English in Nursing

By Irena Baumruková

English in Nursing is a new textbook designed for individuals, medical schools, universities, and language schools. This is the first part for English in Nursing. Casuistics was published in 2017.

The presented reading book is a collection of professional medical texts. Teachers can choose materials suitable for their students (basic, intermediate, or advanced levels). There are exercises and translations as well as detailed vocabularies containing pronunciation transcription in each unit. The students are supposed to find the meanings by themselves and learn the words in their mother language; that is why the textbook is perfect for international studies.

The material is divided into four parts: (1) nursing minimum, (2) essentials of nursing practice, (3) health care across the lifespan, and (4) body systemsphysiology and pathology.

• Language: English
• Publisher: Xlibris UK
• Release date: Jul 16, 2018
• ISBN: 9781543491470

Irena Baumruková

The author has been teaching medical English for more than fifteen years. She would like to draw the readers’ attention to other materials published to help physicians, dentists, dental hygienists, medical students, paramedics, and nurses to learn professional English in an interesting and pleasant way.

Book preview

PART 1

NURSING MINIMUM

UNIT 1

ASSISTING PATIENTS WITH THEIR NUTRITIONAL NEEDS

Text 1

Providing patients with food they want to eat is an important aspect of patient care that is a fundamental aspect of the nurse’s role. Sometimes patients being cared for in a variety of settings may not be able to take food and drink by mouth and need extra help in the form of an adjunct, such as nasogastric or enteral tube.

Once a patient is admitted to hospital the risk of malnutrition increases; this is due to a number of factors, including their changing physical or psychological condition. Malnutrition can result in longer hospital stays and poorer outcomes for patients. Malnourished patients visit their GP twice as frequently as those who are well nourished and have an increased risk of being admitted to hospital. The effects of malnutrition are numerous.

It often goes undetected and therefore untreated, which can result in a number of adverse consequences such as:

• Difficulty in keeping warm.

• Increased susceptibility to respiratory problems and other infections due to poor immune responses.

• Wounds are slow to heal.

• Increased recovery time from illness.

• In children, growth and development can be impaired.

• In women of child-bearing age, conceiving can be difficult.

• Psychologically, individuals can become low in mood, uninterested in eating and drinking and may lack self-esteem.

Maintaining nutritional balance requires that patients have access to the correct information and can make informed choices about what they eat.

Nutritional screening and assessment

When a patient is admitted to hospital, screening for the risk of under-nutrition should be undertaken first 24 hours of admission, and then on a continual basis. Most screening tools divide nutritional risk into three groups – low, moderate and high risk – and most provide some form of nutritional advice, including dietetic assessment.

Determining the level of risk of malnutrition will give you a clear plan of action regarding how to manage the nutritional requirements of the individual. This action will support any future intervention by a dietician, who will be responsible for undertaking a more detailed nutritional assessment.

The rapid, simple five-step procedure calculates the patient’s risk score and therefore their level of malnutrition risk. This is done by considering weight, height, recent weight loss and current acute clinical/psychological condition.

Much of the information relating to a patient’s nutritional intake, and any unintentional weight loss, can be obtained through history-taking and health records, but in the first instance information should be obtained by talking to the patient.

Weighing a patient (Wt)

Essential equipment

Appropriate weighing scales:

• 0-2 years – baby scales

• Over 2 years sitting or standing scales

• For patients with mobility needs – hoist scales

What to watch out for and action to take

While undertaking any nutrition-related skill, you should also assess:

• the patient’s positioning and ability to mobilize;

• their neurological condition – are they alert and responsive?

• any signs or complaints of pain or discomfort;

• the patient’s or relatives’ views, as these may provide you with important additional information.

Remove clothing as appropriate:

• O-2 remove clothing

• over 2 remove shoes or slippers and empty pockets

Ensure scales are on flat surface and the dial is on zero, and apply brakes if appropriate. If the scales are stand on type ensure that patient stands on scales centrally, with feet slightly apart, and keeps still to ensure patient safety and promote accuracy of reading. If a patient has additional nutritional needs, a dietitian or speech and language therapist (if there are swallowing problems) will need to be informed.

Patients who are recorded as having a medium to high risk score will have their weight recorded on an ongoing basis. Supplementary high energy and nutrient-dense snacks are often suggested; these might include foods such as whole milk, full-fat yoghurts, cakes and biscuits.

Many patients are commenced on a total intake chart or a food diary if they are recorded as being at medium or higher risk of malnutrition. A total intake chart provides detailed information relating to all food and fluids consumed over a 24-hour period. It is therefore critical that such charts are kept up to date and food intake is recorded at the time of the meal and not retrospectively. This can lead to inaccuracies and may have future impacts on the patient’s wellbeing and clinical outcomes.

Translation 1

1. Take food and drink by mouth, extra help, nasogastric or enteral tube; 2. change physical or psychological condition, malnourished patients, be admitted to hospital; 3. adverse consequences, keeping warm, respiratory problems, poor immune responses, wounds are slow to heal; 4. recovery time from illness, growth and development impaired, conceiving can be difficult, lack self-esteem, maintain nutritional balance; 5. screening tools, nutritional risk low, moderate and high, nutritional advice, plan of action, nutritional requirements; 6. detailed nutritional assessment, rapid, simple five-step procedure, consider weight, height, recent weight loss and current acute clinical and psychological condition; 7. history-taking and health records, weighing a patient, baby scales, sitting or standing scales, hoist scales; 8. ability to mobilize, alert and responsive, pain or discomfort, additional information; 9. remove clothing, remove shoes or slippers and empty pockets, flat surface, dial is on zero, stand on scales centrally, keep still, accuracy of reading; 10. high energy and nutrient-dense snacks, whole milk, full-fat yoghurts, cakes and biscuits; 11. total intake chart, food diary, keep up to date.

Text 2

Nutritional care and the mealtime experience

Mealtimes in hospital and the care home setting are particularly important for any patient. Interruptions at mealtimes can be frequent due to the unpredictable nature of healthcare: medication rounds, ward rounds or the patient having investigations off the ward, for instance. Taking steps to ensure that there is a structured and organized approach to meal times is paramount in ensuring patients receive their meals in a manner which suits their individual needs.

The staff need to prioritize their time to ensure that patients are served their meals at the correct temperature, as well as ensuring that they receive the assistance and encouragement they require. Patients are able to eat and drink in a clean, quiet and safe environment

• Ensuring that the patient is prepared and the environment is conductive to eating and drinking, whether in a hospital, care home or home setting is important

• Ensure that patients of all ages are offered the opportunity to wash their hands prior to eating food. Also ensure that they have a clean mouth and teeth or dentures.

• Meals can be offered either in a dedicated dining room or by patient’s bed. Socialization at mealtimes can promote a patient’s appetite as well as improve the mealtime experience.

Providing assistance and support

Many hospitals and care homes implement a range of local processes to ensure that patients who are nutritionally at risk or who are unable to eat or drink independently are identified. Required eating and drinking aids, such as cutlery or plate guards, should be easily accessible at all times. Occupational therapists may be involved in assessment as to when additional assistance is needed and may prescribe the use of plate guards, adapted cutlery or non-slip mats to promote independence.

