objects close, you reduce the load on your spine and improve your balance.
• Maintain a stable base: Standing with your feet shoulder-width apart provides a stable base of support. This makes it easier to maintain balance and reduces the chance of slipping or falling, especially when lifting or moving patients.
• Avoid twisting while lifting: Twisting puts unnecessary strain on your spine. Instead of twisting, always turn your whole body by pivoting your feet. This protects your back and ensures a safer movement.

Example of Application: Imagine helping a patient who has limited mobility to sit up in bed. Without proper technique, you might bend your back and lift with your arms, which can lead to back pain or injury over time. However, if you bend your knees, keep the patient close, and use your legs to lift, you reduce the risk of injury to both yourself and the patient.

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1.2 Application of Body Mechanics in Nursing Care

Body mechanics isn’t just a theory—it’s a practice you’ll use every day in nursing. The application of body mechanics extends to a wide range of daily activities, including:

• Repositioning patients in bed: Some patients, particularly those who are bedridden or immobile, need to be repositioned regularly to prevent pressure ulcers (bedsores). Proper body mechanics help nurses move patients smoothly and safely without straining themselves.Example: If a patient needs to be turned from their back to their side, the nurse should use a wide stance for stability, bend their knees, and pivot rather than twist, while keeping the patient close.
• Assisting patients in and out of bed: Many patients require help getting out of bed, either to walk or to transfer to a wheelchair. This is a common scenario in hospitals, and it requires safe lifting and transferring techniques. Using mechanical aids like hoists can also reduce physical strain.Example: When moving a patient from bed to a wheelchair, the nurse uses a transfer belt, keeps the patient close, and lifts with their legs, not their back, to ensure a smooth and safe transfer.
• Moving equipment and supplies: Nurses often carry medical supplies, reposition IV stands, or adjust heavy hospital beds. Practicing proper lifting techniques is crucial to avoid injuries that can occur from lifting heavy or awkward objects.

1.3 Use of Appropriate Gadgets in Lifting and Changing Patient Positions

Modern healthcare facilities have various devices that assist with moving patients, reducing the risk of injury to both patients and healthcare providers. Some of these devices include:

• Hoists and lifts: These mechanical devices are used to lift heavy or immobile patients from beds to wheelchairs or onto examination tables. They reduce the physical strain on nurses, especially when handling heavier patients. Hoists can be operated by a single nurse or a team, depending on the situation.
• Slide sheets: These are smooth fabric sheets placed under a patient to reduce friction and make it easier to move the patient across a surface, such as a bed. Slide sheets are used when turning or repositioning patients without having to lift them completely.Example: A slide sheet can be used to help a patient shift from one side of the bed to the other, reducing friction and allowing the nurse to move the patient more easily.
• Transfer belts: A transfer belt (or gait belt) is worn around the patient’s waist to provide stability when helping them stand or walk. The belt gives the nurse something secure to hold onto, helping prevent falls.

Scenario Example: If a patient is unable to move themselves from their bed to a chair, the nurse uses a hoist. By placing the patient in the hoist’s sling and operating the device properly, the nurse can safely lift and transfer the patient with minimal physical effort.

2. Basic Nursing Procedures

As a nurse, you will perform a variety of procedures that ensure the comfort, hygiene, and safety of your patients. These basic nursing procedures are the foundation of good patient care and help maintain the patient’s dignity and well-being.

2.1 Positions Used in Nursing Patients

The way a patient is positioned in bed can affect their comfort, recovery, and even their ability to breathe. Different positions serve different purposes, and nurses must be familiar with the proper techniques for placing patients in these positions. The most common patient positions include:

• Supine Position: In the supine position, the patient lies flat on their back with their arms by their sides. This position is often used for patients who are recovering from surgery, during medical examinations, or for those who are unconscious. The supine position allows for easy access to the front of the body for medical procedures or assessments.Example: A post-operative patient may be placed in the supine position to ensure that they remain comfortable while their surgical site heals.
• Fowler’s Position: This involves elevating the patient’s head to a 45-60 degree angle. Fowler’s position is particularly useful for patients with respiratory difficulties, as it allows for better expansion of the lungs. It is also used during feeding for patients who cannot get out of bed.Example: A patient who has difficulty breathing due to pneumonia may be placed in Fowler’s position to help them breathe more easily.
• Lateral (Side-Lying) Position: In the lateral position, the patient is placed on their side. This position helps prevent pressure ulcers by relieving pressure on the back and is commonly used for patients who are unable to change positions on their own.Example: A nurse may turn a bedridden patient to the lateral position every two hours to prevent the development of bedsores.
• Prone Position: In the prone position, the patient lies flat on their stomach. This position is sometimes used for patients with respiratory issues, such as those with severe COVID-19, as it can improve oxygenation.Example: A nurse places a patient with respiratory distress in the prone position to improve their lung function.
• Trendelenburg Position: In this position, the patient lies flat on their back but with their feet elevated above their head. This position is often used in emergency situations to increase blood flow to vital organs.Example: A patient experiencing shock may be placed in the Trendelenburg position to improve blood circulation.

