INSTRUMENT INDENTIFICATION IN THE WARD

1. NASAL PRONG/ NASAL CANNULA

A nasal cannula/nasal prong allows the

delivery of oxygen concentrations of between 24
to 40% at flow rates between 1 to 6LPM making
them suitable for use with most portable oxygen
concentrator units.
One end of the plastic tubing is equipped
with curved nasal prongs which fit into the
front of the nostrils, with the loop hooked
over the ears and the end attached to an
oxygen source.

2. VENTI MASK/ FACE MASK

open side ports to allow

air to enter and dilute the
oxygen as well as allow
the escape of carbon
dioxide.
The mask is attached via
an elastic strap which fits
behind the head and over
the ears with the end of
the tubing attached to an
oxygen source.
A face mask allows
oxygen delivery via either
the nose or mouth so is
suitable for nose and or
mouth breathers.
allow higher
concentrations and rates
of flow of oxygen.

3. HUMIDIFIER OXYGEN
 Rationale:

Cold, dry air increases

heat and fluid loss
Medical gases
including air and oxygen have
a drying effect and mucous
membranes become dry
resulting in airway damage.
Secretions become
thick & difficult to clear or
cause airway obstruction
Indications:
I. Patients with thick copious secretions
II. Non-invasive and invasive ventilation
III. Nasal prong flow rates of greater than 2 LPM (under 2 years of age) or
4 LPM (over 2 years of age)
IV. Facial mask flow rates of greater than 5 LPM
V. Patients with tracheostomy
4. high flow mask

5. nebulizer

there will be
gas coming out
from the mask

6. IV CANNULA
Indications : Contraindications :
I. Administration of fluids I. Sites close to infection
II. Administration of medication II. Veins of fractured limbs
III. Administration of blood and III. Where there is AV fistula
blood product present
IV. Radiological imaging using IV IV. Oedema
contrast V. Affected side of CVA
VI. Side of mastectomy
Location of IV cannula :
Arm and forearm

Complications :
hemato ma:
infiltratio n:
-when infusate enters the
subcutaneous tissue instead of
the vein.
embol ism:
- this can be caused by air, a
thrombus, or fragment of a catheter
breaking off and entering the
venous system. Possibly even
causing a Pulmonary Embolism. Air
emboli can be avoided by making sure that there is no air in the system. A
thromboembolism can be avoided by using a smaller
cannula.
phlebitis:
-inflammation of the vein
7. IV solution
8. TPN (TOTAL PARENTERAL NUTRITION)
 INDICATIONS : IV. Essential vitamins, minerals
I. Some stages of UC COMPLICATIONS :
II. Chrons disease
III. Bowel obstruction I. Infection
IV. Gastroschisis II. Blood clots
V. Prolonged diarrhea III. Fatty liver, liver failure
IV. Hunger
CONTENTS : V. Cholecystitis
-statis of bile salts because no
I. Water
food ingestion
II. Glucose
VI. Gut atrophy
III. Amino acids
-GIT lama xpakai

9. Incentive spirometry
Biasa case bladder ca.

INDICATIONS :
I. Improve lung functions after surgery (post-
anesthesia)
II. Prevent pneumonia
III. Prevent atelectasis

Xnak bagi alveolar collapse

10. DRAIN 15. 4. To form a controlled

11. Indications: fistula e.g. after common bile
12.1. To eliminate dead space duct exploration Indication
13.2. To evacuate existing
accumulation of fluid or gas, 16. Classifications :
To remove pus, blood, serous 17. Open Vs Closed Systems
exudates, chyle or bile Open: ada gauze pad atau
14.3. To prevent the potential
stoma bag. the risk of
accumulation of fluid or gas
infection
 Closed: tubes draining into a 18. Active (suction) Vs. Passive
bag or bottle. Include chest (gravity)
and abdominal drains
19. Types:
20.
21.
22.
T-tube
23.
24.
Penrose drain
25.
26.
Pigtail catheter
27.
Drain from pleura
28.
space.
29.
30. bengkok sbb nak
31. slowkan flow kalau
32. x burst out leads to
33. injury
Redivac
34. abscess
Active drainage.
drainage. with
35. Cth: bile, urine,
vacuum. (high negative
36. Types of exudate: pressure)
37. Serous (clear)
38. Sero-sanguineous (pink) Cth: drain blood bawah
39. Sanguineous (red) kulit, (mastectomy,
40. Wound Assessment thyroidectomy) or deep
41. Location space
42. Size
43. Condition (Odor, Colour &Temp)
44. Types of tissue found
45. Wound drainage
46. TED stockings (thrombo-embolism deterrent stockings)

