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Chapter 21 CPCT Skills.

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Presentation on theme: "Chapter 21 CPCT Skills."— Presentation transcript:

1 Chapter 21 CPCT Skills

2 Admission/Transfer or Discharges
Many HC facilities have specific forms & admission/transfers/ discharge procedures to complete- they can include: H & P Advanced Directives consents Medication form/ allergies Emergency contact form Pt. valuable form Orientation to room and equipment

3 Admission Procedure Wash hands Set up room for new admission—
Open the bed linen by fan folding linen Assemble admission kit Check all room equipment to ensure all equipment is operational; Go pick up the patient Meet, Greet and Identify patient Ensure privacy Assist the patient to change into hospital gown Complete necessary paperwork Ensure comfort and safety

4 Transferring Patients
Many HC facilities have a transfer checklist that must be completed and travels with the patient This will include: Transfer list Personal belongings/ Valuables list Wheelchair or stretcher

5 Transfer Procedure Gather equipment & Wash hands
Gather patient belongings Assist patient safely into W/C or stretcher Transfer to new unit Introduce patient to new staff members Orient to new surroundings Review personal belonging checklist with new staff member Complete transfer checklist & Obtain signatures Ensure comfort and privacy

6 Discharging Patients Dr. order required for discharges
If AMA_ Follow specific protocol Assist pt with gathering belongings Inventory and compare to admission form Check over room Allow RN to give all DC instructions Escort patient Or wait on other transportation

7 Discharge Procedure Be sure an order is written Assemble equipment
Wash hands Coordinate discharge time with patient Help patient dress if needed Gather all of the patient belongings Check over room Have RN give all instructions Complete valuable & belongs sheet- pt & staff member sign Assist into WC and escort to lobby/car

8 Documentation Record all information on the patients chart Date Time
Whether admission, transfer or discharge How patient tolerated Any other pertinent information Signature Report procedure and all findings to your superior

9 Summary Make every attempt to alleviate anxiety and fear during admissions, transfers, and discharges Follow agency policy and use the proper forms Care for the patient’s belongings and valuables and always obtain proper signatures when these items are checked

10 DHO- Chapter 21:1 Positioning, Turning, Moving, and Transferring Patients

11 Positioning, Turning, Moving, and Transferring Patients
Improper turning, moving can cause serious injury Enough staff, proper mechanical devices, and good body mechanics are essential

12 Alignment Is defined as positioning body parts in relation to each other to maintain correct body posture Benefits include: Pressure ulcer prevention aka Decubitus ulcers Contractures- Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

13 Decubitus or Pressure Ulcers
AKA= bedsores Caused by prolonged pressure to an area of the body Interferes with circulation Common areas ( bones close to the skin) Sacral area Hips knees Heels elbows

14 Pressure points

15 Stages of Decubitus Ulcers/Bedsores
Stage 1- Skin is unbroken but irritated Stage 2- Skin is broken into the epidermis or dermis Stage 3- Ulcer extends to the subcutaneous fat tissue Stage 4- Ulcer extends to muscle or bone

16 Progression of Pressure Ulcer

17 Sacral, Buttock and Gluteal Areas

18 Elbow, Heels, Ankles, Head

19 Pressure Ulcers

20 Prevention Turning patients every 2 hours
Elevate and cushion pressure points at all times Massage high pressure areas to promote circulation Use of egg crates- gel mattress, air mattress Careful observation and documentation of skin condition Good nutrition

21 Contractures Contractures
Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

22 Contractures

23 Preventive Devices

24 Positioning, Turning, Moving, and Transferring Patients (continued)
Dangling Transfers

25 Turning All patients confined to bed must be turned frequently
Stimulated circulation Exercise Preventing ulcers & contractures At a MINIMUN – q2h!!!! Turning clock used in most facilities

26 Dangling Should be done when patients has been in bed for a long period of time Recommendation- check pulse rate before, during and after the dangling procedure Dangling_ Sitting on the side of the bed with legs hanging over the side Allows for readjustment of BP and pulse rate Assess of dizziness or weakness, pallor, respiratory changes as well

27 Dangling

28 Transfers Patients are frequently moved in the hospital environment
Before moving check doctor order mode of transportation utilize the necessary staff During the move Assess and constantly observe patient Any changes in pulse, RR, color, weakness, dizziness, pain must be reported STAT RETURN To Comfortable position

