ARMY SERVICE FORCESSCHOOL FOR

MEDICAL DEPARTMENT ENLISTEDTECHNICIANS

FITZSIMONS GENERAL HOSPITALU. S. ARMY

DENVER, COLORADO

HANDBOOK OF NURSING PROCEDURES

FOR

MEDICAL AND SURGICAL TECHNICIANS

1944

INTRODUCTION

Nursing is a series of basic prin-ciples that do not vary, althoughthere may be a wide range of varia-tion of the procedures involvingthese principles. The problem con-fronting you as a technician is tovary these basic principles to fitthe needs of the individual pa-tients, There is, for example, abasic method of making a hospitalbed, but this method may be variedgreatly to provide the utmost com-fort for the patient. An instru-ment tray used for making an incis-ion or for dressing an oper woundwould vary in content dependingupon the type of wound, but'theprinciples of sterilization wouldalways be present, achieved by themost practical method available.

Always consider what measures itwill be necessary for you to use toprotect yourself in caring for eachtype of patient. Consider what mea-sures must be taken to prevent thespread of infection to others, andalso what means of protection willbe indicated for the equipment youare using.

Examples of protection of equip-,meqt would be:1, protection of mattress by use

of rubber sheet or paper.2. Choice of method and timing

in the„sterilization of rub-ber goods.

In each assignment learn whatduties you, as a technician, willbe expected to perform, whetherthese duties be to carry out theentire procedure or to preparethe equipment, assist the doctor,and care for the equipment afteruse.

Learn to observe and reportabnormal conditions. Learn torecognize which are serious e-nough to be handled as emer-gencies.

This book is your reference.Keep it with you while you areon duty...you will use it often.Make it your book by adding inthe space provided any special-techniques, lists of equipment,or standing orders which mayprove valuable to you as a Medi-cal Department Technician.

YOUR RESPONSIBILITY TO EVERY PATIENT

A, Carry out.doctor’s orders withexactness. If order is contra-indicated, notify the doctor.Examples:1. Respirations below fourteen

per minute if morphine isordered,

2. Oral medications if patientis* vomiting*

B. Use nursing measures to relievediscomforts; keep bed dry andfree from wrinkles, observerults of oral hygiene, etc.

C. Observe and report signs andsymptoms,

D. Prevent the spread of infection:1, Use only clean thermometers•2. Give adequate care to con-

taminated dishes.3* Dispose of germ laden’dres-

sings properly.A, Keep your hands meticulous-

ly clean.E, Prevent complications. Examples:

1. Avoid secondary infection inburns•

2, Maintain correct positions inburns and orthopedics.

F, General observations:1. Is patient getting enough rest?2. Is the food adequate for his

needs?

II* OUTLINE FOR NURSING PROCEDURES

Ao Define procedure. Plan your ac-tion.

B. What is the prupose of thisprocedure you are to do? What 1results should be expected?Is it clean or sterile?

•

G. What equipment do you need?To save time and effort, pre-pare lists of equipment neces-sary for common procedures*

D. Test your equipment. Faultyequipment may cost a life.Examples:

. 1* Equipment to be used assterile not sterilized.

2. Hollow instruments (cath-eters, needles, etc)plug-ged or dirty on innersurface*

3* Glass syringes misnatedor stuck.

E* What will you record? . ,

F. Avoid spread of contaminationby careless handling of usedequipment. Care of equipmentis not complete until it isclean or sterile and returned,to its proper place ready foruse again.

III. RULES FOR CLEANING EQUIPMENT

A. If used in isolation or on sep-tic wound, disinfect beforecleaning.

B. If bloody, wash with cold water.G. Wash well with soap and water.

3e sure that hollow equipment(hollow needles, catheters, en-ema tips, etc.) is clean insideas well as outside. t

D. Rinse well in clean water.E. Boil the following items for 3

full minutes:Levine tubes Enema tipsRehfuss tubes Oxygen masksStomach tubes Oxygen cathetersColon tubes

F. Put away and cover clean equip-ment until it is ready for use.

G. Boil the following items 13 to20 minutes;Dishes Medicine glassesDrinking glasses EnamelwareDrinking tubes

H. Bed pans and urinals are some-times cleaned and sterilized byspecial flush and steam equip-ment. They may also be cleanedby washing well with strong soap,or 3/o solution of Army Germicide#3.