47.
48. INDICATIONS : III. Support venous and lymphatic
drainage in bed ridden patient
I. Prevent DVT
-post surgery patient
II. Use in chronic venous disease
 49. CONTRAINDICATIONS II. Heart failure
: III. Septic phlebitis
IV. Oozing dermatitis
I. Peripheral obstructive arterial V. Advance neuropathy
disease
50.
51. URINE CATHETER/FOLEY CATHETER (CBD)
52.
53.
54.
55.
-size 10-12 french(female)56.
Or
57.
-Size state 14-18 french(male)
58.
59.
60.
61.

62. INTRODUCTION 7. Empty bladder before

surgery to avoid infection
1. Made from latex-cannot keep during surgery
more than 1 week
8. Take sample of urine for
2. There are other foley catheter culture
that made from silicon that
can last for 3 months. 64. CONTRAINDICATION

3. Inflate by 30ml of distilled 1. Urethral trauma

water
65. COMPLICATION
63. INDICATION
1. Infection
1. Bladder outlet obstruction
2. Trauma
-mass on hypogastrium
3. Aggrevate trauma
2. Renal failure
4. Retention of the catheter
3. Intravesical chemotheraphy
5. Stricture
4. Hemostasis drainage
66. IMPORTANT STEP
5. Take foreign body in
esophagus 1. Consent
6. Monitor urine output 2. Indication
-postoperative
3. Ask patient for urogenic
bladder
-do not feel to pass urine
 4. Sterile table of procedure 4. Put lubricant on the catheter
67. PREPARATION 5. Insert catheter whole inside
penis until reach the bladder
1. Cleaning solution
-chloro hexidine 6. Attach bag
2. Catheter 7. Insert 30ml distilled water and
inflate ballon
3. Lubricant
8. Tape the catheter to the hip
4. Sterile glove
9. Clean the part
5. Drainage bag
70. Taking out the
68. PROCDURE
bladder
69. Putting inside the
1. Drain water to deflate the
bladder
ballon
1. Wear glove
2. Take out and dispose in to
2. Hold pens straight yellow bin

3. Clean penis straight with swab 3. Clean the penis and

surrounding
71.
15. 24 hours urine collection/ hourly urine collection aka Urine
meter
72.

to calculate urine output hourly

risk of AKI in a patient

73.
74.
75.
76.
77.
16. STOMA
78. INTRODUCTION :
I. Surgically opening from the inside of an organ to the outside.
II. Stoma from the word mouth/ opening
79. TYPES :
I. Colostomy
80.- opening from the large intestine to the abdominal wall so faeces bypass
the anal canal.
 81.
II. Ileostomy
82.- opening from the small intestine to the abdominal wall so faeces bypass
the large intestine and the anal canal.

83.
III. Urostomy
84.- connection between the urinary tract and abdominal wall leading to a
'urinary conduit' so urine passes straight into a stoma bag and thus
bypasses the urethra.
IV. Gastrostomy and jejunostomy
85. - openings between the stomach and jejunum respectively and the
abdominal wall, used predominantly for enteral feeding tubes
86.

87. 93. location: RIF

88. 94. effluent: continuous, liquid
89. ILEOSTOMY 95.
90. type: temporary (as a loop ileostomy) 96.
or permanent 97.
91. indications: IBD, inherited polyposis 98. COLOSTOMY
coli syndrome
92. appearance: spout of mucosa
99. type: temporary (as a loop, but largely
replaced by loop ileostomy) or
permanent (an as end)
100. indications: colorectal
cancer, diverticular disease
101. appearance: flush with the
skin, mucosa sutured to skin
102. location: permanent: LIF,
temporary, LIF or right hypochondrium
103. effluent: intermittent and solid
 104.