Some patients may require simple assistance such as unwrapping cutlery from a napkin, opening packets and removing lids. Others may require additional assistance, including cutting up food or placing cutlery in their hands, particularly if they have poor manual dexterity or limited use of limbs.

Allowing patients sufficient time to eat their meal will assist with their food and fluid consumption. It is important that those who may be slower eaters are not rushed by activities such as the collection of meal trays, as this can have a negative impact on their meal consumption.

Assisting a patient to eat and drink

Observation and monitoring the patient’s consumption of food and drink should be carried out.

Essential equipment

• Utensils – adapted if appropriate

• Crockery and any necessary adapted items, such as a plate guard

• Clothing protection for the patient, such as disposable covers or napkins, as required

• The meal and suitable drink

Many mental health conditions can affect appetite and the ability to prepare food as well as to eat and drink normally. Elderly patients may not eat or drink adequately due to problems with dentures and oral hygiene, plus accessibility of food, or because of the effects of medication.

When assisting a patient to eat or drink, you should also assess:

• the patient’s positioning and ability to mobilize;

• their neurological condition – are they alert and responsive?

• any signs or complaints of pain or discomfort;

• the patient’s or relatives’ views

Step-by-step clinical skill

1. Prepare the patient for the meal by:

✓ Offering toilet and hand-washing facilities before the meal arrives

✓ Ascertain where patient wishes to eat

✓ If using a bed table remove surplus equipment, particularly items such as sputum pots and vomit bowls. Clean the table and correct height.

✓ Collect the correct diet for the patient and the utensils they require.

✓ Ensure you have a supply of fresh water and appropriate fluid.

2. Position yourself close to the patient, at the same level as them, in a comfortable position.

3. Ensure the patient approves of the food choice and that food is at an appropriate temperature and consistency.

4. While assisting the patient ensure pace is correct by asking for feedback. Ensure you offer food in the order the patient wishes, following their preferences. Communicate appropriately with the patient while they are eating.

5. Remember to offer and encourage fluids at frequent intervals while the patient is eating to aid swallowing and promote digestion.

6. Ensure the patient is not rushed and has sufficient time to complete their meal to ensure the patient eats and drinks the amount they wish.

7. Clear away crockery and utensils; offer patient appropriate hygiene, such as hand-washing, mouth care, clean dentures and clean bed table.

8. Leave patient in a comfortable, upright position for at least thirty minutes with their call bell to hand. For children this will depend on their condition and stage of development, but in general aim is to disturb the child as little as possible after feeding and encourage quiet activities for a while.

Caring for those who may be vulnerable

The pleasure of eating, drinking and mealtimes may be lost for some patients. Patients with dementia may have a reduced or limited recognition of hunger or thirst and any patient who is disorientated with regard to time and place may not recognize the meal that is put in front of them. Getting to know a patient is fundamentally important in ascertaining what time the person normally eats, plus what food and fluids they like, dislike or choose not to eat for cultural or religious reasons.

Finding out further information

Making sure the person is comfortable and settled and then talking about the meal about to be served is also helpful in preparing the patient. Within some settings, such as care homes, it is beneficial to involve the patients in the setting of tables and general mealtime preparation.

Patients who are visually impaired will have different needs. Explaining where food is situated on a plate by using a clock as comparison can be helpful. For those who are visually impaired it is possible to offer the use of different coloured crockery, or use contrasting colours of plates, utensils and drinking vessels and crockery that has a rim. Other patients may find it hard to chew their food and swallow solids, so will require additional assistance.

After mealtime

Ensuring that patients are left feeling comfortable after a meal is also important. Making sure hand-washing facilities are offered and food debris is removed from clothes or around their mouths, plus offering mouth care, will promote patient comfort. Patients should be left upright after their meal for at least thirty minutes, either in their chair or bed, to aid digestion.

Translation 2

Mealtimes, interruptions, medication rounds, ward rounds, investigations off the ward, organized approach is paramount; 2. clean, quiet and safe environment, wash the hands, clean mouth and teeth or dentures; 3. dining room, by patient’s bed, required eating and drinking aids, cutlery or plate guards, non-slip mats, easily accessible; 4. unwrapping cutlery from a napkin, opening packets and removing lids, cutting up food, place cutlery in their hands; 5. poor manual dexterity, slower eaters, not to rush, sufficient time to eat, collection of meal trays; 6. utensils, crockery, disposable covers or napkins; 7. elderly patients, problems with dentures and oral hygiene, effects of medication, positioning and ability to mobilize; 8. neurological condition, pain or discomfort, toilet and hand-washing facilities; 9. bed table, remove sputum pots and vomit bowls, collect the utensils; 10. supply of fresh water, close to the patient, food choice, temperature and consistency; 11. correct pace, fluids at frequent intervals, aid swallowing, promote digestion; 12. sufficient time, clear away crockery and utensils, clean bed table; 13. comfortable, upright position, call bell to hand, for children, quiet activities; 14. dementia, disorientated, limited recognition of hunger or thirst, food and fluids they like, dislike; 15. care homes, setting of tables, general mealtime preparation; 16. visually impaired, using a clock as comparison, contrasting colours of plates, utensils and drinking vessels, have a rim; 17. feel comfortable after a meal, leave upright, to aid digestion.

Text 3

Adjuncts assisting a patient’s nutritional intake

Enteral feeding

A number of conditions may affect a patient’s ability to eat and drink sufficient amounts to meet the body’s requirements. Sometimes a patient may have a difficulty swallowing, so it becomes necessary to bypass the mouth and oesophagus. In this case nutritional needs can be met artificially by enteral feeding, which involves the insertion of an enteral tube; nutrition, fluids and medication can then be administered safely.

Types of enteral tubes used for feeding

1. Nasoenteric tubes: nasogastric, nasojejunal, post pyloric

2. Enteric tubes: gastrostomy, jejunostomy

Nasogastric (NG) tube feeding

Nasogastric (NG) tubes can be used in both children and adults, being passed through the nostril of the patient down the oesophagus and into the stomach.

Child and adult alimentary canal

Normal ingestion of food travels from the buccal cavity, through the oesophagus and then into the stomach before entering the intestine. When patients are unable to eat and drink a nasogastric tube can be passed through their nasal cavity to the stomach thus bypassing the mouth.

Passing the NG tube can be achieved quickly and easily while the patient is conscious, although some may find it unpleasant. NG tubes are less well tolerated than gastrostomy tubes and can need to be replaced more frequently. Common problems with an NG tube are oesophagitis and upper gastrointestinal ulceration; any gastric intolerance may mean that nutritional status is compromised.

NG feed tubes usually need replacing every 10-28 days depending on the tape and material of the tube and the manufacturers’ recommendations. Extreme care is required as inadvertent placement into the lungs can be a problem and, if unrecognized, will have serious consequences. The position of all NG tubes should be confirmed after placement by X-ray, and before each use the position of the NG tube should be checked by agitation and pH graded paper.

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) tubes are suitable for both adults and children, facilitating direct access to the stomach from outside of abdomen. As an endoscope is required to insert a PEG tube, the patient must be fit for sedation. Careful monitoring is required after the insertion as peritonitis and perforation of the colon may occur.

