Handout on Advanced Nursing II (RGN 211) for Nursing Students

Introduction to Advanced Nursing II

The Advanced Nursing II course is designed to equip student nurses with the skills and knowledge necessary for managing patients with specific medical and surgical conditions across various body systems. It covers the preparation of diagnostic and therapeutic procedures, as well as specialized care for patients with cardiovascular, respiratory, gastrointestinal, urinary, and reproductive issues. Additionally, it focuses on managing patients with musculoskeletal, endocrine, neurological, and ENT (eye, ear, nose, and throat) conditions.

This handout provides a comprehensive guide, covering critical nursing responsibilities, from setting up trays and trolleys for procedures to caring for patients with specific conditions. It aligns with the Ghana Nurses and Midwifery Council (NMC) Curriculum, ensuring a thorough understanding of advanced nursing practices.

1. Nursing Management of Patients with Cardiovascular Conditions

Cardiovascular conditions require specialized care, and nurses must be skilled in preparing patients and setting up for diagnostic and therapeutic procedures.

a. Setting Trays and Trolleys for Cardiovascular Procedures

i. Cardiac Catheterization

• Cardiac catheterization involves inserting a catheter into the heart through blood vessels to diagnose or treat heart conditions.
• Tray Setup Includes:
  • Sterile drapes and towels.
  • Syringes, catheters, and guide wires.
  • Sterile gloves and gowns.
  • Medications for sedation and anticoagulation.

ii. Echocardiography

• Echocardiography is a non-invasive procedure that uses ultrasound to examine the heart’s structure and function.
• Tray Setup Includes:
  • Ultrasound gel and transducer.
  • Sterile drapes and towels.
  • Sterilized instruments for cardiac monitoring.

iii. Electrocardiography (ECG)

• Electrocardiography records the electrical activity of the heart to diagnose arrhythmias or other heart problems.
• Tray Setup Includes:
  • ECG electrodes and leads.
  • Paper for recording ECG tracings.
  • Alcohol swabs to clean electrode sites.

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2. Nursing Care of Patients with Respiratory Problems

Patients with respiratory conditions may require special diagnostic and therapeutic interventions. Nurses play a critical role in preparing patients and ensuring the correct setup of trays and trolleys for these procedures.

a. Setting Trays and Trolleys for Special Procedures

i. Thoracentesis

• Thoracentesis is a procedure to remove excess fluid from the pleural space in the lungs.
• Tray Setup Includes:
  • Sterile needle and syringe.
  • Sterile drapes and collection containers.
  • Local anesthetic and antiseptic solution.

ii. Underwater Seal Drainage

• Underwater seal drainage is used to drain air or fluid from the pleural space.
• Tray Setup Includes:
  • Chest tube, drainage system, and sterile water.
  • Suction apparatus and dressing supplies.

iii. Tracheostomy

• Tracheostomy is the creation of an opening in the neck to place a tube into a patient’s windpipe, allowing air to bypass an obstructed airway.
• Tray Setup Includes:
  • Sterile tracheostomy tube and ties.
  • Suction equipment, forceps, and scalpel.
  • Oxygen supply and sterile drapes.

iv. Postural Drainage, Bronchoscopy, Laryngoscopy, and Thoracoscopy

• Postural drainage helps clear mucus from the lungs.
• Bronchoscopy and laryngoscopy involve inserting a scope to examine the airways and vocal cords.
• Thoracoscopy involves examining the pleura and lungs through a small incision.
• Tray Setup Includes:
  • Bronchoscope or laryngoscope.
  • Sterile tubing for suction and saline solution.
  • Local anesthetic and sedative agents.

b. Use of Suctioning Machines

• Suctioning machines are used to clear the airways of mucus, blood, or secretions. Proper usage and maintenance of suctioning equipment are essential to ensure patient safety and prevent complications.

c. Positioning Patients with Cardiac and Respiratory Conditions

• Correct positioning is crucial for patients with cardiovascular and respiratory problems. For example, patients with respiratory distress may require a semi-Fowler’s or Fowler’s position to improve lung expansion and ease breathing.