29 Transportation & Mechanical Lifts
Many modes of transportation are used Wheelchairs Stretchers Mechanical lift

30 Wheelchairs

31 Stretchers

32 Mechanical Lifts

33 Summary Always obtain proper authorization or orders before moving or transferring a patient Never move or transfer a patient without correct authorization Watch the patient closely during any move or transfer

34 Summary (continued) If you note any abnormal changes, return the patient to a safe and comfortable position and check with your immediate supervisor Supervisor will determine if the move or transfer should be attempted

35 DHO- Chapter 21:2 BEDMAKING

36 21:3 Bed making Correctly made beds provide comfort and protection for patients confined to bed for long periods of time Care must be taken when beds are made Beds must be free from wrinkles (continues)

37 Bed making (continued)
Mitered corners Types of beds Draw sheets Body mechanics Infection control Standard precautions

38 Bed making (continued)
Mitered corners Used to hold the linen in place If fitted sheets are used– you should only miter the top sheets & blankets

39 Types of Beds You Will Make
Closed bed Done after a patient is discharged After terminal cleaning of a unit Open bed This is a closed bed converted to an open bed by fan folding (pleating) the top sheets back Done to welcome a patient or for patient who are OOB for short periods of time

40 Types of Beds ( continued)
Occupied Bed A bed made while the patient is still in it Done after a bath or whenever linen is soiled and requires changing Bed Cradle A device placed on a bed under the top sheets to prevent bed linen from touching parts of the patient’s body

41 Bed Cradle Images

42 Linens Draw sheets Aka half sheet, pull sheet or lift sheet
Placed between a patients shoulders and knees Used to protect the mattress Can be easily changed if soiled without the need of making the entire bed Some institutions will also use either a washable or disposable impervious pad to protect bed linens

43 Bed making Body mechanics
To prevent injury always use proper body mechanics while changing/making a bed Use common sense--- attempt to have the linen in the correct order of use to minimize time and conserve energy Make the bed in its entirety of one side--- then move to the opposite side

44 Infection Control with Bed Making
If linen is contaminated with blood and /or body fluids Observe STANDARD PRECAUTIONS Standard precautions Hands should be washed prior to making and after making a bed Always wear gloves to handle soiled linens Follow the policy of the healthcare facility for disposal of linen

45 Contaminated Linen Contaminated linen
is always handled differently than linen that is just “ dirty” Heavily contaminated lined is doubled red bagged a discarded for cleaning separately Double bagging prevents leakage of contaminated linen

46 Summary Follow correct procedures for bed making
Observe infection control methods and standard precautions at all times Use correct body mechanics to prevent injury Be alert to patient safety and comfort

47 Summary Follow correct procedures for bed making
Observe infection control methods and standard precautions at all times Use correct body mechanics to prevent injury Be alert to patient safety and comfort

48 Personal Hygiene

49 21:4 Administering Personal Hygiene
Usually includes the bath, back care, perineal care, oral hygiene, hair care, nail care, and shaving when necessary Must be sensitive to the patient’s needs and respect the patient’s rights to privacy while personal care is administered Reasons for providing personal hygiene (continues)

50 Administering Personal Hygiene (continued)
Types of baths Oral hygiene Hair care Nail care Shaving Backrub Gowning

51 Summary Providing personal hygiene is an important part of patient care Follow correct procedures while providing personal hygiene Observe standard precautions at all times Make careful observations during the procedures, and report any abnormal conditions noted

52 21:5 Measuring and Recording Intake and Output
A large part of the body is fluid, so there must be a balance between the amount of fluid taken into the body and the amount lost from the body Swelling and edema Dehydration Intake and output (I&O) forms vary between facilities (continues)

53 Measuring and Recording Intake and Output (continued)
Intake: fluids taken in by patient What is included in intake Output: fluids eliminated by patient What is included in output Records must be accurate Fluids usually measured by metric system (continues)

54 Measuring and Recording Intake and Output (continued)
Agencies follow different policies for recording I&O Careful instructions should be given to patients on I&O Standard precautions

55 21:6 Feeding a Patient Good nutrition is an important part of a patient’s treatment Make mealtimes as pleasant as possible Mealtimes are regarded as social time Proper preparation for mealtime Delay of meals Check food tray

56 Feeding a Patient (continued)
Allow patient to feed themselves whenever possible Test temperature of food Principles to follow while feeding Relaxed, unhurried atmosphere Observe amount eaten Observe for any signs of choking

