Unit 3  Admitting and Discharging the Patient

Chapter 1  Admitting the Patient

The Admission Routine

The patient arrives at the nursing unit 

Before the patient arrives, the nurse should check to be sure that the unit is equipped completely and in order, and open the bed.

Checking the doctor’s orders  

When a patient is admitted, the admitting nurse check the doctor’s order sheet for any stat (at once) orders, such as medications to be given or tests to be done.

Removing the patient’s clothes   

Give the patient whatever assistance he may need in undressing; sometimes a member of the family will assist, particularly if the patient is a child, for a child may resist being undressed by a stranger or may not understand the need for his going to bed during the day.

Assisting the patient into bed

If a patient is weak or tired when admitted, remove his shoes and outdoor clothing and help him to lie down on the bed immediately. Cover him with a bath blanket or with the bedclothes. His lying down will help to prevent more fatigue.

Orienting the patient to the hospital 

Find out from the head nurse or team leader what the patient is allowed to do. If he is allowed bathroom privileges (BRP), show him where the bathroom. Put his bathrobe and slippers in a spot that is handy for him.

Observation of the patient 

To help plan a newly admitted patient’s treatment, the physician depends on the admitting nurse’s ability to collect meaningful data about that patient. A skilled nurse needs excellent powers of observation, and a systematic approach to information gathering.

Reporting an admission 

The admitting nurse should report to the head nurse or charge nurse when the admission procedures are completed. Typically, the charge nurse is extremely busy, and therefore she may not always know exactly when a new patient reaches the unit. Report notes that you made either mentally or on paper during the admission procedure, along with your regular nurses’ notes.

Admitting the critical patient 

If the patient is critically ill, take him straight to the ICU or emergency room. Prepare emergency equipment and medication for the patient. Observe the patient’s condition such as temperature, pulse, respirations, blood pressure and so on. Inform the doctor of seeing the patient immediately. The patient who is unable to relate correctly the history of his condition and demand may let his relatives or members of his family accompany him.

Classifications of Nursing Care

Special classic nursing 

Suit for critical patients needing to be observed at anytime such as severe trauma, sophisticated operation, organ transplanting, a large amount area burned and some emergent medicines. Intervention includes:

 ● Arrange special nurses to take care of the patient in 24 hours.

● Observe carefully the patient’s condition and vital signs.

●  Make planning and correctly carry it out.

●  Fill in special nursing sheet.

●  Prepare emergent equipment and medications for the patient.

●  Provide good basic nursing care for the patient and keep the patient comfortable and safe.

The first classic nursing 

Suit for critical patients needing to take rest absolutely such as all kinds of sophisticated operation, shock, coma, paralysis, high fever, severe hemorrhage, renal failure, liver failure, heart failure and premature infant. Intervention includes:

●  See the patient at every 15~30 minutes.

●  Observe the patient’s condition and vital signs.

●  Make planning for the patient and correctly carry it out.

●  Fill in correctly special nursing sheet timely.

●  Give good basic nursing car中国卫生人才网e for the patient and prevent the patient from taking complications

 ●  Meet the patient’s psychological and physiological needs.

The second classic nursing 

Suit for the patients who are unable to care for themselves such as after miner operation, older and weak adults, children and chronical disease patients needing to take more rest.

Intervention includes:

●  See the patient at every 1~2 hours.

●  Observe the patient’s condition.

●  Provide the nursing care for the patient according to the routine of nursing practice.

●  Assist necessarily the patient to meet daily emotional needs.

The third classic nursing 

Suit for the patients who can care for themselves basicly such as chronic disease, the period of the disease recovery and optional operation.

Intervention includes:

●  See the patient twice everyday.

●  Observe the patient’s condition.

●  Provide the nursing care for the patient according to the routine of the nursing practice.

●  Teach the patient knowledge about the disease.

●  Instruct the patient to follow in the principles of the hospital.

●  Meet the psychological and physiological needs of the patient.

Chapter 2  Discharging the Patient

Discharge planning 

In the hospital, the head nurse is responsible for seeing that the patient or the family has the necessary instruction. The patient, at discharge, must know:

●  The day and the date for the next scheduled visit to or by the doctor or to the clinic for a checkup. Remind him of getting advice from the doctor when he needs it.

●  How and when to give medications. Explain the need for care, caution and accuracy. Teach him to do it exactly as you do.

●  How to change dressings. Show how and explain why. Tell him where to get the dressings.

●  The amount of rest that the patient must have and the amount of activity that he is allowed.

●  The diet. Describe it as simply as possible. Name the foods that are not allowed, the foods that are necessary every day, and the amounts allowed. The patient might make out a day’s menu and discuss it with you. In the hospital the dietician usually gives instructions about special diets.

Chapter 3  Methods of Transferring and Moving

Guidelines of Transferring and Moving a Client

Frequently it is necessary to move a helpless client. The client must be kept in good alignment and protected from injury while being moved. There are certain recommended guidelines the nurse should follow when moving and lifting clients:

●  Know the client’s d医.学全在线iagnosis, capabilities, and any movement not allowed. Place braces or any device the client wears before helping from the bed.

●  Plan carefully what you will do before moving or lifting a client. Assess mobility of attached equipment, You may injure the client or yourself if you have not planned well. If necessary, enlist the support of other nurses. This reduces the strain on all involved.

●  Be sure the client is in good body alignment while being moved and lifted to protect the client from strain and muscles injury.

●  Move your body and the client in a smooth, rhythmic motion. Jerky movements tend to put extra strain on the muscles and joints and make the client uncomfortable.

Transferring methods of the cart

The transferring methods of the cart are usually used to transfer those clients such as fractures and serious patients. Safety and comfort are very important when the nurse assist the client out of the bed. The client must be kept in good alignment and protected from injury while being moved.

●  Movement:

●  One-carrier lift

●  Two-carrier lift

●  Three-carrier lift

●  Four-carrier lift