DUTIES OF NURSING OFFICER

Staff Nurse:

NURSING OFFICER 

General:

1.      Work under the instructions of Assistant Nursing Superintendent, Nursing Sister and Ward Incharge.

2.      Maintain professional ethics. Encourage colleagues to maintain professional ethics and participate in professional activities.

3.      Keep professional knowledge up to date and encourage colleagues to do the same.

4.      Act as “de facto” sister as and when situation arises in the ward or department. Work in place of the Ward Incharge in his/her absence.

5.      Implement and maintain ward policies and routines.

6.      Help the Ward Incharge to carry out her work. Draw up nursing care plan for all patients in the ward in consultation with the ward sister.

7.      Help the ward sister in indenting and checking drugs and other supplies and maintaining the inventory of each category of items.

8.      Keep a sub-store of drugs, linen and other supplies in her charge for use. Ensure availability of materials and drugs round the clock in all three shifts. Report shortages to sister in charge.

9.      Co-ordinate patient care with various health team members including those from other departments.

10.  Accompany very ill patients to other departments or to other institutions when transferred.

11.  Take reports and take detailed bed to bed round at the time of changing of shift in the unit. Sign night report after checking. Give and receive reports.

12.  Help in making diet register and supervise distribution of diet.  See that diets are served to and eaten by the patient.

13.  Maintain poison (schedule) drugs registers.

14.  Supervise students and other junior nursing personnel. Supervise medicine given by students. Supervise nursing care being given by nursing students.

15.  Maintain emergency trays and other duty room trays, sterilizers, instruments in working condition by getting indents from sister or getting repairs done in case of a break down. Maintain all procedure trays in readiness.

16.  Maintain safety of the ward equipment.

17.  Take over from previous duty nurse all new and serious patients, instruments, supplies, drugs etc.

18.  Write day and night orders.

19.  Checklist and keep patients belonging in safe custody as per hospital policy.

20.  Routinely care and clean dressing trolleys, cupboards, apparatus etc.

21.  Maintain clean and safe environment for the patients. Supervise the work of the subordinate staff and ensure that cleanliness and sanitation of ward and cleanliness of furniture, equipment and all ward fixtures are maintained by them. Ensure regular mopping and dusting. Report any dereliction of duty in this regard to superiors.

22.  Ensure that items are properly sterilized and sterilize items as and when required.

23.  Prepare surgical, supplies, bandages, splints in advance to ensure availability.

24.  Take care of clean and soiled linen. Ensure disinfection of linen, beds, floor and bed pans.

25.  Maintain ward records and reports assigned to her/him by the sister incharge. Maintain ward statistics.

26.  Maintain good inter-personal relations with all other staff

27.  Supervise subordinate staff. Make sure that they maintain discipline.

28.  Be polite and sympathetic to the patients and their attendants. Assist and instruct patient and their relatives.

29.  Ensure that Universal Precaution equipment is readily available and is being used by the staff.

30.  Look after Bio-medical hazards and Bio-medical waste management and ensure that equipment and processes for the same are in place.

31.  Follow and ensure that others follow appropriate universal precautions and hospital waste disposal rules and regulation.

32.  Utilize HIS and other software as needed/instructed.

33.  Assist in measures directed towards management of mass casualties and disasters.

34.  Maintain cleanliness of person and dress.

35.  Educate and direct junior staff.

36.  Any other duty assigned by competent authority.

                                                 

Nursing:

1.      Give expert bedside care to patients and perform special technical duties in areas like operation theatres, intensive care units, clinical specialties etc., as assigned.  Ensure that total health needs of all the patients are met.

2.      Be aware of the physical condition of all patients, especially paying attention to those who are seriously ill and be aware of any special nursing problems. Attend to patients with utmost sincerity and devotion.