105. Introduction

name and role

explain dkt pt
explain kenapa nak check
dpt consent
confirm the patients name and age

106. Preparation
wash hands
put on gloves
appropriate exposure 'nipples to knees'

107. Examination
ask PAIN
108. EXTRA: asking the patient about pain shows good clinical care to the patient and
avoids you looking incompetent infront of the examiner (and the patient!) if later on pain is
ellicited to your surprise.
INSPECT from the end of the bed to see if the patient looks well, abdominal contour,
scars, swellings and the site of the stoma
109. EXTRA: a general inspection allows one to ascertain the sick from the well patient
and to pick up clues as to the possible underlying disease/s that the patient may be suffering
from, while assessing its site allows one to begin to build up clinical information to differentiate
between ileostomies, colostomies and urostomies.
INSPECT the stoma closely noting its colour, number of lumens, presence of a
spout or flush with the skin, presence of blood, mucus or leakage of faeces
110. EXTRA: stomas should be a healthy pink/red colour and should be moist and
glistening. Darker and matter hues may indicate ischaemia while a pallor may suggest
anaemia. Sometimes the number of lumens is difficult to determine by inspection alone and a
digital examination may be required. The number of lumens detected will allow distinction
between an end, loop or double barrelled stoma. The presence of a spout identifies an
ileostomy while a stoma flush with the skin is usually a colostomy.
INSPECT the stoma bag noting the colour, consistency and the volume of the
contents
111. EXTRA: brown fully formed contents suggest a colostomy. Semi-solid or liquid
contents dark green in colour suggest and ileostomy. Ribbon like stools may indicate
stenosis. Yellow liquid suggests a urostomy and hence urine in the bag. The volume of the
stoma bag contents is extremely important as a common complication of
stomas is high output loss and fluid and electrolyte imbalance. Large volumes passed may
therefore require adequate fluid management, while reductions in volume may indicate
stenosis and therefore an impending obstruction.
INSPECT the surrounding skin for erythema, rash, ulceration and mucocutaneous
junction seperation
PALPATE the surrounding area for tenderness and masses such as parastomal hernias
112. EXTRA: stomas cause a range of complications such as skin
changes that include erythema, fissuring and allergic reactions due to the materials used in
the stoma equipment, necessitating the use of barrier creams and seals. Other complications
 include bleeding, separation between the mucocutaneous edge and skin, prolapse,
parastomal hernias, narrowing and subsequently obstruction.
PERCUSSION of the abdomen
AUSCULTATION to ensure bowel sounds are present and therefore an indication of a working
bowel
113. EXTRA: Digital examination of the stoma
114. This is not routinely done in a stoma examination and is more often left to a senior or
more experienced member of the team to carry out when indicated. For completion, it
includes the insertion of a gloved lubricated index finger into the stoma lumen. At times, this
may be all that is needed to relieve an obstruction due to adhesions or fibrosis. The removed
gloved finger is then inspected for faeces, blood or mucus.
115.

116. FEATURES HEALTHY STOMA :

117.
I. Stoma should be above the skin level.
II. Red and moist stoma (pallor = anaemia;
dark hue= ischaemia).
III. No separation between the
mucocutaneous edge and the skin.
IV. No erythema, rash, ulceration or
inflammation

118.
119. Complications of Stomas
Poor siting site susah nak jaga. Should be senang nampak and away from bone, old scars
or the umbilicus.
Stoma proper masalah stoma tu sendiri necrosis, retraction, prolapse, bleeding and luminal
stenosis, functional disorders such as diarrhoea and constipation
Peri-intestinal area - parastomal hernia.
Mucocutaneous junction stoma dgn kulit tepi stoma terpisah. separation of the stoma
from the peri-stomal skin. erythema complication of poor surgery or secondary to retraction or
necrosis. Common in the immunocompromised state such as patients receiving steriods, DM and
malnourished
Iatrogenic - Iatrogenic complications include belts that rub the stoma, razors when shaving
peri-stomal skin. Injury to stomas often goes unnoticed as stomal mucosa has no nerve endings.

120. MEDICATION THAT HELPS PATIENT

I. DIARRHOEA
121. -loperamide, opiates, codeine phosphate
II. Constipation
-magnesium hydroxide, ispaghula husk
122. RESECTION TYPE OF STOMARESECTION TYPE OF STOMA
123.
124. Hartman
n
procedure

125. Emergency
procedure

126. Diseased
large bowel (eg.
colorectal
tumours) is
removed
leaving the
proximal
segment of
bowel as an end colostomy while the remaining distal bowel is oversewn as a rectal stump.

127. months later, once the inflammatory process has subsided, the two ends of bowel
may be rejoined. However, often the colostomy is well tolerated that another major rejoining
operation is avoided.

128.
17. TYPES OF ABDOMINAL INCISION Paramedian
129. Ke tepi sikit boleh
dapat Kidney,
130. adrenal, spleen
131.

Midline= semua
abs
CS procedure
atau anything
boley
lower abs atau
pelvis
Lanz lagi
lawa dari
McBurne
y. Can
wear
bikini :p
132.