If Dininfeotion of thermometers*1. Place thermometer in green

soap' solution.2. .uipe Tjltii gauze or tissue,

using a spiral motion. Besure to start' at end oppn-

’ site mercury bulb.3. Place'thermometer in any

disinfecting solution avail-able. The strength andtiming 17111 vary with the

' solution used, 1 Read labelon bottle thoroughly.

4. Neutralize with alcohol toprevent burns from 'disin-fect ant, If possible, letthermometer' stand' in al*»cohol one full minute.

IV. PREFERRED RET.‘.CDS OF STERIL-IZATION

A. Articles to be sterilized" byautoclaving:1. Ordinary instruments.2. Sharps, if so ordered. (Pro-

tect edgbs of sharps withcotton).

3. Syringes. (Separate pistonfrom barrel).

A. Needles, both hollow andsuture•

5. Rubber goods, includingrubber gloves.

6. Suture material."7. Solutions. (Fill jar only

2/3 full. Do not use vacuum.Refer to autoclave instruc-tions for timing)*

0. Ointments. (Place in pans tocatch overflow and seepage)•

9. Vaseline gauze, if hot airmethod is impractical.

10. Enamel ware.11. Linen.12. Glove powder, in snail’quan-

tities.Ail articles to be sterilized by;autoclave should be nut up in con-tainers in which they can be ster-ilized, stored and removed withoutcontamination.

B. Articles to be sterilized byboiling:1. Ordinary.instruments 3 BO-

BO min,2. Syringes, 13-20 min. Sep-

arate the pistons fromthe barrels,

3. Needles, 5-10 min. Insertstylets before boiling.Suture material } unlessmarked non-boilable, 20-p0 mini.

5. Soft rubber goods to beused as sterile l$-20min.

6, Water to be used as ster-ile ’should be boiled for20 min.

G, Articles to be'sterilized bychemicals;1, Sliarp instruments, place

in Phenol for two min-utes. Rinse in sterilewater and place in alcohol

* 70f- for 10 minutes,2# needles "or syringes, Rinse

well with sterile water be-fore use,

D, Articles to be sterilized, bydry heat:1* Needles and syringes,2, Ointmentsvaseline gauze,3m Powder, when sterilized in

large quantities,

V, PROCEDinSS* TO "ESS DO!IE iETTIICDSA! I EQUIPMENT

Baths BedmakingEnemas Throat irrigationsLavage Nasal irrigationsGavage ' Temperatures-Stupes (if skin is unbroken)

Equipment to be used as clean:Ice bags '• Ernes is • basinsAir cushions Hot water bottlesMedicine glasses Drinking glassesBed pans ’ Drinking tubesUrinals Kitchen utensilsOxygen equipment

is st of clean equpment;Mould YOU be willing to have thisequipment used on YOURSELF?

VI. PROCEDURES TO BE DONE WITHSTERILE EQUIPMENT;

Puncture procedures;Hypodermic injectionsVeni punctureHypodermoclysisChest tapSpinal tapAbdominal tap (Paracentesis)

Incision and drainageDressings on open woundsCatheterizationBladder irrigations

While setting up a sterile trayor assisting a doctor with asterile procedure, it is best tomask, use sterile ’'pick-up 1' for-ceps, and always avoid reachingover the sterile field*

VII. BATHS 4

A. Cleansing baths: bed bath, tubor shower, choice dependingupon the patient*s strength andfacilities.1. Assemble all equipment,2. Avoid drafts, make tempera-

ture of room comfortable,3* Test water temperature,4, Expose only the part of the

patient being bathed; avoidgetting the bed wet,

5, Handle patient gently, aidhim when turning*

6, Change linen after bath.B, Therapeutic baths; (given only

with Doc tor * s order),1, Tepid or cold bath: given

to reduce temperature* pro-cedure the same as for cleaising bath, omitting the soajbut the water is tepid orcold. Apply the water withyour hand or a cloth, thenpat dry, do not rub dry,with towel. Place an ice .

bag or cold compress at thepatient*s head and a hot'water bottle at his feet.It may be necessary to pro-tect the bed

with a rubber sheet. Recordthe treatment, temperature'atend of treatment, and the temp-erature one hour later.

2. Alcohol sponge bath, given toreduce temperature. Alcohol isapplied with the hand in gen-erous amounts with some mas-sage. Record the treatment,temperature at end of treat-ment, and the temperature onehour later.