3. Specific Management of Medical and Surgical Conditions Under Various Systems (Continued)

c. Nursing Care of Patients with Female Reproductive Problems

Reproductive health care involves specific diagnostic and therapeutic procedures that nurses must manage carefully. Proper preparation of the patient, equipment, and tray setup is crucial for ensuring successful outcomes.

i. Preparation of Patients for Gynecological Examinations

• Before conducting a gynecological exam, nurses must provide patient education, ensuring that the patient is comfortable and understands the purpose of the examination. The nurse should:
  • Obtain Consent: Ensure informed consent is obtained.
  • Provide Privacy and Comfort: Use appropriate draping to maintain the patient’s dignity.
  • Explain the Procedure: Briefly explain each step of the exam to alleviate anxiety.

ii. Identification of Instruments for Gynecological Examinations

• Gynecological instruments include speculums, forceps, swabs, and dilators. Nurses must ensure the correct instruments are sterilized and prepared for the procedure.
  • Examples of Instruments: Cusco’s speculum, Ayre’s spatula (for Pap smear), uterine sound, and swab sticks for sampling.

iii. Setting of Trays and Trolleys for Gynecological Examinations

• Proper preparation is essential for successful gynecological procedures.
  • Salpingogram: An imaging test to check the fallopian tubes.
    • Tray Setup: Contrast medium, sterile swabs, and speculum.
  • Pap Smear: A procedure to detect precancerous or cancerous cells in the cervix.
    • Tray Setup: Sterile spatula, cytobrush, and a glass slide for the smear.
  • High Vaginal Swab (HVS): A test to detect infections.
    • Tray Setup: Sterile cotton swabs, culture media, and speculum.

iv. Breast Examination

• Nurses play a vital role in breast examination to detect early signs of breast cancer. This includes teaching patients about self-breast exams and assisting in clinical exams.
  • Procedure: The nurse palpates the breast tissue for lumps, evaluates the nipple for discharge, and observes any skin changes.
  • Tray Setup: Gloves, lubricant, antiseptic wipes, and sterile gauze (if needed).

v. Vulva Swabbing

• Vulva swabbing is performed to collect samples for diagnostic purposes, such as detecting sexually transmitted infections (STIs).
  • Tray Setup Includes: Sterile swabs, culture medium, and gloves.

d. Nursing Care of Patients with Male Reproductive Problems

Male reproductive health care includes specific procedures that require careful preparation and management by nurses.

i. Preparation of Patients for Examinations

• Before male reproductive exams, the nurse must:
  • Ensure Patient Comfort: Explain the procedure clearly and provide privacy.
  • Obtain Consent: Ensure the patient understands the purpose of the exam.

ii. Setting of Trays and Trolleys for Procedures

• Bladder Irrigation: This procedure is used to clear blockages or maintain catheter patency.
  • Tray Setup Includes: Sterile irrigation fluid, catheter, and drainage bag.
• Urethral Smear: A test to detect infections or STIs.
  • Tray Setup Includes: Sterile swabs, slides, and culture medium.

iii. Testicular Examination

• Testicular examination involves palpating the testicles to detect lumps, swelling, or other abnormalities that could indicate conditions like testicular cancer.
  • Procedure: Nurses can educate patients on self-examination and assist in clinical assessments by palpating for lumps or changes in the size and consistency of the testes.
  • Tray Setup Includes: Sterile gloves, lubricant, and antiseptic wipes.

e. Nursing Care of Patients with Musculoskeletal Problems

Nurses must be well-versed in orthopedic care, including handling fractures, applying casts, and assisting with surgery.

i. Setting Trays/Trolleys for Orthopedic Procedures

• Orthopedic procedures involve restoring function to bones, joints, and muscles.
  • Tray Setup Includes: Sterile gauze, bone reduction instruments, plaster of Paris (P.O.P.), and splints.

ii. Application of Plaster of Paris (P.O.P.), Splints, and Traction

• Plaster of Paris (P.O.P.): Used to immobilize a fracture and promote healing. The nurse ensures that the P.O.P. is applied correctly and educates the patient on keeping the cast dry and monitoring for signs of complications like swelling or skin irritation.
  • Example: After a wrist fracture, P.O.P. is applied to stabilize the bones.
• Splints: These provide temporary immobilization. Nurses apply splints in emergency situations before definitive treatment.
• Traction: Traction is used to realign fractured bones or relieve pressure on a compressed nerve. Nurses monitor the traction to ensure proper alignment and manage complications like bedsores or muscle weakness.

iii. Preparation for Orthopedic Surgery

• Preoperative Preparation: Nurses prepare patients physically and emotionally for surgery. This includes fasting instructions, providing pre-surgical education, and ensuring consent forms are signed.
  • Postoperative Care: After orthopedic surgery, nurses monitor vital signs, manage pain, and encourage mobility as appropriate.

