Admission

ADMISSION, OBSERVATION AND DISCHARGE OF PATIENTS

Admission Is the allowing of a patient(s) to stay in hospital for observation, investigation, treatment and care purposes. Purpose (of Admission):

• For proper management of the patient’s condition.
• To assess the patient’s status from which a nursing care plan can be initiated and implemented.
• To make the patient feel welcome, comfortable and at ease.
• To acquire vital information regarding the patient for further management.
• To monitor the patient’s progress and sudden changes; this produces fear and anxiety.

Types of admission:

• Emergency admission: This means the patient are admitted in acute conditions requiring immediate treatment e.g. patient with accidents, poisoning, burns and heart attacks. Routine admission is postponed until the patient is out of danger.
• Routine/planned admission: The patients are admitted for investigations, medical or surgical treatment given accordingly e.g. patients with hypertensions, diabetes and bronchitis. Preparation before the arrival of the patient on ward is started when the ward is informed of incoming patient and all the necessary items are made ready according to the patient’s condition.

General Rules on Admission:

• Nurses should make every effort to be friendly and courteous with the patient (good nurse-patient relationship)
• Make proper observations of the patient’s condition, record and report.
• Orient the patient and relatives to hospital and ward policies.
• Observe policies in dealing with medico-legal cases.
• Deal with the patient’s belongings very carefully to prevent communicable diseases.
• Isolate the patients who are suffering from communicable diseases.
• The nurse should recognize the various needs of the patient and meet them without delay.
• There is need to understand the fears and anxieties of the patient and help them to over come.
• The nurse should find out the likes and dislikes of the patient and include the patient in his plan of care.
• The nurse should address the patient by their name and proper title.
• The patient’s valuables and clothes should be handed over to the relatives with proper recording.

Equipment needed for admission:

• Admission bed
• Vital observation equipment
• Equipment used for physical examination such as weighing scale, inch tape measure etc.
• Admission forms (patient’s case sheet, doctors, nurses’ and progress notes)
• Investigation forms (blood, x-ray, urine stool and sputum)
• Bath trolley if needed.
• Complete record in a file.
• Emergency treatments, oxygen apparatus, suction apparatus.
• Admission book.

Procedure (Admitting a Patient):

1. When the ward has been informed that a new patient is going to be admitted, a bed is prepared either; an admission bed for a seriously ill patient as this patient needs a bed bath OR an occupied bed for walking patient as s/he will be able to go to the bathroom.
2. On arrival: – greet the patient and relatives and introduce yourself to them.
3. Receive the patient cordially and seat them comfortably.
4. Introduce the patient to other persons in the ward if necessary.
5. Complete the admission record and should be filled in block letters especially full name, age, address, phone number if possible.
6. Collect history and carry out simple physical examination e.g. vital observations, weight and consent form signed if required. The charts are filled by the nurse in charge.
7. Issue visitor a pass or explain to the relatives rules about visiting hours and then they can leave. Do not let them go if you will need consent form signed in case of minors.
8. Handover the patient’s valuables to the relatives if need be.
9. Orient the patient to the ward; toilet, bathroom, drinking water supply, nurse’s station and treatment room.
10. Help the patient to maintain personal hygiene and change into hospital clothes. A bed bath should be given to patients who cannot do it for themselves and those who can go to the bathroom depending on the condition.
11. Encourage the patient to take hospital diet if any, especially when therapeutic diet is ordered.
12. A specimen of urine should be obtained, tested or sent to the laboratory for investigation.
13. A nurse should observe the patient, during the admission especially when giving a bed bath and note any obvious deformities or skin conditions and report or record in the patient’s chart.

Observations made on admission:

The nurse should observe the patient for the following;

• Observe the whole patient, whether weak, paralyzed, emaciated edematous, dehydrated etc.
• Special observations:
  • Skin: color; pale, blue, jaundice, on touch, warm/cold, clammy or dry, sores, operation scars etc.
  • Eyes: yellow, infected, sunken
  • Mucous membrane: pale, blue, dry, moist, tongue; coated, conjunctiva; pale, infected
  • Skeletal system: deformities, injuries, wounds, paralyzed, gait.
  • Excreta: stool; color, quantity, smell, formed or diarrhea, with blood. Urine; color, quantity, smell, frequency. Vomit; frequency, quantity, content. Sputum; mucus, blood, purulent. Vital observations: Temperature, Pulse rate, Respiration, Blood pressure.
• Mental state: oriented, conscious, semi-conscious, unconscious, delirious.
• Position in bed: posture
• Facial expression: anxious, worried, feeling pain.

Equipment for diagnostic examination:

All the equipment needed for the physical examination are kept ready at hand.