2.2 Bed Making

Proper bed making is essential to patient comfort and hygiene. A well-made bed reduces the risk of pressure ulcers, promotes better sleep, and ensures that the patient’s environment is clean and safe.

• Unoccupied Bed: This is a bed made when the patient is not in it. The goal is to prepare the bed for the patient’s return. Nurses must ensure that the bed is free from wrinkles, clean, and comfortable.Steps in Making an Unoccupied Bed:
  1. Strip the bed of used linens and place them in a designated laundry bag.
  2. Clean the mattress if necessary.
  3. Place the bottom sheet, ensuring there are no wrinkles.
  4. Lay down the top sheet and blankets, folding the corners neatly.
  5. Prepare the pillows and ensure the bed looks welcoming.
• Occupied Bed: When a patient is too ill or immobile to leave the bed, nurses must change the linens while the patient remains in bed. This requires careful coordination to avoid discomfort.Steps in Making an Occupied Bed:
  1. Help the patient turn to one side of the bed.
  2. Remove the linens from the opposite side of the bed and replace them with clean linens.
  3. Gently roll the patient to the clean side and complete the bed-making process.

  Example: A nurse makes an occupied bed for a patient recovering from a stroke. The nurse ensures that the bed linens are smooth and wrinkle-free to prevent discomfort or skin breakdown.

• Pressure Area Care: When making a bed, nurses must be mindful of areas of the body that are prone to pressure sores, such as the back, buttocks, and heels. Special mattresses and cushions can be used to reduce the risk of pressure ulcers.

2.3 Maintenance of Personal Hygiene

Maintaining personal hygiene is a critical aspect of patient care, particularly for those who are bedridden or too ill to care for themselves. Good hygiene practices prevent infections, promote comfort, and preserve the patient’s dignity.

• Bed Bathing and Bathroom Bathing: For patients who are unable to bathe themselves, nurses provide bed baths or assist with bathroom bathing. This helps keep the skin clean, removes dirt and bacteria, and promotes circulation.Steps for Bed Bathing:
  1. Gather all supplies, including warm water, soap, washcloths, towels, and clean linens.
  2. Ensure the patient’s privacy by closing doors or curtains.
  3. Begin by washing the patient’s face, neck, and arms, moving downward. Clean the genital area last to avoid cross-contamination.
  4. Dry each area before moving on to the next.
  5. Change the linens after bathing is complete.

  Example: A nurse provides a bed bath to a post-surgical patient to ensure cleanliness, prevent infection, and promote comfort.

• Oral Hygiene: Regular oral care is essential for maintaining a healthy mouth, especially in patients who are unconscious or unable to brush their teeth. Good oral hygiene prevents gum disease, reduces the risk of respiratory infections, and ensures patient comfort.Steps for Oral Hygiene:
  1. Gather supplies such as a toothbrush, toothpaste, and a basin.
  2. Place the patient in a semi-Fowler’s position to prevent choking.
  3. Brush the patient’s teeth or clean their mouth with a moist swab, paying attention to gums and tongue.
  4. Ensure the mouth is rinsed and dry.

  Example: A nurse performs oral care for a patient who is unable to swallow and is on a ventilator, preventing infections and ensuring the patient’s comfort.

• Hair Care and Grooming: Maintaining a patient’s appearance can improve their self-esteem and psychological well-being. Nurses may wash and comb hair, treat scalp conditions, and help patients with personal grooming tasks such as shaving.Example: A nurse washes and combs the hair of a bedridden patient, improving the patient’s appearance and promoting comfort.
• Feeding Helpless Patients: Nurses assist patients who are unable to feed themselves due to illness, injury, or surgery. This involves helping the patient eat, ensuring they are receiving adequate nutrition, and monitoring for any issues with swallowing or digestion.Example: A nurse assists a stroke patient with feeding by offering small spoonfuls of food, ensuring that the patient chews and swallows each bite safely.