f. Nursing Care of Patients with Endocrine Problems

Endocrine disorders, such as diabetes, require specialized care to monitor and regulate hormone levels.

i. Preparation of Patients for Basal Metabolic Rate (BMR) Estimation

• Basal Metabolic Rate (BMR) measures the energy expended by the body at rest, providing insight into metabolic health.
  • Procedure: Ensure the patient is fasting and rested before the test. Assist in attaching monitoring equipment.

ii. Blood Glucose Testing

• Blood glucose monitoring is essential for managing conditions like diabetes.
  • Procedure: The nurse performs a finger-prick test using a glucometer to measure blood sugar levels. This test helps adjust medications or insulin for diabetic patients.

g. Nursing Care of Patients with Neurological Problems

Neurological care requires detailed assessments and diagnostic testing to understand brain function and nerve health.

i. Preparation for Neurological Examinations

• Neurological exams assess brain, spinal cord, and nerve function. Common tests include:
  • Computerized Tomography (CT) Scan: Used to create detailed images of the brain.
  • Electroencephalography (EEG): Measures electrical activity in the brain to diagnose seizures or other abnormalities.
  • Magnetic Resonance Imaging (MRI): Provides detailed images of the brain and spinal cord.
  • Cranial Nerve Assessment: Tests the function of the 12 cranial nerves that control facial movements, vision, and other sensory functions.
  • Reflex Testing: Used to assess motor responses and diagnose neurological issues like nerve damage or spinal cord injuries.

ii. Setting Trays/Trolleys for Neurological Investigations

• Tray Setup Includes: Sterile gauze, EEG electrodes, antiseptic wipes, and sterile instruments for spinal taps or nerve conduction studies.

4. Nursing Care of Patients with Abnormalities of the Eye

Eye conditions require careful nursing management to prevent vision loss and manage complications.

a. Preparation for Eye Examinations, Investigations, and Therapy

• Visual Acuity Testing: Measures how well a patient sees at different distances.
  • Procedure: Use a Snellen chart to assess vision. Ensure the patient understands the test and provide clear instructions.

b. Setting Trays/Trolleys for Eye Examinations and Treatment

• Eye Irrigation: Used to remove debris or chemicals from the eye.
  • Tray Setup Includes: Sterile saline solution, eye pads, and irrigation tubing.
• Instillation of Eye Drops and Application of Eye Ointment: Administering medication to treat infections or relieve symptoms like dryness or inflammation.
  • Tray Setup Includes: Eye dropper, sterile gauze, and prescribed medication.
• Tonometry: Measures intraocular pressure to detect conditions like glaucoma.
  • Tray Setup Includes: Tonometer, sterile gloves, and anesthetic eye drops.
• Ophthalmoscopy: A procedure to examine the retina and optic nerve.
  • Tray Setup Includes: Ophthalmoscope, eye drops to dilate pupils, and sterile drapes.

5. Nursing Care of Patients with Ear, Nose, and Throat (ENT) Problems

a. Preparation for ENT Examinations, Investigations, and Therapies

• ENT examinations assess the ears, nose, and throat for infections, blockages, or other abnormalities. Nurses assist by preparing the necessary instruments and positioning the patient.

b. Setting Trays/Trolleys for ENT Examinations and Treatment

i. Ear Washout

• Ear washout is performed to remove earwax or debris.
  • Tray Setup Includes: Ear syringe, warm water or saline, and a kidney dish for fluid collection.

ii. Antrum Washout

• Antrum washout is a procedure to drain fluid from the sinuses.
  • Tray Setup Includes: Sinus irrigation kit, sterile water, and antiseptic solution.

iii. Instillation of Ear Drops

• Ear drops are used to treat infections or soften earwax.
  • Tray Setup Includes: Ear dropper, sterile gauze, and prescribed medication.

iv. Auroscopy

• Auroscopy involves examining the ear canal and eardrum using an otoscope.
  • Tray Setup Includes: Otoscope, sterile speculums, and antiseptic wipes.

This Advanced Nursing II (RGN 211) Handout has provided a detailed overview of the essential skills and knowledge required to manage patients with a variety of medical and surgical conditions. From preparing trays and trolleys for diagnostic and therapeutic procedures to delivering specialized care for patients with cardiovascular, respiratory, gastrointestinal, reproductive, and ENT conditions, nurses must be equipped with a wide range of competencies.

For more study materials and previous lessons, please visit asonyagh.com.

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