Alerts for these complications include:

• severe pain that is not relieved by simple analgesia or that is made worse by using the tube;

• fresh bleeding or gastric fluid or feed leaking from the wound site;

• sudden change in the patient’s vital signs or changes in levels of responsiveness or behaviour

The tube can be flushed with 50 ml of water four hours after the procedure; if no pain occurs, then the tube can be used. Feeding must be commenced slowly and follow a prescription issued by a dietitian. Management of constipation is something that has to be considered when feeding a patient enterally. Following successful insertion and close monitoring during the first 72 hours, the PEG tube and the site of insertion must be monitored daily or more often if required.

Peripheral venous cannula

As many as a third of patients cared for in hospital have a peripheral venous cannula. A peripheral cannula is a small hollow tube which is inserted through the skin into a peripheral vein to be used for intravenous (IV) therapy, which could include the administration of medications, blood and blood products or fluids. Peripheral cannulae are not without complications, however, including infection and phlebitis, so you need to be able to provide efective care in order to minimize this risk.

Translation 3

1. Enteral feeding, difficulty swallowing, bypass the mouth and oesophagus; 2. insertion of an enteral tube, nutrition, administer fluids and medication; 3. nasoenteric tubes, nasogastric, nasojejunal, post pyloric; 4. enteric tubes, gastrostomy, jejunostomy, down the oesophagus and into the stomach, enter the intestine, need to be replaced; 5. common problems, oesophagitis, upper gastrointestinal ulceration, gastric intolerance, nutritional status is compromised; 6. inadvertent placement into the lungs, serious consequences, confirm by X-ray; 7. percutaneous endoscopic gastrostomy, direct access to the stomach, outside of abdomen, fit for sedation; 8. peritonitis and perforation of the colon, severe pain, fresh bleeding, gastric fluid or feed leaking, sudden change in vital signs; 9. flush the tube, commence feeding slowly, management of constipation; 10. peripheral cannula, small hollow tube, inserted through the skin, peripheral vein, intravenous (IV) therapy, medications, blood, fluids, infection and phlebitis.

Exercise 1

Fill in the missing words

1. Assisting patients with 1_________________ is a fundamental role of the nurse. Ensuring this is carried out in a safe and effective way while considering the patient’s 2__________________ will promote recovery, aid the 3______________ and help prevent deterioration in a patient’s conditions and general health. 4____________ to hospital increases the risk of malnutrition.

2. Undertaking 1____________________ using a validated tool and carrying out a full assessment are essential for all at risk patients. Communication with the patient, family, carers and multi-disciplinary teams is vital to promote a 2___________ for the patient. This includes good 3_____________. Providing a patient with adequate nutrition, including 4_________, involves a person-centred, holistic approach on the part of the entire multi-disciplinary team.

Exercise 2

Tasks and questions

1. What are the adverse consequences of malnutrition?

2. Speak about nutritional screening and assessment.

3. How to provide good nutritional care, care planning.

4. Assisting a patient to eat and drink. Step-by-step clinical skill.

5. Characterize adjuncts assisting a patient’s nutritional intake.

Vocabulary 1

accuracy /ˈækjʊrəsɪ/

alimentary /ˌæl əˈmɛn tə ri/

apart /əˈpɑːt/

artificially /ˌɑː.tɪˌfɪʃ.iˈæl.ɪ/

basis /ˈbeɪ.sɪs/

bowl /bəʊl/

brake /breɪk/

bypass /ˈbaɪ.pɑːs/

colon /ˈkəʊ.lɒn/

complete /kəmˈpliːt/

conceive /kənˈsiːv/

conductive /kənˈdʌk.tɪv/

crockery /krɒkərɪ/

cut / kʌt/ up /ʌp/

cutlery /ˈkʌtlərɪ/

dexterity /dekˈster.ə.ti/

dial /daɪl/

diary /ˈdaɪərɪ/

dietetic /ˌdaɪɪˈtetɪk/

digestion /da ɪˈdʒes.tʃən/

enteral /ˈen.tə.rəl/ tube /tjuːb/

enterally /ˈɛn tər əli/

enteric /enˈtər.ɪk/

feed /fiːd/

gastrostomy /ɡæsˈtrə.stə.mi/

hoist /hɔɪst/

hollow /ˈhɒl.əʊ/

hydration /haɪˈdreɪ.ʃən/

identify /aɪˈden.tɪ.faɪ/

impaired /ɪmˈpeəd/

inaccuracy /ɪnˈæk.jʊ.rə.si/

inadvertent /ˌɪn.ədˈvɜː.tənt/

ingestion /ɪnˈdʒest.ʃən/

intestine /ɪnˈtes.tɪn/

intolerance /ɪnˈtɒl.ər.əns/

jejunostomy /dʒɪdʒuːˈnɒstəmɪ/

lid /lɪd/

mat /mæt/

mobilize /ˈməʊ.bɪ.laɪz/

napkin /ˈnæpkɪn/

nasoenteric /ˌneɪzəʊˈɛnˈtɛrɪk/

nasojejunal /ˌneɪzəʊˈdʒɪˈdʒuːnəl/

non-slip /nɒn slɪp/

nutrient-dense /ˈnjuː.tri.ənt dens/

oesophagus /ɪˈsɒf.ə.gəs/

packet /ˈpæk.ɪt/

paramount /ˈpær.ə.maʊnt/

percutaneous /ˌpɜːkjuːˈteɪ.ni.əs/

perforation /ˌpɜː.fərˈeɪ.ʃən/

peritonitis /ˌper.ɪ.təˈnaɪ.tɪs/

pH graded /ˈgreɪdɪd/

phlebitis /flɪˈbaɪtɪs/

plate /pleɪt/ guard /gɑːd/

prioritize /praɪˈɒrɪˌtaɪz/

pyloric /paɪˈlɔr ɪk/

reading /ˈriːdɪŋ/

rim /rɪm/

rush /rʌʃ/

self-esteem /self.ɪˈstiːm/

settle /ˈset.l̩/

site /saɪt/

slipper /ˈslɪpə/

surplus /ˈsɜːpləs/

tray /treɪ/

undetected /ˌʌn.dɪˈtekt.əd/

unintentional /ˌʌn.ɪnˈten.ʃən.əl/

unpredictable /ˌʌn.prɪˈdɪk.tə.bl̩/

unwrap /ʌnˈræp/

utensil /juːˈtensəl/

visually /ˈvɪʒ.u.əl.i/

ward /wɔːd/ round /raʊnd/

Solutions to Exercise 1

1. 1b); 2d); 3c); 4a)

2. 1b); 2c); 3a); 4d)

UNIT 2

ASSISTING PATIENTS WITH THEIR ELIMINATION NEEDS

Text 1

Assisting patients with their elimination needs involves undertaking a series of procedures. The role of the nurse within these is to maintain the dignity and privacy of the patient while delivering the fundamental care required. Elimination is activity which we undertake several times a day to remove waste products from metabolism (urine and faeces) from the body. Elimination is normally undertaken in private and methods are influenced by social and cultural norms.

Assisting patients with their elimination needs

The fundamental skills are:

1. Bowel assessment

2. Assisting a patient to use a bedpan or urinal

3. Assisting a patient to use a commode

4. Emptying a catheter

5. Providing catheter care

6. Urinalysis

Common steps for all elimination-related skills

Essential equipment

• Suitable personal protective equipment (PPE)

• Bedpan and paper cover, urinal, commode

• Toilet paper

• Equipment to enable the patient to wash their hands

• Manual handling equipment and possibly assistance from another member of the healthcare team

• Soap and warm water, single-use wash-cloths and towels

• Sterile jug or container

• Alcohol swabs

What to watch out for and action to take

While assisting a patient with their elimination needs, you should also observe and assess:

• the condition of the skin;

• their ability to move or mobilize independently;

• their neurological condition – are they alert and responsive?