2.4 Serving of Bedpans and Urinals

For patients who are unable to walk to the bathroom, nurses provide bedpans or urinals. This task is essential for maintaining patient dignity and preventing complications like incontinence or urinary tract infections (UTIs).

3. Principles of Asepsis

Asepsis refers to practices that keep areas and objects free of harmful microorganisms to prevent infections. As a nurse, you will be responsible for maintaining asepsis during all procedures to protect both yourself and your patients.

3.1 Medical and Surgical Asepsis

• Medical Asepsis (Clean Technique): The goal of medical asepsis is to reduce the number of pathogens. This includes everyday practices like hand washing, disinfecting surfaces, wearing gloves, and using clean techniques during procedures. It is commonly used for basic procedures such as wound cleaning and administering injections.Example: Before inserting an IV, the nurse disinfects the patient’s skin, wears gloves, and uses sterile equipment to minimize the risk of infection.
• Surgical Asepsis (Sterile Technique): Surgical asepsis ensures that an area or object is completely free of all microorganisms. This is essential during invasive procedures like surgeries, catheter insertions, or wound care for large or deep wounds. Sterile gloves, gowns, masks, and equipment are used to maintain a completely sterile environment.Example: A nurse assisting in a surgical procedure must ensure that all tools are sterilized, wear sterile gloves, and avoid touching non-sterile surfaces to prevent contamination.

3.2 Steps for Maintaining Asepsis

1. Hand Hygiene: Hand washing is the single most effective way to prevent the spread of infections. Nurses must wash their hands before and after every patient interaction and wear gloves when necessary.
2. Sterilization of Equipment: Instruments used during medical and surgical procedures must be sterilized to kill all microorganisms. This is typically done using an autoclave, which uses high-pressure steam.
3. Using Sterile Supplies: In situations requiring surgical asepsis, nurses must use only sterile supplies that have been properly packaged and stored.

4. Concept of Homeostasis

What is Homeostasis? Homeostasis refers to the body’s ability to maintain a stable internal environment despite changes in the external environment. It ensures that conditions like temperature, pH, and electrolyte levels remain within narrow limits, allowing the body to function properly.

4.1 Components and Mechanisms of Homeostasis

• Temperature Regulation: The body maintains a constant temperature (around 37°C) through mechanisms like sweating to cool down or shivering to generate heat. The hypothalamus in the brain plays a key role in regulating body temperature.Example: A patient with a fever will sweat to cool down as the body tries to return to its normal temperature. Nurses monitor body temperature and may administer antipyretics (fever-reducing medications) to help the body maintain homeostasis.
• Fluid and Electrolyte Balance: The kidneys help regulate the amount of water and electrolytes (such as sodium and potassium) in the body. When there’s too much fluid, the kidneys produce more urine to excrete the excess. When the body is dehydrated, the kidneys retain water.Example: A patient who is dehydrated due to vomiting may need intravenous fluids to restore their fluid balance and prevent complications like kidney failure.
• Blood Sugar Regulation: The pancreas helps regulate blood sugar by releasing insulin after a meal to lower blood glucose levels and by releasing glucagon during fasting to raise blood glucose levels.Example: In a diabetic patient, the body cannot produce enough insulin, leading to high blood sugar levels. Nurses monitor blood glucose levels and administer insulin to help maintain homeostasis.

5. Admission, Transfer, Discharge, Continuity of Care, and Rehabilitation

5.1 Admission

The admission process involves gathering the patient’s medical history, assessing their current condition, and developing a care plan. Nurses play a key role in welcoming the patient, explaining hospital policies, and answering any questions the patient or their family may have.

5.2 Transfer

Transfers occur when a patient needs to be moved to another department or facility for specialized care. This process requires clear communication between healthcare providers and ensures that the patient’s medical records and any necessary equipment are transferred with them.

5.3 Discharge

Discharge planning begins as soon as the patient is admitted. Nurses provide the patient and their family with instructions for continuing care at home, including medication management, wound care, and follow-up appointments.

6. Supporting the Dying and Their Families

6.1 Meeting the Supportive Needs of the Dying

Nurses play a crucial role in ensuring that patients who are nearing the end of their lives are treated with dignity and compassion. This involves managing pain, providing comfort, and addressing emotional and spiritual needs.

6.2 Grief and the Grieving Process

When a patient dies, their family will experience grief. Nurses support families through this difficult time by offering empathy, listening to their concerns, and helping them navigate the grieving process.

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