3. Sitz bath, used to relieve1 ?

congestion in the pelvic reg-ion. Often ordered followingproctoscopic andrectal operations. Watershould ,be as hot as the patientwill tolerate, and the bathshould last from ten' minutesto one-half hour, dependingupon the patient's strength.

4. Sedative pack, used to inducesleep or relax as mental pa-tient is wrapped in blanketsand wet sheets (avoid wrin-kles) until the desired dergree of relaxation has beenaccomplished.

VIII. NURSING CARE OF BURES

A. Equipment assembly for emer-gency treatment*Sterile hypodermic set-up fortetanus toxoid, gas bacillusand morphine.Plasma and venoclysis set.Vaseline and RO mesh gauze,sterile.

Sterile gowns ; masks for every-one.

Equipment for shock bed.B. Refer to S.G.O* Circular Let-

ters concerning Burn Treatmentsfor both emergency and defini-tive treatment*

C. Observe and report signs andsymptoms indicative of patient'scondition:

T.P.R. DiarrheaAnuria ConstipationNausea Delirium or stuporVomiting Symptoms of localExtreme infection.

,r " thirst.

D* Follow doctor’s orders accura-tely.

E. Contaminated dressings should bewrapped for burning* Contaminatedequipment should be immediatelydecontaminated after it has beenin contact with an infected pa-tient.

IX. NURSING CARE OF COMMUNICABLEDISEASE

A. Respiratory diseases, spreadthru oral and nasal dischargesDiphtheria TuberculosisCommon Cold MeaslesScarlet Fever PoliomyelitisInfluenza MeningitisMumps Septic Sore-Pneumonia 1 throat

B. Intestinal diseases, spreadmainly thru alimentary dis-charges:Typhoid •

ParatyphoidBacillary DysenteryAmebic DysenteryCholera

C. Insect-borne diseases;Malaria Trench FeverYellow fever Bubonic PlagueDengue FilariasisTyphus Tularemia

D* Isolation, This is a techniqueemployed to prevent the spreadof a communicable disease fromthe patient to others* Infec-tive organisms are carried bythe hands and clothing of per-sons who come in contact withthe patient or his surround-ings, on dishes, linen, nurs-ing utensils, and personalarticles that are contaminated.Personnel attending the patientshould be gowned, and the fol-lowing rules observed:1. Gown should cover entire

uniform.2m Neckties and neck band should

be kept clean-3. Gown should be nut on and

taken off in such a ~;ay thatthe inside remains clean.

4. Gown, if hung outside cubicle,must be hung with contamin-ated side folded in.

5. Personnel should be masked,flasks should be of closelywoven material, clean, dry,and should cover nose andmouth. Masks are worn toprotect yOU, as well as thepatient*

Some general rules of isolation '

to be remembered are:1. Bed linen, towels, pajamas,

attendant’s gowns, etc., areplaced in a bag narked isola-tion before being sent tolaundry. There they are auto-claved or disinfected beforebeing handled.

2. Dishes and enamel ware areboiled, autoclaved or soakedin 3% Army Germicide #5«

3* Disposable, tissues and foodscraps will be wrapped in;aclean wrapper and disposed ofby burning.With intestinal diseases andpoliomyelitis, the fecal dis-charges and urine must be dis-infected before it is-disposedof. This is done by.soakingthese discharged in 3% ArmyGermicide #5, or any other

germicides available.3. Keeping the patient in bed

wall help prevent complica-tions, and help prevent thespread of infection.

Rules of Terminal Disinfection:1. Patient should be bathed and

dressed in clean clothing.2. Personal articles that cannot

4be disinfected should beburned.

3. Hattresses can be autoclavedor aired in the sun for 6•hours on each side.

h. Furniture of the patient’sunit should be washed withsoap and water and aired thor-oughly .

5. balls } woodwork and floor shoulcbe meticulously scrubbed*

:{ f NURSING- CARE OF PHEUKONIA

I# Follow the general rules ofisolation when caring for apneumonia patient.