• any signs or complaints of pain or discomfort;

• the patient’s or relatives’ views – for example, saying that their needs have changed or that they are experiencing problems

Step-by-step clinical skill

1. Ensure you promote patient dignity and privacy by drawing curtains, or moving the patient to a bathroom if possible. Elimination needs are intimate and personal.

2. Patients need to be in a comfortable position to promote comfort and reduce anxiety.

3. Discard PPE, any single-use equipment and other used materials. Clean any equipment used.

4. Document findings on the patient’s observation chart and/or in the patient’s notes.

5. It is vital to report any abnormalities immediately

Assessing bowel functioning

Assessment of a patient’s bowel functioning provides us with precise information relating to their eliminatory functioning. It is just as important that you communicate effectively with the patient, making them feel as comfortable as possible.

What is normal?

Normal bowel function can vary greatly: some patients open their bowels daily, others every two or three days. If possible it is best to ask the patient what is normal for them and whether they take laxatives. As you approach the patient observe them carefully to assess whether they are well nourished and hydrated. Do they look in good health or do they appear unwell, and are they able to move unaided?

Step-by-step clinical skill

1. Document the history of the present bowel complaint.

2. Undertake a holistic assessment of the patient’s condition, which includes details of their diet, fluids, mobility, dexterity, cognitive function and usual environment, to obtain assessment which may identify the underlying reason for the patient’s altered bowel habit, whether constipation or diarrhoea.

3. Ask the patient what medications they are currently taking to assess if medication has affected the normal bowel routine.

4. Ensure that future bowel actions are monitored and accurately recorded to monitor condition and detect abnormalities.

Gastrointestinal system

The function of the digestive system is to convert food from the diet into substances which can be used by the various cells of the body to perform everyday functions. The digestive system can be divided into four parts: the uper part, the middle portion, the lower segment and the accessory organs.

The gastrointestinal tract is a long hollow tube running from the mouth to the anus. The digestive process begins in the mouth, where food is broken down into smaller components through the action of the teeth, lips and cheeks in chewing (mastication) and saliva, which includes digestive enzymes and which provides moisture to aid swallowing.

Food boluses then travel to the stomach via the oesophagus – a muscular collapsible tube which is approximately 25 cms long. The stomach sits in the abdominal cavity. Gastric acid and pepsin in the stomach contribute to the breakdown of food, with most meals leaving the stomach four hours after being ingested. On leaving the stomach, the partially digested foodstuffs, or chyme, moves into the small intestine.

The small intestine is approximately six metres long and has three subdivisions: the duodenum, the jejunum, and the ileum. As the chyme progresses along the small intestine, additional digestive enzymes are added, including pancreatic juice (from the pancreas) and bile (from the liver), which enter the duodenum. Chyme spends 3-6 hours in the small intestine, where nutrients and fluids are absorbed.

As the process continues, the chyme enters the large intestine as fluid faeces, where it travels through the caecum, ascending colon, transverse colon, descending colon, sigmoid colon and finally reaches the rectum in preparation for defecation.

The primary function of the large intestine is the absorption of water to turn fluid faeces into semisolid faeces. Defecation occurs when the stretching of the rectum, as it fills with faeces, initiates the defecation reflex. It is controlled by the action of the internal and external sphincters and is consciously controlled in a healthy adult.

Translation 1

1. Remove waste products from metabolism, urine and faeces, assist patients with elimination; 2. fundamental care, use a bedpan or urinal, use a commode; 3. catheter care, emptying a catheter, urinalysis, essential equipment, personal protective equipment; 4. soap and warm water, use wash-cloths and towels, container, alcohol swabs; 5. watch out, what action to take, the condition of the skin; 6. alert and responsive, pain or discomfort, experience problem; 7. draw curtains, dignity and privacy, promote comfort and reduce anxiety; 8. discard used materials, clean any equipment used; 9. document findings, observation chart, patient’s notes, bowel functioning, eliminatory functioning; 10. take laxatives, observe the patients carefully, well nourished and hydrated, appear unwell; 11. document the history of the present bowel complaint, holistic assessment, diet, fluids, mobility, dexterity, cognitive function, move unaided; 12. constipation or diarrhoea, medications, bowel actions, record accurately, detect abnormalities; 13. digestive system, convert into substances which can be used by cells, the uper part, the middle portion, the lower segment and the accessory organs; 14. mouth, food is broken down, the teeth, lips and cheeks, chewing (mastication) and saliva; 15. digestive enzymes, moisture, aid swallowing, oesophagus, approximately 25 cms long; 16. stomach subdivisions: the duodenum, the jejunum, and the ileum, gastric acid, breakdown of food; 17. partially digested chyme, additional digestive enzymes, pancreatic, pancreas, bile, liver, small intestine; 18. fluid faeces, nutrients and fluids are absorbed, large intestine, caecum, ascending colon, transverse colon, descending colon, sigmoid colon; 19. absorption of water, semisolid faeces, stretching of the rectum, defecation reflex, internal and external sphincters, consciously controlled.

Text 2

Bedpans, urinals and commodes

You will find that assisting a patient to use a bedpan, urinal or commode is one of the most frequent elimination-related skills you carry out. Female patients may need to use a bedpan or commode to both micturate and defecate; male patients may prefer to micturate in a urinal, which may be easier if they stand up.

Essential equipment

• Appropriate personal protective equipment (PPE)

• Appropriate bedpan and paper cover or commode or urinal and paper cover

• Toilet paper

• Facilities to allow the patient to wash their hands

• Manual handling equipment as required

• Possible assistance from a further member of the healthcare team

Bedpan or urinal

1. Remove the bedclothes and, if the patient is able, assist them to sit upright. Ask the patient (or use moving and handling equipment if required) to raise their hips/buttocks to allow the bedpan or urinal to be correctly positioned. If the patient cannot raise their hips/buttocks, a rolling motion may be used with appropriate moving and handling techniques to roll the patient onto the bedpan. Support with pillow if required.

2. When the patient is on the bedpan or has the urinal in position, ask them to move their legs slightly apart so that you can check the position is correct.

Commode

1. Take the equipment to the bedside, checking that the wheels on the commode are secured and there is a bedpan receiver placed under the commode. Remove the commode cover and assist the patient to transfer from bed/chair to the commode.

2. Check the patient is positioned correctly on the commode. Checking the position will reduce the risk of spillage and associated contamination or cross-infection.

3. If safe to do so, leave the patient, ensuring that toilet paper is close at hand and giving them a nurse call button. Cover the patient’s legs with a towel or sheet.

4. When a patient has finished using the bedpan, commode or urinal, you may need to assist them with personal hygiene. Clean the patient’s bottom using toilet paper, wiping from front to back. Skin cleanser or warm, soapy water may be required. Wiping from front to back will reduce the spread of infection from the bowel to the urethra (especially in women).