3.      Especially responsible for the care of acutely ill or seriously ill patients.

4.      Observe changes in patients’ condition and records, take necessary action and report promptly to the concerned authority. Inform and send call to doctor when patient’s condition so warrants. Complete and hand over all relevant records and reports to the next shift staff nurse.

5.      Render pre-operative, post-operative and intensive care to patients. Prepare patients for operations and ensure that he/she is sent to operation theatre with all necessary papers and medications. Reassure pre operative patients.

6.      Prepare for and assist in diagnostic procedures.

7.      Attend to normal and special nutritional needs of patients and give special types of feeds (nasogastric, gastrostomy etc.) and supervise serving of meals and special diets to the patients. Prepare invalid diet and other special feeds and feed helpless patients.

8.      Ensure proper admission, transfer and discharge of patients. Verify the details of patients coming from Casualty, OPD or other departments for admission and ensure that the papers of the patients are in order before admitting, discharging or transferring them. Ensure that a discharged patient goes home with proper understanding of the follow up procedure and details of the diet, medication and exercise etc.

9.      Carry out administration of Oxygen, nebulization, BIPAP/CPAP. Do catherization, and give enema, bowel wash, stomach wash, eye and ear care, perineal care, breast care and baby care etc. Do irrigations and dressings.

10.  Maintain personal hygiene and comfort of patients. Bathe/ wet scrub patients once daily, and more frequently if required. Give daily care of eyes, mouth, nails and pressure points. Give four hourly, or more frequent attention to pressure points. Give and remove bed and urine pans and hot water bottles.

11.  Make beds daily and change clothes of those patients who are unable to do so.

12.  Prepare articles and patients for medical or nursing procedures and assist in them. Clear up after procedure.

13.  Maintain record of temperature, pulse, B. P intake/output or any other parameter as required, medicines and injections administered with date time.

14.  Insert and fix I/V^* cannulas. Give oral medications and I/V^* and I/M injections as prescribed by doctors. Clear up after injections. Keep a record of medications given and injections administered.

15.  Draw blood^* for investigations. Collect samples, label them and dispatch to laboratory with proper forms filled by doctors. Do bed side urine testing, spot blood glucose level testing by Glucometer and other tests as feasible and desired by competent authority.

16.  Keep Blood transfusion tray ready and help the doctor with the procedure. 

17.  Accompany doctors on rounds. Take round notes, note and make alterations in treatment as prescribed by the doctors in treatment book and carry out all their instructions.

18.  Ensure that reports are collected in time and attached to case sheets.

19.  Make proper case sheets with details of patient in each page and keep them in neat and clean order. Maintain them properly and in good condition. Attach all reports, temperature charts and intake output charts or any other special chart to it.  Make sure that case sheets are not handled by anyone except the doctors in-charge of the patient, especially medico legal cases. Ensure that case sheets are not misplaced, mishandled or mutilated. Keep all records up to date.

20.  Prepare dead bodies as per protocol and ensure that they are transferred to the Mortuary or handed over to relatives after completing all legal and hospital formalities.

21.  In special areas carry out special duties in addition to normal duties, as assigned by competent authority.  Some of the duties which require expert handling are below (this is by no means a comprehensive list) :

i)                   Labour Room	Assist in normal and difficult deliveries, D&C and other procedures. Maintain records of deliveries.
ii)                 Operation Theatre	Maintain suture material, linen, instruments, gloves, sterilization trays and trolleys. Timely sterilization of OTs. Maintain records. Assist surgeons in procedures and surgeries.
iii)               Nursery	Take care of new born in all respects. Feed babies, change nappies, do gastric lavage, give vaccination.
iv)               ICU/ICCU	Total patients care, use various devices and monitors, help with all investigative procedures.

Teaching:

1.    Impart health education to patients and their attendants. Carry out health teaching for individuals or groups of patients. Take public lectures on health topics.

2.    Assist in orientation of new staff nurses and other subordinate staff.

3.    Initiate and plan for staff education programme in consultation with superiors. Participate in staff education programmes and attend staff meetings.