3, Comfort is important in thetreatment;of pneumonia* thisincludes good general nursingcare, frequent and completeOrel hygiene, alcohol rubs,change of position, warmth andfreedom from drafts,Mental rest and freedom fromworry are important factors inrecovery. Visitors should berestricted or limited, visit-ing tine should be brief,

3, Absolute bed rest is essential.The patient should be assistedto turn in bed, he should be'fed rather than feed himself,and he should never be awakenedexcept for the administrationof suTfa drugs,

f. Record intake and output daily,f, Note and record any abnormal

signs or symptoms, cyanosis,intolerance for sulfa drugs,

recurrence of fever, etc.

XI* PREOPERATIVE CARE

A* Mental preparation:Your patient should be reas-sured that he will be all rightafter the operation, for fearis a major factor in the fail-ure of some operations*

B. physical preparation:1# Rest, usually with sedation.2. Diet, usually restricted-to

fluids immediately prior tothe operation.

3. Skin preparation; area aboutthe site of incision shouldbe shaved the evening beforethe operation; scrub of areawith green soap and alcoholafter shaving is optionalwith the surgeon. Skin pre-paration will be completedin the operating room.

4* Immediate preoperative care;Have patient empty bladder.Remove jewelry and falseteeth. Give preoperativemedication.

XII. POSTOPERATIVE GAPE

A, Prepare postoperative bed .be-fore the patient returns to theward.1, Extra blanket should be

right over patient.2. Bed should be pre-warned.

Protect bed with rubber sheet‘ 4» Clear space so litter can

be wheeled in 'without delay,1. Immediate care;

1. handle patient gently,2. Observe pulse, respiration,

Skin, lips, nails for sighsof shock.

3., Check dressings for hemor:*-' rhage•

4, ’Stay with patient while heis unconscious,

5* Be prepared to start I,V.fluids•

■ 6; Have ernesis basin, mouthwipes, scratch pad, andpencil on the bedside table,

G. General Care;1, Change linen and pajamas as

often as necessary,2, Record accurately intake

and output.

3. Encourage patient to emptybladder 8-12 hours after- theoperation. Be prepared tocatheterize if patient can-not void voluntarily*

4. Enemas as ordered,5. Strict oral hygiene 1 at least

twice a day,6. Watch diet closely, from, surg-

ical liquid, liquid, light toregular,

7. Prevent respiratory infections,Encourage deep breathing, chan-position frequently, and en-courage pabient to cough,

8. Give patient whatever assist-ance he needs, with personalhygiene, meals, etc. If he isunable to see, arrange his'foo*in a logical manner (as in re-lation to the figures on aclock) and tell him where eachkinci of food is on his plate.

XIII. NURSING CARE OF PATIENTIN CAST

A, Do not cover cast while it iswet, but a Hot; it to dry thor-oughly,

B, Watch for evidence of pressureas the cast driesj cyanosis,pain, numbness or swelling mayresult from a tight cast.

C, Watch for skin irritation atthe edges of casts,

D, Make the bed in such a mannerthat the weight of the coverswill not be supported by theaffected part. Additional cov-ers may be necessary to pro-tect the chest or lower limbs.Avoid drafts by tucking thecovers in at the bottom of thebed.

£• Protect the cast when the pa-tient uses the bed pan if it isa low body cast or a high legcast.

o'. If the cast is a heavy one,assist the patient to turn inthe bed whenever possible. Fora double spica of the hip, al-ways have two technicians toturn the patient.

H V , Li IdTo

A, Cleanliness is the primary ruleto be remembered in any kitchen.

B, Tray should be attractive as itcan bo made. Avoid spillingsoup or beverage*

C. Be sure that patient can reachfood. Assist him whenever youcan.

D. Common diets are;1. Surgical liquid: Broth, tea.

fruit juices and carbonatedbeverages*

2. Full liquid; As above, withthe addition of milk, creamsoup,’ jello, and ice cream,

3. Soft; Poached eggs, toast,baked potatoes, cookedcereal, st ewed fruit*

Dental soft; includes theabove" with'" ground meat andvegetables.

4. Light; Gait heavy moat,(pork, highly seasoned meat*fried foods, and pastry,

5. Regular; includes all aver-age"" foods *

IV. STANDARD NURSING PROCEDURES

1. Irrigations, general:Equipment used for irrigationsmay include;

.

Irrigating can with tubing andtip,- bulb syringe, piston sy-ringe, or medicine dropper.Choice will depend upon equip-ment available and cavity, tq beirrigated.Solution for irrigating.Treatment sheet to protectclothing and bed.

t Receptacle for waste.Clean or sterile sponges forcleaning area around cavity.