5. Pat the skin dry after assisting the patient with their personal hygiene to prevent deterioration of the patient’s skin.

6. Help the patient to wash and dry their hands.

Use of incontinence pads

It is important that the use of incontinence pads meets the individual needs of the patient. Incontinence pads should never be routinely applied or used instead of assisting patients to use a toilet, commode, urinal or bedpan. The main issues to consider when applying and changing incontinence pads are:

• The manufacturer’s instructions should be followed.

• Only one pad should be applied to the patient at a time; if one pad in insufficient then further assessment is required, because using two pads may damage the patient’s skin.

• Skin care and personal hygiene should be carried out every time a pad is changed to maintain the condition of the patient’s skin.

• Always be cautious with the use of barrier creams and do not apply talcum powder under an incontinence pad.

• Appropriate infection-control steps should be taken as you are dealing with bodily fluids.

The urinary system

The bladder is a hollow muscular organ which, in an adult, can hold approximately 350-750 ml of urine. The process of micturition is controlled via a complex series of neurological links between the bladder, spinal cord and brain stem, with the urge to pass urine beginning as the bladder stretches as it fills. A healthy adult is able to control the process of micturition. The urine travels from the bladder outside the body via the urethra, which is longer in men than in women.

Children’s bladders are much smaller, with their size and capacity gradually increasing during the first eight years. A full control of micturition is usually gained by the age of three or four. Children have a reduced ability to concentrate urine, so are at greater risk of dehydration.

Micturition

The production of urine and micturition involves the renal system. Urine is composed of 95 per cent water and 5 per cent dissolved solids in the form of metabolic waste. It is clear, amber-coloured liquid and arroud 1.5 litres are produced each day in a healthy adult.

Urine is formed in the kidneys by three processes:

1. Filtration: where blood enters the glomeruli of the kidney and the fluid crosses the membrane by osmosis and diffusion.

2. Selective reabsorption: where around 99 per cent of the filtrate from the filtration stage is reabsorbed; this includes substances like sodium, calcium and potassium.

3. Secretion: the remaining waste products are secreted by the nephron into the collecting duct, eventually leaving the kidney via the ureter.

When fully grown the ureter is approximately 25-30 cm in length and connects the kidneys to the bladder. Although urine is formed within the kidneys it is the bladder which stores urine and controls its elimination from the body.

Translation 2

Remove the bedclothes, assist the patients to sit upright, further member of the healthcare team, handling equipment; 2. raise their hips, buttocks, rolling motion, roll the patient onto the bedpan, legs slightly apart, check the position; 3. at the bedside, the wheels are secured, bedpan receiver under the commode, risk of spillage, cross-infection; 4. toilet paper at hand, nurse call button, clean the patient’s bottom, wipe from front to back, infection from the bowel to the urethra; 5. pat the skin dry, incontinence pads, never apply routinely, manufacturer’s instructions; 6. individual needs, only one pad at a time, not to damage the patient’s skin, not to apply talcum powder; 7. production of urine, the renal system, water, dissolved solids, metabolic waste; 8. three processes, filtration, reabsorption, secretion; 9. filtration, glomeruli, fluid crosses the membrane, osmosis and diffusion; 10. selective reabsorption, substances like sodium, calcium and potassium; 11. secretion, nephron, the collecting duct, the ureter, connects the kidneys to the bladder; 12. bladder, hollow, muscular organ, controls the elimination; 13. neurological links between the bladder, spinal cord and brain stem, the urge to pass urine, urethra, control of micturition.

Text 3

Caring for a patient with a urinary catheter

A high standard of catheter care is required to reduce the complications associated with the use of an indwelling catheter, especially if it is going to be long-term use. Catheters should only ever be used when absolutely necessary and those caring for patients with a catheter need to ensure they provide effective catheter care. This includes strict hand-washing principles, keeping the catheter clean and encouraging the patient to drink sufficient fluids.

Performing catheter care

Essential equipment

• Appropriate personal protective equipment (PPE)

• Soap and warm water

• Single-use washclots

• Towel

Step-by-step clinical skill

1. Assist the patient to be correctly positioned for the procedure.

2. Clean the genital area using soap and water. Soap and water are appropriate; anti-bacterial or antiseptic solutions are not required.

3. Perform meatal cleansing:

In male patients by pulling back the foreskin (if uncircumcised). Note that the foreskin should not be forcibly pulled back. It can take until the late teenage years before the foreskin can be retracted. Clean around the glans, moving away from the meatal opening; clean the area where the catheter enters the penis and then downwards along the catheter. Rinse and dry the area. Return the foreskin to the original position.

In female patients by gently parting the labia. Clean the area where the catheter enters the meatus and then downwards along the catheter. Rinse and dry the area. Talcum powder should be avoided as irritation may be caused.

After providing catheter care it may be appropriate to empty the patient’s catheter bag. It is important to recognize that performing catether care and emptying a patient’s catheter bag are two separate procedures and that you must adhere to strict infection control and prevention measures between the procedures.

Emptying a patient’s catheter bag

What is normal?

Catheter bags should only be emptied when they are full, as each time you perform this procedure you are potentially introducing an infection risk. Do not forget that a catheter bag is attached to a patient and that you need to ask for their consent to perform this procedure.

Essential equipment

• Appropriate personal protective equipment (PPE)

• Alcohol swabs

• Sterile jug

What to watch out for and action to take

Notice when emptying the bag that the patient has passed little or no urine. It may indicate a problem relating to catheter drainage or an alteration in the patient’s condition. Check the patient’s fluid balance chart.

Step-by-step clinical skill

1. Open the port and allow the urine to drain into the jug to empty the bag and, to allow measurement of the volume of urine passed.

2. Close the port and clean again with an alcohol swab to reduce the risk of infection.

3. Reposition the catheter bag and check that the patient is comfortable.

4. Cover the jug and transfer to the sluice where the urine can be disposed of.

Urinalysis

Essential equipment

White-top sterile specimen containers or bedpans are the most commonly used receptacles. To undertake accurate urinalysis the receptacle needs to be clean but not necessarily sterile.

Step-by-step clinical skill

1. Ensure the container you are going to use to obtain the specimen is appropriately labelled with the patient’s indentification details to ensure that you test the correct specimen.

2. First voided morning urine is best suited for urinalysis. Its concentration provides the most reliable results.

3. It is best to test specimens immediately; if not possible then do so within two hours. This provides the most reliable results.

4. After shaking the sample, briefly completely immerse the whole section of the strip where the test pads are located into freshly voided urine. Shake the sample to ensure it is mixed so the concentration will be constant throughout. Dip the strip briefly to avoid dissolving out reagents from the test pads which would produce incorrect results.

5. As you remove the strip from the sample, run its edge against the edge of the receptacle – apply the dip and drag stages of the dip, drag, blot, read technique to remove excess urine and prevent the strip from dripping.

6. Hold the strip horizontally to avoid potential mixing of reagents due to them running down the strip. This would cause cross-reactions that will produce unreliable results.

7. Remove excess urine by applying the blot stage to prevent the strip from dripping.

8. Compare all test pads with the corresponding colour chart. At the time specified, record all results. It is important to follow the timings specified to ensure that your results are correct. Colour changes that have occurred after two minutes are invalid and will not provide accurate results. Make sure that when you are comparing the test pads with the corresponding colour you do not hold the strip directly against the container, as there may be urine remaining on the strip which you would transfer to the container.

