CHAPTER 24 NURSING CAREERS Lesson 2 Journal Question: What are some of the various settings in which a nurse may work

Chapter 24 Learning Objectives Differentiate among the roles of the registered nurse, licensed practical nurse, and nurse assistant. Identify three items considered to be intake and three to be output.

Chapter 24 Learning Objectives Identify three conditions that indicate the need to measure intake and output. Describe methods of maintaining a clean and safe facility or unit.  

Nurse Assistant Education Employment opportunities Certification program of at least 75 hours and pass a certification examination to be a certified nursing assistant (CNA) Employment opportunities Hospital Long-term care facility Home health A nursing assistant can follow a career ladder to become an LPN/LVN or an RN with additional training.

Nurse Assistant Job description Works under the direction of the registered nurse or licensed practical nurse to provide basic care Provides basic care, such as bathing, grooming, and feeding the patient Assists the nurse with the use and security of medical equipment Assesses vital signs NAs who work in a home care setting are called home care aides. Assists the patient with activities of daily living (ADLs), meal preparation, and general maintenance of the home Home care aides usually work with a patient over an extended period.

Nursing Process The nursing process is one model for delivery of care that is used by the nursing staff to meet the needs of patients Five steps in the nursing process Assessment Information is gathered by interviewing the patient, physical examination, and observation. Information may be objective or subjective. Nursing diagnosis Planning Implementation/intervention (ADPIE) Evaluation Objective (signs) information for the nursing plan is information that can be heard, smelled, or felt. Subjective (symptoms) information is reported to the nurse by the patient.

Nursing Process

Fluid Balance Fluid balance Fluid taken into the body and eliminated from the body should be approximately equal in volume to maintain electrolytes and fluid to perform daily processes Oral intake Anything that is liquid at room temperature and taken by mouth Forcing fluids: offering at least 100 mL of liquid each hour Administration and measurement of intravenous fluids is a function of the RN. When an individual is unable to eat, has severe diarrhea, or has a high fever, the output may be greater than the intake. Refer students to Skill List 24-7 Measuring Oral Intake, and discuss steps.

Fluid Balance Output includes Urine Vomit Drainage from wounds Liquid stool Body also loses fluid that cannot be measured in the form of perspiration on the skin and through lungs during respiration. Refer students to Skill List 24-9 Measuring Urine Output, and discuss procedure.

Fluid Balance FIGURE 24-4 Oral intake is determined by estimating the amount of liquid that is not consumed when the meal is finished. To estimate the amount consumed, the amount remaining is subtracted from the total amount held by the container.

Personal Care Assistance with ADLs Personal hygiene Assisting to bathroom or with a bedpan Helping patient to bathe or brush teeth Assisting the patient with eating Positioning Repositioning a person who is not able to move independently every 2 hours Changing positions helps to prevent decubitus ulcers. Health care worker should approach the patient in a professional, calm, and caring manner. Refer students to Skill Lists 24-1 Positioning the Patient and 24-2 Assisting the Patient to Eat.

Personal Care Range-of-motion (ROM) exercises Designed to move the muscles and joints of patients who are not able to move independently or have limited abilities Prevent contractures Should be be performed once every 8 hours Refer students to Skill Lists 24-3 Range-of-Motion Exercises.

Range-of-Motion Exercises FIGURE 24-6 Range-of-motion exercises may be performed as part of the bed bath.

Postmortem Care Postmortem care is care of the body after death. Body is treated respectfully by providing dignity and privacy. Preparation is made for viewing by the family or removal of the body by the funeral services. After the body is removed, all linens are removed, and the unit is thoroughly cleaned. Refer students to Box 24-3 in their textbook or use the next slide, and discuss procedures.

Postmortem Procedures

Cultural Beliefs and Practices Regarding Death and Funeral

Unit Maintenance Sheets may be changed with the patient Out of bed (unoccupied) In bed (occupied) Special bed-making skills may be needed for postsurgical patients. Rules of medical asepsis are followed when changing linens. Sheets should be free of wrinkles.

Security Procedures A basic and important safety practice used by nursing personnel is to check identification (ID) of the patient before administering care. Nursing staff must be familiar with emergency procedures. Codes are used to signal various threats. Call signals are used to indicate a cardiac arrest, fire, bomb threat, intruder, or other emergencies.

ID Bracelet FIGURE 24-8 It is the responsibility of all staff members to check the patient’s identification bracelet before giving care. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)

Performance Instruction

Bed Bath A routine is established for assisting with the bed bath, moving from the cleanest areas such as the eyes to dirtier areas such as the face, hands, back, and so forth. Refer students to Skill List 24-6 Giving a Bed Bath, and discuss the steps. FIGURE 24-9 The bed bath provides comfort and cleanliness for the patient confined to a bed while protecting his or her dignity.

Stretcher and Tub The stretcher and the person are lowered into the tub. FIGURE 24-10 Patients who are unable to walk can be bathed using a stretcher and tub. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)

Back Rub A back rub may be given at the same time as the bed bath to increase circulation and provide comfort. Refer students to Skill List 24-5 Giving a Back Rub, and discuss the steps. FIGURE 24-11 The backrub stimulates circulation to the tissues of the back and provides comfort. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)

Catheter Urine output may be collected and measured by using a catheter. Refer students to Skill List 24-9 Measuring Urine Output. FIGURE 24-12 When a catheter is used, a paper towel is placed under the graduated cylinder to prevent any urine from contaminating the floor during emptying of the catheter bag.

The Unoccupied Bed Refer students to Skill List 24-10 Making an Unoccupied and Surgical Bed, and discuss the steps. FIGURE 24-13 The unoccupied bed is made with mitered corners. (From Sorrentino SA: Mosby’s textbook for nursing assistants, ed 7, St. Louis, 2008, Mosby.)

Summary The NA usually works under the supervision of an LPN, RN, or medical doctor. The LPN usually works under the supervision of the RN or medical doctor. The RN may work under the supervision of a medical doctor or independently.

Summary The items considered to be input include water, Jell-O, and intravenous fluids. Three types of output include urine, vomit, and drainage from wounds. Three situations that may indicate measurement of intake and output include the inability to eat, diarrhea, and fever.

Summary Methods of maintaining a clean and safe facility or unit include providing clean sheets, keeping a tidy room, and following procedures to prevent spread of pathogens.

Review Bradypnea refers to: a. Without nutrition b. Vomiting blood c. Slow breathing d. Painful breathing e. Below the tongue

Review Bradypnea refers to: a. Without nutrition b. Vomiting blood c. Slow breathing d. Painful breathing e. Below the tongue

SOAP Notes S statement – chief complaint (what patient tells you is wrong with them), why you or patient is there.

SOAP Notes O observation – What you see, how the patient is positioned.

SOAP Notes A assessment – What you did to the patient ( vitals etc)

SOAP Notes P plan – what will you do for the patient.

SOAPIE Notes I implementation – what you have done to complete the plan of action

SOAPIE Notes E evaluation – how has the patient responded to the treatment plan