2. Eye irrigations:Sterile procedure if possible.Solution commonly used:Boric acid Sterile waterSaline Soda water ' .

Position of patient:Sitting or lying in a posi-

-• tion which will allow the ,

solution to escape at theouter cantbus of the eye.

Direct flow away from nose intothe pocket made by retractingthe lower lid.

Dangers to be.avoided;Injury to eye with irrigatingtip.Us® of wrong solution.Infection from unsterile equip-ment,

3. Ear irrigations:Sterile procedure only if infec-tion is present, or if skin ormembrane is broken.Solutions commonly used; .

Sterile water Normal saline' Boric acidPosition of■patient:Sitting or lying in any posi-tion that favors a return flow.

Dangers to be avoided:freessive force•Failure to provide for returnflow.

L* Nasal irrigations;C1ean pr ocedure•Solution co mionly used:Normal saline Tap water

Position of patient:Sitting vdth head bent forward,or with head turned to side andsupported with billows.

5• Throat irrigations:C1ean procedure,Solnt ion s coiandhly used;

Normal saline Tap waterPosition of patient;

Sitting, with head bent for-ward to favor return flow.

Avoid aspiration of the irri-gating fluid by the patient,

P,ecord after ach irrigations;Time of treat .cnt.Solution used.Nature of return flow.

Clean all equipment and returnit to storage place ready forthe next person to use,

6• Ext ornal applicat ions:Net Drossings:Sterile if there is a break inthe skin < aboutthe area of the dressing, Withall equipment sterile, thedressing nay be put on the skindry and the solution added withan asepto syringe, or the dres-sings may be put in pan of solu-tion and applied with

•ipiGhsiipM forceps• Clean wet dres-sings may be wrung out by hand.Always protect the patient'sclothes and bedding from becomingmoist.If the skin becomes irritated, itnay be protected* b3r applying oilor ointment about the area.Hot applications should be madethick enough to retain the heat,unless there is danger from pres- *

sure. If this danger exists,- fre-quent' change will be necessary.(This is usually true of eye ap-plications) . Cold compresses willbe made thin.

Hot water bottles:Fill bottles only 2/3 full, andconsider the weight of the bottlewhen applying it to the patient.Do not have it hot enough to burnthe ‘patient, test it yourself first.Always use a bottle cover or blan-ket for protection# Never amplydirectly to patient's skin. Watchclosely for burns on unconsciouspatient.Test for leaks and expel all airbefore applying#Use onlv clean water#

Ice caps *

Avoid using sharp pieces of ice.Avoid using crushed ice. It istoo heavy and melts too fast,hatch for symptoms of frostbite;cyanosis, swelling and circulatoryfailure.Use only clean ice.Test for leaks.Use coyer or towel to protectpatient,

7* Intravenous infusions:Equipment•Sterile flask with solution,Sterile tubing with clamp andadaptor.Sterile need’’ ;s.Tourniquet,Treatment sir ct and towel.Antiseptic solution for prepar-ing skin, with necessary sponges.Forceps in solution.Receptacle for waste.Adhesive to immobilize needle.Duties of technician:Preparation of equipment•Assist'doctor 1 in starting pro-cedure, or completing entireprocedure. Watch patient thru-out procedure. Record tine,amount and kind of

solution, .and name of per:- , I- gprocedure. .

Dangers.to. be,avoided; ..

V/rong ,s olut ion •

Infection from unsterile equipment.Running solution too fast.Billing.needle out of vein, or push-ing needle.through vein,

B, Enemas:Equipment (clean),

Irrigating■can or funnel.Tubing with clamp.Enema.tip or colon tube.Treatment sheet and cover.Lubricant,Standard,Bed pan with, cover*Toilet paper.

Solutions frequently used*Saline’ (one tsp. salt*to 500 cc.’s

' of water),Soda (One tsp, to 500 cc.’s water),i ap > .r a u cr •

Soapsuds. (Use mild soap),.Amount of solution for cleansingenema is usually 500 cc, of solu-tion.

Position ox patr it for enema;Preferable pos:’ ion is on leftside with as few pillows r as pos-sible for support* If patient isunable to retain enema, allow

.him to remain on back with bedpan under hips* To expel enema,patient will be elevated on pil-lows* Ambulatory patient may usebathroom*

Record:Time of treatment*Solution used, results obtained*Abnormalities of return fluid*

Care of equipment after use:Wash well with soap and water*Glean tubes inside as.well asoutside.