Translation 3

1. Indwelling catheter, long-term use, keep the catheter clean, drink sufficient fluids; 2. strict hand-washing, single-use washclots, anti-bacterial or antiseptic solutions; 3. clean the genitals, pulling back the foreskin, clean around the glans, rinse and dry the area, return the foreskin; 4. gently parting the labia, clean the area where the catheter enters the meatus; 5. to empty the catheter bags when they are full, ask for the consent; 6. sterile jug, catheter drainage, an alteration in the patient’s condition, fluid balance chart; 7. open the port, drain into the jug, measurement, close the port and clean again, alcohol swab, reposition the bag, transfer to the sluice, be disposed of; 8. urinalysis, white-top sterile specimen container, obtain the specimen, appropriately labelled, indentification details; 9. first voided morning urine, freshly voided urine, reliable results, test specimens immediately; 10. shaking the sample, briefly completely immerse the whole strip, remove the strip from the sample, remove excess urine; 11. dip, drag, blot, read technique, test pads, hold the strip horizontally, to avoid mixing of reagents, not to hold the strip directly against the container; 12. compare all test pads with the corresponding colour chart, record all results.

Exercise 1

Fill in the missing words

Assisting patients with their 1________________ is very much associated with the role of the nurse. Compassion and person centred care are closely 2____________. With regard to elimination needs, the nourse should provide information about the various 3______ _________ to the patient to ensure their elimination needs are met in a person-centred and compassionate 4_____________.

2. Maintaining a patient’s 1______________ is an essential component of all aspects of elimination care. Central to the success of undertaking the skills is good 2_____________ between the nurse, or nurses, and the patient. Assisting a patient with their 3_____________ requires the nurse to be aware of the professional, legal and ethical issues associated with performing 4____________.

3. 1____________ has various signs and symptoms which nurses should be aware of in relation to their particular patient group. The key function of 2___________ and the digestive system is the removal of 3_____ ________ from the body. As assisting a patient with their elimination needs involves dealing with 4______ ______, awareness of 5_____ _________ prevention and control procedures is vital.

Exercise 2

Tasks and questions

1. Speak about assisting patients with their elimination needs (fundamental skills, essential equipment).

2. How to assess bowel functioning.

3. Describe gastrointestinal system.

4. How to use bedpans, urinals and commodes?

5. Describe the urinary system.

6. Speak about caring for a patient with a urinary catheter.

7. Describe urinalysis and step-by-step clinical skill.

Vocabulary 2

alteration /ˌɔːltəˈreɪʃən/

amber /ˈæmbə/

anus /ˈeɪ.nəs/

approximately /əˈprɒk.sɪ.mət.lɪ/

ascending /əˈsen.dɪŋ/ colon /ˈkəʊ.lɒn/

bedclothes /ˈbedˌkləʊðz/

bile /baɪl/

blot /blɒt/

bolus /bəʊ.ləs/

brain stem /ˈbreɪn.stem/

buttock /ˈbʌt.ək/

button /ˈbʌt.ən/

caecum /ˈsiː.kəm/

calcium /ˈkæl.si.əm/

chart /tʃɑːt/

chyme /kaɪm/

cleanser /ˈklen.zər/

collapsible /kəˈlæpsəbəl/

commode /kəˈməʊd/

cross-infection /krɒs ɪnˈfekʃən/

defecation /ˌdef.əˈkeɪ.ʃən/

descending /dɪˈsend.ɪŋ/ colon /kəʊlən/

diffusion /dɪˈfjuː.ʒən/

dip /dɪp/

drag /dræg/

drainage /ˈdreɪ.nɪdʒ/

drip /drɪp/

duodenum /ˌdjuː.əˈdiː.nəm/

filtration /fɪlˈtreɪ.ʃən/

finding /ˈfaɪn.dɪŋ/

forcibly /ˈfɔːsəbəlɪ/

foreskin /ˈfɔːˌskɪn/

glans /glænz/ penis /ˈpiː.nɪs/

glomerulus /ɡlɒˈmer.jʊ.ləs/ pl glomeruli

hold /həʊld/

ileum /ˈɪl.i.əm/ pl ilea

immerse /ɪˈmɜːs/

indwelling /ˈɪn.dwel.ɪŋ/

invalid /ˈɪn və lɪd/

irritation /ˌɪr.ɪˈteɪ.ʃən/

jejunum /dʒɪˈdʒuː.nəm/

jug /dʒʌg/

labia /ˈleɪbɪə/

large /lɑːdʒ/ intestine /ɪnˈtes.tɪn/

laxative /ˈlæk.sə.tɪv/

mastication /ˌmæs.tikˈei.ʃən/

meatus /mɪˈeɪtəs/

micturate /ˈmɪktjʊˌreɪt/

nephron /nef.rən/

osmosis /ɒzˈməʊsɪs/

pancreas /ˈpæŋ.kri.əs/

part /ˈpɑːt/

port /pɔːt/

portion /ˈpɔː.ʃən/

potassium /pəˈtæs.i.əm/

reabsorption /riː.əbˈzɔːp.ʃən/

reagent /riːˈeɪdʒənt/

rectum /ˈrek.təm/ pl recta

retract /rɪˈtrækt/

rinse /rɪns/

rolling /ˈrəʊlɪŋ/

saliva /səˈlaɪ.və/

secretion /sɪˈkriː.ʃən/

section /ˈsek.ʃən/

segment /ˈsegmənt/

selective /sɪˈlek.tɪv/

semisolid /ˌsemɪ ˈsɒlɪd/

sigmoid /ˈsɪg.mə.ɪd/ colon /ˈkəʊ.lɒn/

sluice /sluːs/

small /smɔːl/ intestine /ɪnˈtestɪn/

sodium /ˈsəʊ.di.əm/

solution /səˈluː.ʃən/

sphincter /ˈsfɪŋk.tər/

stretch /stretʃ/

strip /strɪp/

subdivision /ˈsʌbdɪˌvɪʒən/

talcum /ˈtælkəm/ powder /paʊdə/

transverse /trænzˈvɜːs/ colon /ˈkəʊ.lɒn/

uncircumcised /ʌnˈsɜːkəmˌsaɪzd/

upright /ˈʌpˌraɪt/

ureter /jʊəˈriː.tər/

urethra /jʊəˈriː.θrə/

urge /ɜːdʒ/

urinal /jʊˈraɪnəl/

urinalysis /ˌ jʊə.rɪ.ˈnæl.ə.sɪs/

void /vɔɪd/

washcloth /ˈwɒʃˌklɒθ/

watch /wɒtʃ/ out /aʊt/

Solutions to Exercise 1

1. 1c); 2a); 3b); 4d)

2. 1c); 2b); 3d); 4a)

3. 1c); 2a); 3e); 4b); 5d)

UNIT 3

ASSISTING PATIENTS WITH THEIR HYGIENE NEEDS

Text 1

While maintaining hygiene describes the physical act of cleansing the body, this activity is closely linked with the provision of compassionate care which maintains comfort, dignity, selfesteem and a positive body image, all of which are integral aspects of nursing practice.

