Unit 20 Nurse Assistant Skills

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.2 20:1 Admitting, Transferring, and Discharging Patients  Procedures may vary slightly in different facilities  Basic principles apply to all facilities  Alleviating anxiety and fear  Admission forms  Procedures performed on admission

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.3 Admitting, Transferring, and Discharging Patients (continued)  Protect patient’s or resident’s possessions  Orient patient to facility  Transfers  Discharges  Basic principles for admitting patient  Basic principles for transferring patient  Basic principles for discharging patient

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.4 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5 20:2 Positioning, Turning, Moving, and Transferring Patients  Responsibility of health care assistant  If procedure done correctly, provides patient with optimum comfort and care  Also helps worker prevent injury to self and patient  Improper moving, turning, or transferring can result in serious injury to patient

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Positioning, Turning, Moving, and Transferring Patients (continued)  Correct body mechanics essential for any of these procedures  If you are unable to move or turn a patient by yourself, always get help  Alignment  Basic principles of aligning the patient

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Positioning, Turning, Moving, and Transferring Patients (continued)  Moves and turns  Basic principles of moving patient to head of bed  Basic principles for turning patient  Dangling  Basic principles for dangling patient

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Positioning, Turning, Moving, and Transferring Patients (continued)  Transfers  Basic principles for transferring patient to chair, wheelchair, or stretcher  Basic principles for transferring a patient with a mechanical lift

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.9 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11 20:3 Bedmaking  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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Bedmaking (continued)  Mitered corners  Types of beds  Draw sheets  Body mechanics  Infection control  Standard precautions

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Bedmaking (continued)  Basic principles of making a closed bed  Basic principles for making an occupied bed  Basic principles for opening a closed bed  Basic principles for placing a bed cradle

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Summary  Follow correct procedures for bedmaking  Observe infection control methods and standard precautions at all times  Use correct body mechanics to prevent injury  Be alert to patient safety and comfort

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.15 20:4 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Administering Personal Hygiene (continued)  Types of baths  Oral hygiene  Hair care  Nail care  Shaving  Backrub  Gowning

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.17 Administering Personal Hygiene (continued)  What to observe  Standard precautions  Respect patient’s rights  Basic principles for providing oral hygiene  Basic principles for administering a complete bed bath

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.18 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.19 20:5 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  I&O forms vary between facilities

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.20 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.21 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  Basic principles for completing I&O records

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.22 20:6 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.23 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.24 20:7 Assisting with a Bedpan/Urinal  Elimination of body waste is essential  Terminology  Many patients sensitive about using bedpan/urinal  Accurate observations important  Standard precautions  Basic principles of assisting with bedpan/urinal

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.25 20:8 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.26 Providing Catheter and Urinary- Drainage Unit Care (continued)  Careful observation of catheter and drainage unit  When catheter and urinary-drainage unit in place, preferable to never disconnect unit  Catheter care  Observation of urine

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.27 Providing Catheter and Urinary- Drainage Unit Care (continued)  Follow correct procedure to empty drainage unit to prevent contamination and infection  Bladder training program  Principles of providing catheter care  Basic principles for emptying a urinary-drainage unit

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.28 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.29 20:9 Providing Ostomy Care  Ostomy: surgical procedure in which an opening, called a stoma, is created in the abdominal wall  Why ostomies are done  Ostomies can be for draining urine from the bladder or for emptying the bowel (stool or feces)

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.30 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.31 20:10 Collecting Stool/ Urine Specimens  Laboratory tests are performed on the specimens  Specimens must be collected correctly in order for tests to be accurate  Routine urine specimen  Clean-catch or midstream-voided specimen

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.32 Collecting Stool/Urine Specimens (continued)  Sterile urine specimen  24-hour urine specimen  Basic principles for collecting urine specimens  Routine stool specimen  Stool for occult blood

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.33 Collecting Stool/Urine Specimens (continued)  Basic principles for collecting stool specimens  Label all specimens correctly  Observe standard precautions

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.34 20:11 Enemas and Rectal Treatments  Enemas  Impactions  Rectal tube  Suppositories  Standard precautions  Basic principles for giving enemas  Basic principles for inserting a rectal tube

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.35 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.36 20:12 Applying Restraints  Chemical restraints  Physical restraints  Conditions that may require restraints  Types of physical restraints  Points to remember when using restraints  Complications of restraints

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.37 Applying Restraints (continued)  Most health care facilities have specific rules and policies regarding the use of restraints  Basic principles for applying restraints

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.38 20:13 Administering Pre- and Postoperative Care  Three phases of operative care  Every patient will have some fears  Preoperative care  Basic principles for administering preoperative care  Skin preparation or surgical shave  Basic principles for shaving the operative area

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.39 Administering Pre- and Postoperative Care (continued)  Anesthesia  Postoperative unit  Basic principles for preparing a postoperative unit  Postoperative care  Surgical or elastic hose

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.40 20:14 Applying Binders  Usually made of heavy cotton or flannelette with elastic sides or supports  Where applied  Functions of binders  Application of binders  Straight binders  Breast binders

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.41 Applying Binders (continued)  T-binders  Precautions while using binders  Basic principles for applying binders  Montgomery straps

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.42 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.43 20:15 Administering Oxygen  Blood must have oxygen  Signs of oxygen shortage  Deficiency of oxygen  Methods of administration of oxygen  Humidifier  Safety precautions

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.44 Administering Oxygen (continued)  Pulse oximeters  Points to check while oxygen in use  Legal considerations  Basic principles of administering oxygen

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.45 20:16 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

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.46 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  Morgue kits

Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED.47 Giving Postmortem Care (continued)  Care of valuables and belongings  Two people often work together to complete care  Basic principles for giving postmortem care