Enema tip or ..tube should beboiled for three full, minutesafter use. lie turn equipment

•clean and ready-for use again.Allow patient to wash well afterthis procedure.Be sure bed is clean and dry be-fore leaving patient*

9, Catheterization: (Sterile pro-cedure) Equipment; (Sterile)Rubber catheters -

, 2 LubricantMedicine glasses, 2 SpongesSolution bowls, 2 ForcepsSpecimen container SyringeAdditional equipment;Antiseptic solution lor.prepar-ing field.Antiseptic solution for instil-lation-if ordered.Sterile gloves in wrapperReceptacle for urineReceptacle for wasteTreatment sheet and cover

Record;Time of treatmentAmount of fluid obtainedName of person doing procedure

10. Aspirations: (Sterile pro-cedure’s)’’.’Sqivipnent:Syringe, with novocains.Springe, for asmiration.Needles, assorted sizes. Spin-al needl.es if for spinal tap.Antiseptic f ,.r skin prepara-tion.Medicine glasses. *

Applicators and sponges.Forceps. *

Specimen tubes.Sterile gown and drapes.Sterile gloves.Graduate measure.Treatment sheet.Receptacle for waste.

Technicians’ duties:Preparation of equipment.Assist during procedure.Record time, amount and char-acter of fluid obtained, nameof person doing procedure.Take specimen to laboratory.Care for equipment.

il* Hypodermic nedicatlons;Equipment;

Sterile syringe*Sterile needle.Sterile prepared solution, ordrug tablets to be dissolved insterile, water. (Spoon method)Alcohol sponge.

Procedure;Assemble syringe and preparemedication. (If you are not sup-plied with the drug In the dos-age ordered, divide what youwant to give by what you have on

„, hand. If your order is for panto-pon gr. 1/A and you have gr. 1/3tablets; Divide l/A / 1/3 = 1A x3/1 - 3/A. Therefore you will use3/A of the. tablet in. the numberof minims divisible by four. Use16 minims to dissolve the tablet,and give the' patient 12, discard-ing the other four minims con-taining l/h of the tablet).Choose site of injection.

| Prepare site of injection withalcohol snonge.Expel all air from syringe.

Inject solution with needle heldat angle of about 60 degrees.Withdraw needle and massage areagently for a few seconds.Record on patient’s chart.Record on narcotic record.Observe and note reaction todrug,CAUTION; Always he sure that youare administerin the right drugin the correct a :ount to theright patient. If morphine is be-ing given, count the respirationsbefore administration. If respira-tions are'below 16 per minute,withhold drug and notify doctorimmediately •

12. Pouring medications:Be sure of'time and dosage.Read label three times.Never risk unlabeled bottles.Never talk while pouring.Snake well if in suspension.Hold measure level with-eyes.Pour from side opposite label.Dilute liquids, except cough mix-ture ,

Record,Know and watch for normal results.Keep medicines locked.

13* Preparation of DressingCarriageSterile Supplies :

Instruments Dressings:Dressing.Forceps ABD PadsTissue Forceps ( x 8 f 6Henostats 4 x 4'sTissue scissors 2 x 2 f sSuture Scissors Tonsil SpongesScalpel Blades . ApplicatorsKnife Handles

Ointments: Solutions:Petrolatum Jelly Boric AcidBoric Acid Dint* Normal SalineZinc Oxide Oint. Sterile Water

H3rd.r0 genPeroxide

Drugs:Gential violetIodine, 3%Ether or benaineSilver NitrateAlcohol, 95%t?+ r>fJ DU •

Unsterile Suppli.es:Emesis BasinsRoller BandageSafety pinsReceptacle for WastePaper for Soiled Dressings, Etc.

14* Preparation of dressing tray:-(Used for changing dressing.ononly one patient).The sterile supplies, instru-ments, dressings, drugs, andsolutions, and the unsterilesupplies used on a dressingtray will vary with the type■of dressing to be done, >andwith the standing orders fordressing the patient.. It isused for convenience in dres-sing a single patient.

15.* Oxygen Therapy

Equipment:Oxygen tank. . -

Oxygen mask’, nasal* catheter orOxygen tent.Lubricant for catheter.Adhesive for immobilizing cath-eter.