• Sphygmomanometer
• Stethoscope
• Fetoscope
• TPR tray (thermometer, wrist watch and patient’s chart)
• Tongue depressor
• Pharyngeal retractor
• Laryngoscope
• Tape measure
• Flash light (torch)
• Weigh machine and height measurement
• Ophthalmoscope
• Otoscope
• Tuning fork and head mirror
• Nasal speculum
• Patellar hammer (percussion hammer)
• Safety pins
• Cotton wool
• Cold and hot water
• Snelle’s chart
• Alcohol swabs
• Drape or sheet
• Dressing gauze
• Gloves (sterile and non-sterile)
• Lubricants
• Pen light
• Wool or cotton applicator
• Skin pencil
• Substance for testing smell (e.g. pepper, mint) and taste (sugar, salt)
• Toilet paper
• Swabs
• Sponge forceps
• Specimen containers and slides
• Protoscope
• Spatula
• Vaseline or KY jelly
• Hebitane/antiseptic lotion
• Labels and lab forms
• Test tubes and pipettes
• Vaginal speculum

Methods of Examination:

• Inspection: Visual examination of the body is called inspection. It is the observation with the naked eyes to determine the structure and functions of the body.
• Palpation: It is the feeling of the body or parts with the hands to note the size and positions of the organs. In palpation the finger pads are used to feel, not the finger tips.
• Percussion: Is the examination by tapping with the fingers on the body to determine the condition of the internal organs by the sound that’s produced. It is done by placing a finger of the left hand firmly against the part to be examined and tapping with the finger tips of the right hand.
• Auscultation: It is the listening to sounds within the body with the aid of a stethoscope, fetoscope or directly with the ear placed on the body.
• Others: Manipulations: It is moving of the part of the body to note the flexibility. A limitation of movements is discovered by this method.
• Testing reflexes: The response of the tissues to external stimuli is tested by the means of percussion patellar hammer, safety pins, wisp of cotton, hot and cold water etc.

ROLES OF NURSE BEFORE, DURING AND AFTER THE DIAGNOSTIC EXAMINATION

Before (Diagnostic Examination):

• Nurse prepares patient by ensuring the patient understands and compliance with the pre-procedure requirements.
• Reassurance of the patient and care taker/family.
• Teach relaxation techniques e.g. deep breathing exercises.
• Ensure the patient is in the list of patients to be worked on.
• Collect the specimen for investigation including blood for grouping and cross matching.
• Pass catheter if need be.
• Nil per mouth if ordered by the physician.
• Removal of objects e.g. jewellery or hair clips and any other object which will interfere with the procedure.
• Ensure all supplies and equipment to be used available
• Review patient’s history and physical information to determine current condition, chief complaint.
• The patient’s identity is checked
• Ensure safe keeping of the patient’s valuables
• Determine current medications patient is taking, existence of allergies, history of drug use or abuse including tobacco and alcohol, adverse experience with anesthesia, sedatives or analgesics and last oral intake.
• Reinforce physician’s explanations of procedure to patient and family-patient education.
• Minimize anxiety through anxiety management techniques, ensuring short waiting time and offering reassurance and support
• Ensure written consent is obtained
• Obtain and document baseline data on patient; temperature, heart rate, and rhythm, respiratory status including oxygen requirements, depth of respirations, breath sounds and oxygen saturation, blood pressure, skin condition, level of consciousness and mental status, ability to ambulate, weakness and/or sensory loss in extremities (if indicated), and description and intensity of any current painful condition.
• Pass I.V line and regulate continuous infusion at a keep open rate.
• Prepare all drugs to be administered including readying reversal agents for possible administration.

During (Diagnostic Examination):

• Administer medications under direct supervision of responsible physician.
• Continuously observe and document patient responses.
• Provide reassurance and emotional support throughout the procedure.
• Inform the physician immediately of adverse response or any significant changes in baseline parameters.
• Maintain continuous I.V line if required.
• Perform emergency management procedure if necessary.
• Continuous reassurance of the patient and care take (if any) during the procedure.
• Encourage relaxation of the muscles.
• Check the patient’s identification band to ensure the correct patient.
• Review the medical record of allergies.
• Assess vital signs including pain throughout the procedure.
• Assist the physician with the procedure.
• Assess the patient’s ability to maintain and tolerate the prescribed position.
• Assess for related symptoms indicating complications specific to the procedure.
• Remain with the patient during induction and maintenance of anesthesia.
• Position, drape and monitor the patient’s condition e.g. monitor the patient’s air way.
• Explain what the physician is doing so that the patient knows what to expect.
• Label and handle the specimen according to the type of materials obtained.
• Secure clients transport from the diagnostic area.

After (Diagnostic Examination):

• Check the identification band and call the patient by name.
• Assess the patient closely for signs of air way distress, adverse reaction to anesthesia or other medications.
• Assess for bleeding in those areas where a biopsy was performed.
• Continue monitoring the patient’s condition – observe and record the vital parameters
• Position the patient in recommended position for comfort and accessibility to facilitate performance of nursing measures.
• Assess and document vital signs including pain and monitor according to the frequency required for the specific test.
• Notify the physician when any results are obtained from the diagnostic test
• Reassure the patient and family
• Maintain I.V line if required and administer medications prescribed.
• Implement the physician’s orders regarding the post procedure care of the patient.
• Evaluate the patient’s tolerance to exercises and oral fluids.
• Record the procedure.
• Notify the physician when the patient is fully alert or recovered for an order to discharge.
• Review discharge instructions.