We all have personal hygiene practices, formed by our culture, the practices of our family and our own choices. These choices will involve whether we prefer to bathe or shower and if we do this before going to bed, when we wake up or once a week. Further choices are made as to whether we shampoo our hair daily, weekly or whenever we feel it is necessary.

Within these personal preferences illness may be a limiting factor, but encouraging the patient to maintain their usual routine, enabling them to be as independent and feel as in control as possible while offering assistance, is an important aspect of a nurse’s role.

For personal, social, health and psychological reasons, most people are conscious of their hygiene needs. While the focus in maintaining a patient’s hygiene is frequently on cleansing, daily routines do not end when they are clean. We all rely upon the toiletries we are used to, such as deodorant, hair products and cosmetics.

Patients should not only be assisted with washing their hands before meals and after they have used the bedpan or commode; they may well also wish to clean and floss their teeth or dentures after a meal, or wash their hands and face, brush their hair and reapply make-up before visitors arrive. Hygiene interventions in hospital setting may include the use of antiseptic washes and wipes. This requires explanation, as it may be different from the patient’s usual routine.

Your role as a nurse in assisting a patient with their hygiene needs

There are five components of care to consider when working in partnership with a patient and supporting them to maintain their hygiene

Consider and assess the patient’s needs:

✓ What are their exact personal hygiene needs?

✓ Are they able to maintain their own hygiene with minimal support, or do they need full assistance?

Listen to the patient’s preferences and devise a plan:

✓ How is it appropriate to meet the patient’s needs?

✓ Are there any religious/cultural issues you need to consider?

✓ Is a bed-bath needed or can they go to the bathroom for a wash, bath or shower?

✓ Always remember to obtain consent and maintain patient safety. If uncertain, ask.

Environmental and equipment factors:

✓ Can the patient’s needs be safely met in their environment?

✓ If the patient has a carer, can they meet the patient’s needs without putting the patient or themselves at risk?

✓ Don’t forget other equipment – are the patients preferred toiletries available?

Assistance:

✓ Provide the patient with the care they require.

’Nowledge and skills:

✓ Ensure that the patient and/or their carer have sufficient knowledge and skills to continue maintaining their hygiene.

It is your role to assist a patient to maintain their hygiene not only to keep them physically clean, but, just as importantly, for personal, social and psychological reasons. The intimate nature of personal hygiene can trigger inappropriate or challenging behaviour from some patients. Challenging behaviour is deliberate or non-deliberate, non-verbal, verbal or physical behaviour which makes it difficult to deliver good care. Remember the importance of talking to a patient and understanding their psychological, emotional and physical needs, and involve them in care.

If a patient behaves in a challenging or inappropriate way:

• De-escalate the situation by using effective communication skills. Negotiate, compromise, agree to reasonable requests, distract them and if appropriate offer a change of nurse.

• Consider leaving and returning, as soon as patient safety is not compromised.

• Intimate hygiene care can be misinterpreted, so view the situation from the patient’s perspective and be reassuring and non-judgemental.

Common steps for all hygiene procedures

Essential equipment

• Single use bowls,

• warm water,

• towels,

• soap,

• incontinence pads,

• disposable washcloths,

• skin moisturizer or talc (if the patient wishes),

• clean clothes,

• nightwear or gown for the patient,

• clean bedlinen.

Patients with mental health problem – who are severely depressed, for example, may not view their personal hygiene as important. Those with cognitive impairment such as dementia or psychosis may not realize or even understand what is needed.

What to watch out for/action to take

While maintaining a patient’s hygiene you should assess:

• the colour of the skin, lips, nail beds, and sclera of their eyes;

• the location and appearance of any rashes;

• whether the skin is dry and/or flaky;

• the condition of pressure areas, for any bruises, open areas, pale or reddened areas; the appearance of any wounds and whether or not they are draining

• any complaints of pain or discomfort;

• the temperature of the patient’s skin.

Step-by-step clinical skill

1. Ensure privacy, so close doors and curtains/blinds as necessary. If you are at a patient’s bed space ensure you draw the curtains fully. Assist the patient to find a comfortable position and ensure they will not get cold. Only expose the area of the body you need to attend to at that particular moment.

2. As appropriate, encourage the patient to undertake as much of the process as possible.

3. Equipment used for hygiene needs, such as electric shavers, must not be shared between patients.

4. After you have completed the hygiene procedure, remove any towels that have been used to protect the patient and assist them to get into a comfortable position.

5. Remove your apron and perform hand hygiene. Document in the patient’s notes the care you have given and any relevant observations of pressure areas, etc.

To effectively assess and care for a patient’s skin, lips, nail beds, and mouth you need to understand how they should look and what their normal functions are. The tongue is a muscular structure which covers the floor of the mouth. It is attached by its base to the hyoid bone and by a fold of its covering, called the frenulum. The superior (top) surface has numerous papillae (small projections) which contain the taste buds.

The tongue plays and important role in mastication, swallowing, speech and taste.

Translation 1

1. Compassionate care, comfort, dignity, selfesteem, positive body image; 2. go to bed, wake up, personal preferences; 3. illness, limiting factor, offer assistance, personal, social, health and psychological reasons; 4. deodorant, hair products and cosmetics, shampoo the hair, clean teeth or dentures, floss the teeth, brush the hair, apply make-up; 5. assess the patient’s needs, minimal support, full assistance; 6. bed-bath, a wash, bath or shower, put at risk, sufficient knowledge and skills; 7. intimate nature, challenging behaviour, deliberate or non-deliberate, non-verbal, verbal or physical, psychological, emotional and physical needs; 8. de-escalate the situation, negotiate, compromise, agree, change of nurse, reassuring and non-judgemental attitude; 9. essential equipment, single use bowls, warm water, towels, soap, incontinence pads; 10. skin moisturizer or talc, clean clothes, nightwear or gown, clean bedlinen; 11. assess the colour of the skin, lips, nail beds, and sclera of their eyes, any rashes, dry, flaky skin; 12. pressure areas, bruises, open areas, pale or reddened areas, wounds, pain or discomfort, temperature; 13. not get cold, only expose the area you need to attend; 14. document relevant observations, care for a patient’s skin; 15. mouth, tongue, hyoid bone, frenulum, papillae, taste buds, mastication, swallowing, speech and taste.

Text 2

Bed-bathing

Washing removes perspiration, dirt and odours, stimulates circulation, exercises body parts, refreshes, relaxes, promotes comfort and enables evaluation of a patient’s skin. You can assess their mood, whether they are in pain and how they are feeling in general.

Essential equipment

• Single-use bowl x2,

• warm water,

• towel x3,

• soap,

• incontinence pads,

• disposable wash-cloths,

• skin moisturizer or talc,

• clean clothes,

• nightwear or gown for the patient,

• clean bedlinen.

Step-by-step clinical skill

1. Offer assistance as required to undress the patient. Only uncover the area you are washing; the rest of the patient should remain covered by either the bed sheets or a dry towel.

2. Fill a bowl with fresh warm water, check the temperature carefully and if possible check that the patient is happy with the temperature. Change this water at any time it becomes too cool or dirty. Always change the water after washing the perineal area and buttocks.

3. Disposable wash-cloths are much better than a flannel for washing patients as you can dispense with them when they have been used. Bacteria rapidly multiply in wet, warm environments such as a flannel. Always use new wash-cloths for the patient’s face, torso, back and perineal area. To keep the water as clean as possible, do not put a soapy wash-cloth back into the water – dispose of it and use a new one.

