The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [310]
15 Inspect finger and toe nails, clean under nails using nail file. Cut or clip finger nails to top level of finger, edges can be shaped using an emery board. Toe nails should be cut/clipped straight across. Note any area of skin dryness, inflammation, calluses. To enhance positive body image and patient comfort and reduce risk of infection (NMC 2008b, C).
16 If the patient is to remain in bed, replace clothes and change bottom sheet whilst the patient is being turned. Care should be taken to prevent shaking the sheets and allowing particles to enter the atmosphere. Contact with your clothing must be avoided so the linen should be placed directly into the linen skip. Ensure a minimum of two nurses are present during this procedure. To reduce unnecessary activity for patient and nurse.
To prevent any bacteria from the sheet entering the atmosphere and surrounding environment (Parker 2004, C; Pegram et al. 2007, C).
To maintain safety of patient and safe manual handling, following risk assessment (NMC 2008b, C).
17 Provide appropriate equipment, and assist patient if required, to brush teeth and/or rinse mouth. To maintain good oral hygiene and prevent infection (Fraise and Bradley 2009, E; Parker 2004, E).
18 Dry and comb patient’s hair as desired. To enhance patient comfort, and to promote positive body image (NMC 2008b, C).
19 Remake top bedclothes.
20 Help patient to sit or lie in desired position. To enhance patient comfort and reduce risk of pressure area breakdown (NMC 2008b, C).
21 Remove equipment from bedside; replace patient’s possessions in their appropriate place. Place locker, bedside table and call bell within reach. To maintain a safe environment and promote patient independence (NMC 2008b, C).
22 Remove apron and gloves and dispose of them according to local regulations. To prevent cross-infection (Pratt et al. 2001, C).
23 Wash hands, using alcohol-based handwash. To prevent cross-infection (Fraise and Bradley 2009, E).
Postprocedure
24 Document any changes in planned care. To provide recorded documentation of care and aid communication to the multiprofessional team (NMC 2009, C).
Eye care
Definition
Eye care is the process of assessing, cleaning and/or irrigating the eye, including the instillation of prescribed ocular preparations where applicable; patient education is also included (Stollery et al. 2005, Watkinson and Seewoodhary 2007).
Anatomy and physiology
The eye consists of three main parts: the orbit, the globe (eyeball) and the extrinsic structures.
The orbit
The orbit or socket is formed by seven bones of the skull and is lined with fat; it supports and protects the globe and its accessory structures (blood vessels and nerves) and provides attachments for the ocular muscles (Stollery et al. 2005).
The globe
The globe is approximately 2.5 cm in diameter and can be divided into three layers (Figure 9.2).
The outer layer or fibrous tunic is composed of the transparent cornea and the white sclera. The primary function of the outer layer, in particular the sclera, is protective and it gives shape to the eyeball. The cornea functions as a refracting and protective membrane through which light rays pass on their route to the retina (Watkinson and Seewoodhary 2007).
The middle layer or vascular tunic comprises the choroid, ciliary body and iris; the globe’s vascular supply is provided by the choroid.
The inner layer or nervous tunic is composed of the retina, which contains the light-sensitive cells called the rods and cones and is responsible for converting light rays into electrical signals that are transmitted to the brain via the optic nerve. This area contains the macula