4.    Directly supervise all work done in the ward by nursing students.

5.    Instruct and demonstrate to students the various ward procedures and all aspects of patient care. Teach, supervise and guide nursing procedures performed by student nurses. Assist and participate in clinical teaching programme of student nurses as and when required. Instruct students specially the newly appointed ones in the correct ways of handling bed pans, urinals, sputum cups, kidney trays, soiled dressings, bandages, binders and linen etc. Provide for and demonstrate methods of disinfection and cleaning.

6.    Participate in clinical teaching, both planned and incidental.

7.    Teach and guide subordinate staff.

* Those nurses not trained/unable to undertake I/V procedures like drawing blood shall be made to undergo a 10 days training programme by a team as constituted by the Medical Superintendent/Competent Authority. They will be certified at the end of this training to undertake these procedures

HYDROCORTISONE

In the critically ill patient, adreno cortical insufficiency should be considered when an inappropriate amount of inotropic support is required.
Baseline cortisol levels and short synacthen test do not predict response to steroid.
In patients who demonstrate a normal short synacthen test, but yet show a dramatic response to steroid, it is possible that the abnormality lies in altered receptor function or glucocorticoid resistance rather than abnormality of the adrenal axis. Baseline cortisol levels and short synacthen test are worthwhile to assess hypothalami c –pituitary–adrenal axis dysfunction versus steroid unresponsiveness.  Available as the sodium succinate or the phosphate ester

 Uses     

1. Adrenal insufficiency (primary or secondary)   
2. Prolonged resistant vasopressor dependent shock   
3. Severe bronchospasm    
4. Hypersensitivity reactions     
5. Fibroproliferative phase of ARDS (unlicensed)  Adjunct in  Pneumocystis carinii  pneumonia (see co-trimoxazole and pentamidine)      

Contraindications   
Systemic infection (unless specifi c anti-microbial therapy given)   
 Administration   
•   Adrenal insuffi  ciency   Major surgery or stress: IV 100–500 mg 6–8 hourly    Minor surgery: IV 50 mg 8–12 hourly    Reduce by 25% per day until normal oral steroids resumed or maintained on 20 mg in the morning and 10 mg in the evening IV     
•   Prolonged resistant vasopressor-dependent shock   Initial dose 50 mg IV bolus, 6 hourly for 5 days, then 50 mg 12 hourly for 3 days, then 50 mg daily for 3 days, then stop or 50 mg IV bolus followed by infusion of 10 mg/h for up to 48 hours     
•   Fibroproliferative phase of ARDS   IV infusion: 100–200 mg 6 hourly for up to 3 days, then dose reduced gradually     
• Adjunct in  Pneumocystis carinii  pneumonia (see co-trimoxazole and pentamidine)    IV: 100 mg 6 hourly for 5 days, then dose reduced to complete 21 days of treatment    The steroid should be started at the same time as the co-trimoxazole or pentamidine and should be withdrawn before the antibiotic treatment is complete   Reconstitute 100 mg powder with 2 ml WFI. Further dilute 200 mg and made up to 40 ml with sodium chloride 0.9% or glucose 5% (5 mg/ml)     
 How not to use hydrocortisone   
Do not stop abruptly (adrenocortical insuffi  ciency)   
 Adverse effects   
Perineal irritation may follow IV administration of the phosphate ester
 
Prolonged use may also lead to the following problems: 
•   increased susceptibility to infections 
•   impaired wound healing 
•   peptic ulceration 
•   muscle weakness (proximal myopathy) 
•   osteoporosis 
•   hyperglycaemia          Cautions     Diabetes mellitus 
Concurrent use of NSAID (increased risk of GI bleeding)     
Thanks   

8 elements of primary-health care (PHC)

Primary health care (PHC) is essential health care made universally accessible to individuals and acceptable to them, through full participation and at a cost the community and country can afford. It is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. Primary health-care (PHC) has basic essential elements and objectives that help to attain better health services for all.