4. Start by washing the patient’s face. If possible check with the patient whether they prefer to use soap for areas of their body such as face. If you use soap, rinse it off well. It prevents soap left on the skin from making it dry and itchy. Avoid getting soap in eyes.

5. Wash each area of the patient’s body by wetting the wash-cloth and then wringing it out to prevent dripping water all over the patient. Always pat the skin thoroughly dry with a towel. If possible ask the patient whether they feel dry.

6. Once you have washed the patient’s face, move to the arm furthest away from you. Place a towel underneath and wash the hand, then arm, then armpit using soap. Take special care to avoid any dressings or cannulae. Rinse the soap off well and dry with the towel. Repeat the process for the other arm.

7. Next wash the torso using soap. For female patients or men with gynecomastia, gently lift the breasts and wash underneath. Repeat this procedure with any other skin folds that may be present. Skin under the breasts or skin folds need to be cleaned and dried to avoid fungal infections. Once again, be very careful not to get any dressings, drains, or other lines wet. Rinse the soap off and dry the area thoroughly.

8. If the patient wishes, apply deodorant, moisturizer or talc.

9. Lift the bedsheet back to expose the patient’s feet and legs, but ensure you keep the genitals covered. Place a towel under the leg furthest away and wash the foot and leg with soap. Ensure you clean very gently between the toes. Rinse well. Dry thoroughly and repeat with the other foot and leg.

10. Change the water and put on gloves if you were not already wearing them.

11. Ask the patient if you can wash their genitals now and obtain their consent. Some patients may wish to wash this area themselves, so offer them this opportunity.

12. The genital/perineal area is very delicate and needs special care. Wash very gently with warm water alone, rinse well and pat dry. Work from the cleanest to the dirtiest area, so from the front to back (urethral to anal area). To wash the uncircumcised adult male patient you will need to gently retract the foreskin to wash the urethral meatus. Remember to gently return the foreskin after washing to prevent swelling and discomfort.

13. If the patient has a catheter, carry out the appropriate catheter care in line with the local policy.

14. When clean and dry, re-cover the patient and dispose of the water and the single-use bowl. Remove your gloves and wash your hands. Reapply gloves if necessary and refill a new single-use bowl with warm water.

15. Even if the bedlinen is not wet or soiled, this is a good time to change it. Ensure the bed is at the correct height and use a slide sheet if required to reposition the patient.

16. Assist the patient to roll onto their side, facing away from you and towards the other carer. Ensure the other carer is able to support the patient and the patient feels safe. Cover the patient’s front with the bed sheet.

17. Roll the old sheet into the middle of the bed and place a towel behind the patient.

18. Use soap to wash the patient’s back, then rinse and dry thoroughly.

19. Ask the patient’s consent to wash their sacral area/buttocks. If the patient is soiled put on gloves. Wash, rinse and dry thoroughly.

20. Remove the towel from behind the patient. If sheet rolled up behind/under patient is damp or soiled, cover with an incontinence pad.

21. Tuck a clean sheet under mattress edge closest to you; smooth it over the mattress behind the patient and roll up the part which will go under the patient.

22. Assist the patient to roll on to their other side; remember to tell them they will roll over a bump due to the rolled sheets. Remove old sheet and incontinence pad if appropriate. Dispose of them as per policy.

23. Unroll clean sheet and tuck tightly under the mattress.

24. Assist the patient to re-dress as appropriate and move into a comfortable position.

25. Finish changing the bedlinen by putting clean pillowcases on the pillows, with a clean top sheet and blankets if required.

26. Dispose of bowl or clean with detergent and water if reusable. Store inverted to avoid dregs of water collecting in it. Dispose of/clean any other equipment and return any of the patient’s equipment to their locker. Clean the bedside table and put any belongings you moved back in their original position.

Translation 2

1. Remove perspiration, dirt and odours; 2. refresh, relax, promote comfort; 3. face, torso, back and perineal area, rinse soap off, dry and itchy skin; 4. dripping water, wring the washcloth out, wash the hand, then arm, then armpit, avoid any dressings or cannulae; 5. lift the breasts, other skin folds, avoid fungal infections; 6. not to get any dressings, drains, or other lines wet; 7. feet and legs, clean gently between the toes, rinse well, dry thoroughly; 8. urethral, anal area, re-cover the patient, dispose of the water, change bedlinen; 9. bed at the correct height, roll onto the side; 10. roll the sheet into the middle of the bed, wash the patient’s back, sacral area; 11. tuck a clean sheet under mattress edge, put clean pillowcases on the pillows, blankets; 12. return patient’s equipment to their locker, clean the bedside table, put any belongings in their original position.

Text 3

Shaving

For many men shaving is an important part of their daily routine, although some men may choose not to shave for religious or cultural reasons. If the patient does shave, they should be offered the opportunity to do so daily. They may need you to shave them, or just need support and assistance.

If you are going to shave them, an electric razor will provide the greatest safety. If the patient has their own electric razor you can use this, but, if not, a disposable safety razor is perfectly acceptable as long as the patient is not suffering from a coagulation disorder or on anticoagulation therapy.

For these patients you must use an electric razor. If a patient is cut during a shave, use clean gauze and apply firm pressure until the bleeding stops. Due to the risk of cross-contamination, razors of any type are never shared. Remember the importance of ensuring safety razors are stored safely, especially in settings caring for vulnerable patients or those who may self-harm.

Essential equipment

• Using an electric shaver – electric shaver,

• bowl,

• warm water,

• towel,

• mirror and moisturizer or aftershave (if the patient wishes).

Step-by-step clinical skill

1. Drape a towel around the patient’s front to protect clothes.

2. Wash the patient’s face and dry it thoroughly to clean the area. It enables observation of the skin plus any shaving preferences, such as sideburns, etc.

3. If any of the stubble is more than 1 cm or so long, use a beard-trimmer to cut this first. Long hairs will be pulled out rather than cut by an electric shaver or safety razor.

Electric shaver – shave in the opposite direction to hair growth, making small circular motions if the patient has short stubble. For longer stubble create larger circular motions. Avoid repeatedly shaving the same area.

Safety razor – apply shaving foam to the patient’s face and neck. Pull the area you are about to shave taut – where you start is a matter of preference. Angle the razor to approx. 45 degrees away from the face. Using as little pressure as possible, move the razor across the skin in the direction of hair growth. Repeat this process once more on the same area of skin and then move to another area. Frequently dip the razor into the warm water. If there is a large amount of stubble you may need to use more than one safety razor. Rinse the patient’s face with cool water when you have finished shaving all areas.

4. If the patient desires apply moisturizer or aftershave, but remember if you use aftershave to apply it sparingly, as it can sting. Do not apply moisturizer of aftershave to areas of sore or broken skin.

5. Assist the patient to look at his face in the mirror to ensure they approve of the result.

Translation 3

1. Shaving, electric razor, never share razors, disposable safety razor, mirror; 2. coagulation disorder, cut during a shave, clean gauze, firm pressure; 3. vulnerable patients, self-harm, observation of the skin, sore or broken skin; 4. beard-trimmer, small circular motions; 5. dip the razor into the warm water, apply shaving foam, rinse with cool