Humidifier.

When setting up equipment foroxygen therapy, always takethe following precautions:"Crack the valve" of the tankto avoid injuring valve mech-anism. Avoid use of oils onequipment. Never -allow smok-ing in room. Follow directionswith equipment•

Do not waste oxygen.

XVI. AVERAGE DOSAGE-OF DRUGS' ''

IiETRIC . APOTHECARY-Morphine 0,000 Gin. gr, l/Bsulfate 0,01 Gm. gr. 1/6(narcotic) 0,016 'Gu, gr. 1/4

Codeine 0,016 Gm. gr, l/4sulfate 0,032 Gm. gr, l/2(narcotic)0,064 Gm, ' gr, 1

.vy > •

Atropine ,00043 Cm. gr, 1/150sulfate .00065 Gm. gr, l/lOO

Dilaudid .002 Gm. gr. l/32'(narcotic),0025 Gm. gr, 1/24

Pantopon ,01 Gm. 'gr, 1/6(narcotic),02 Gm. gr. l/3

Scopolamine,00043 Gm, gr, 1/150JOOO63 Gm, gr, l/lOO

Strychnine ,001 Gm, gr, 1/60sulfate ,0005 Gm. gr, l/lOO(Equivalents are approximate)

XVII. EQUIVALENTSGrams or cc, f s Grain er Minims

(

0.06 X0.3 50.6 101.0 150.006 1/100.0006 1/1000.030 1/20.015 1/40.020 1/3XVIII. APPROXIMATE EQUIVALENTS .

4 cc.—1 dram — 1 teaspoon15 cc.—4 drams— 1 tablespoon30 cc.—1 ounce— 2 tablespoons

500 cc.—1 pint — 2 tumblersful1000 cc,—1 quart— 1 liter

XIX. 00:1, I ABBREVIATIONSs

aa of eachad,lib* as much as desired*C, gallonC, centigradec withc.c, cubic centimeterDur, dolor while the pain lastsFt, Let it be madeGm,' gram, grams- '

gr. ' grain, grainsgtt* ' ' a drop, dropsL, ‘ ' a 1 Iter

_

'

min, minim -■■■•■

N.b* note troll0* ’ • a” pintQ*s, as much as is suffi-

cientRx* takes ’

withoutS,o*s* if necessarySs, one-halfTp, teaspoonfulTbsp, TablespocnfulDr, dramOs, ounce

Ar c, Before' mealsAlt. die. alt 0: ■> .at e • y; 2

Alt. Bor. alternate•hoursAlt, noct. alternate nightsB*i.d. twice in dayH, hourII.s. at sleeping tinep.c.. after r.ealsp.r.n. when requiredQ,h. every hourQ,2.h. every two hoursQ.h.h. every four hoursQ.i.d, four tines a dayStat, at onceT.i.d, three tines a dayt.i.d. 8 Ah, 12N, 4 HI,

8 HI.P.C. B Ah, 2 ?h, 6 PII

The following blank pages are tobe used for star ing orders, specif-ic procedures

,an. 1

, any additionalinformation that nay be valuablefor you*

43

45

47

INDEX,Page Par. Sect,

Abbreviations,• common 4-0 XIXBaths 11 VIIBurns, nursing care 13 VIIICasts, special care 22 XIIICleaning equipment 5 IIICommunicable diseasenursing 14 IX

Diets- 23 XIVDosage of Drugs ■ 38 XVIEquivalents 39 XVIIEquivalents, approx,39 XVIIIPneumonia, nur s ing

care 18 XPostoperative care 20 XIIPreoperative care 19 XIProcedures, clean 9 VProcedures, general

outline 4 IIProcedures, standard 24 XVApplications;

Hot water bottlesIce capsWet dressings 26 XV 6

Aspirations: 32 XV 10Catheterization 31 XV 9Dressing carriage 35 XV 13Dressing tray 36 XV 14

Ear irrigations 25 XV 3Enemata ■ . 29 XV 8Eye irrigation 24 XV 2Hypodermic Medication 33 XV 11Intravenous Infusions 28 XV 7Medications 34 XV 12Nasal irrigation 25 XV 4Oxygen therapy 37 XV 15Throat irrigation 26 XV 5Procedures, sterile 10 VIResponsibility to Patient 3 ISterilization 7 IV