There are 8 elements of primary-health care (PHC). That listed below-  

E– Education concerning prevailing health problems and the methods of identifying,  preventing             and controlling them.

L–  Locally endemic disease prevention and control.

E–  Expanded programE  of immunization against major infectious  diseases.

M– Maternal and child health care including family planning.

E–   Essential drugs arrangement.

N– Nutritional food supplement, an adequate supply of safe and basic nutrition.

T–   Treatment of communicable and non-communicable disease and promotion of mental health.

S–  Safe water and sanitation 

Incubation period of various communicable disease

Some disease and their incubation period

Shock(Critical care nursing )

Shock

■      Shock occurs when the circulatory system is no longer able to deliver enough 02 and vital nutrients to adequately meet the metabolic demands of the patient.

■       Although initially reversible,

■      prolonged hypo perfusion will eventually result in cellular hypoxia and the derangement of critical biochemical processes

■       From a clinical standpoint, shock can be divided into the following subtypes:

1.     Hypovolemic

2.     Cardiogenic 

3.     Obstructive

4.     Distributive

Hypovolemic

■      Hypovolemic shock results from an inadequate circulating blood volume owing to either profound dehydration or significant hemorrhage.

■      Traumatic hypovolemia is the most common type of shock encountered in patients <40 years of age

Cardiogenic

■      Cardiogenic shock occurs when the heart is unable to provide adequate forward blood flow secondary to impaired pump function or significant dysrhythmia.

■      Myocardial infarction is the leading cause of cardiogenic shock and typically occurs once -40% of the myocardium is dysfunctional.

Obstructive

■      Obstructive shock results from an extracardiac blockage of adequate venous return of blood to the heart

Example : -

q  Pericardial  Tamponade ,

q  Tension  pneumothorax

q  Massive  pulmonary  embolism [PE)).

Distributive

■      Distributive  shock occurs secondary to an uncontrolled loss of vascular tone

v       Example 

■      sepsis

■      anaphylaxis,

■      neurogenic shock

■      adrenal crisis

■       Neurogenic shock most commonly occurs in trauma patients with high cervical cord injuries and a secondary loss of sympathetic tone and should always be considered a diagnosis of exclusion.

■      Classically these patients will present with hypotension and a paradoxical bradycardia.

■      Suspect septic shock in elderly, immunocompromised, and debilitated patients who are toxic appearing despite only vague symptoms.

■      The prognosis for patients with cardiogenic and septic shock remains grave ,with mortality rates between 30% and 90%.

Pathophysiology  of shock

■      The pathophysiology of shock can be divided into 3 basic categories.

■      a systemic autonomic response

■      endorgan cellular hypoxia

■      The  secretion of proinflammatory mediators .

a systemic autonomic response

■      The autonomic system initially responds to widespread tissue hypoperfusion by globally increasing the overall cardiac output.

■      As tissue perfusion continues to decline,

■      the body shunts circulating blood away from less vital structures including the skin, muscles, kidneys, and splanchnic beds.

■      Reflexively, the kidneys activate the renin-angiotensin axis, prompting the release of various vasoactive substances, with the net effect to preserve perfusion to the most critical organs, namely the brain and the heart.

■       When the preceding response is inadequate despite maximal tissue 02 extraction, cellular hypoxia forces a conversion from aerobic to anaerobic metabolism.

■       By nature, anaerobic metabolism cannot produce enough adenosine triphosphate to maintain regular cellular function.

■       Tissue lactate accumulates, resulting in systemic acidosis, and eventually this breakdown in cellular metabolism leads to widespread tissue death.

■      Injured and dying cells prompt the production and secretion of harmful inflammatory mediators,

■      resulting in the development of the systemic inflammatory response syndrome,

■       defined by the presence of fever, tachycardia, tachypnea, and leukocytosis