57 21:7 Assisting with a Bedpan/Urinal
Elimination of body waste is essential Terminology Many patients sensitive about using bedpan/urinal Accurate observations important Standard precautions Use of gloves important

58 21:8 Providing Catheter and Urinary-Drainage Unit Care
Catheters: hollow tubes usually made of rubber or plastic French or straight catheter Foley catheter External condom catheter Urinary-drainage units Leg bags for ambulation (continues)

59 Providing Catheter and Urinary-Drainage Unit Care (continued)
Careful observation of catheter and drainage unit When catheter and urinary-drainage unit in place, preferable never to disconnect unit If necessary to disconnect catheter, follow agency policy Catheter care (continues)

60 Providing Catheter and Urinary-Drainage Unit Care (continued)
Observation of urine Follow correct procedure to empty drainage unit to prevent contamination and infection Bladder training program Keep records

61 Summary Assisting patient with intake and output important part of care Provide privacy and respect patient’s rights at all times Observe standard precautions Follow correct procedures

62 21:9 Providing Ostomy Care
Ostomy: surgical procedure in which an opening, called a stoma, is created in the abdominal wall Reasons for an ostomy Ostomies can be for draining urine from the bladder or for emptying the bowel (stool or feces) (continues)

63 Providing Ostomy Care (continued)
Can be permanent or temporary depending on condition Types of ostomies Ostomy bags or pouches Care of ostomy Psychological reactions to ostomy Observations while caring for ostomy Observe standard precautions

64 21:10 Collecting Stool/Urine Specimens
Laboratory tests are performed on specimens to detect disease Specimens must be collected correctly for tests to be accurate Routine urine specimen Clean-catch or midstream-voided urine (continues)

65 Collecting Stool/Urine Specimens (continued)
Sterile catheterized urine specimen 24-hour urine specimen Routine stool (feces) specimen Stool for occult blood Label all specimens correctly Use standard precautions

66 21:11 Enemas and Rectal Treatments
Retention enemas Nonretention enemas Types of enemas Cleansing Disposable Oil retention (continues)

67 Enemas and Rectal Treatments (continued)
Impactions—removed by licensed or advanced care provider Rectal tube Suppositories

68 Summary Enemas and rectal treatments cannot be administered without a doctor’s order Follow correct procedures at all times Observe standard precautions to prevent spread of infection

69 21:12 Applying Restraints Chemical restraints—medications
Physical restraints—protective devices Conditions that may require restraints Types of physical restraints Points to remember when using restraints Complications of restraints (continues)

70 Applying Restraints (continued)
Most health care facilities have specific rules and policies regarding the use of restraints Be aware of legal responsibilities

71 21:13 Administering Pre- and Postoperative Care
Three phases of operative care Every patient will have some fears Preoperative care Skin preparation or surgical shave Anesthesia General Local Spinal (continues)

72 Administering Pre- and Postoperative Care (continued)
Preparing a postoperative unit Postoperative care Binders Surgical (elastic) hose Montgomery straps

73 21:14 Applying Binders Usually made of heavy cotton or flannelette with elastic sides or supports Where applied Functions of binders Application of binders (continues)

74 Applying Binders (continued)
Straight binders Breast binders T-binder replacements Precautions while using binders

75 Summary In order to properly care for a surgical patient, it is essential for health care assistants to know and understand all aspects of care that have been ordered Good operative care can mean a faster recovery with fewer complications for the patient Follow standard precautions

76 21:15 Administering Oxygen
Blood must have oxygen Signs of oxygen shortage Deficiency of oxygen (hypoxia) Methods of administration of oxygen Ways of providing oxygen to the patient Humidifier (continues)

77 Administering Oxygen (continued)
Safety precautions Pulse oximeters Points to check while oxygen in use Legal considerations

78 21:16 Giving Postmortem Care
Care given to the body immediately following death Begins when a doctor has pronounced the patient dead Difficult but essential part of patient care (continues)

79 Giving Postmortem Care (continued)
Dealing with death and dying Patient’s rights apply after death Family member may want to view body Procedure for postmortem care will vary with different facilities (continues)

80 Giving Postmortem Care (continued)
Morgue kits Care of valuables and belongings Two people often work together to complete care Observe agency policy

81 Summary The nursing assistant provides quality personal care for patients Many skills are required to perform approved procedures Standard precautions must be observed Record observations carefully Know your legal responsibilities

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