7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Think about the many emotional adjustments and changes residents may.

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Think about the many emotional adjustments and changes residents may have had to make before entering a facility: Fear Uncertainty Anger Loss of health, mobility, independence, family, friends, pets, plants

7 Basic Nursing Skills Handout 7-1: Quiz: You Are Moving! Your house has been sold and you need to move in with your sister and her family for about six months or more. You need to work out some problems; perhaps you will even be staying with them permanently. You don’t know for sure. You will share a room with your niece. Your space is 6 feet wide by 12 feet long. There is a single bed, a chest of drawers, and a soft chair that you can use. There is also a screen available for your privacy. Decide what you will take with you. You can store anything you don’t take, but you will not have access to any stored items until you move again.

7 Basic Nursing Skills Handout 7-1: Quiz: You Are Moving! (cont’d.) Think of space. All six items must fit into your small room, or in your half of the closet, which is a five foot by three foot space. Name six things you will take with you. (Seven outfits of clothing count as one item.) 1. 2. 3. 4. 5. 6.

7 Basic Nursing Skills Handout 7-1: Quiz: You Are Moving! (cont’d.) During the first week, your niece, who is 5 years old, is looking at one of your treasured things, and accidentally drops and breaks it. How do you feel? It is now the second week. You have still not received any of your mail, which you had notified the post office to forward. You mention this to your sister and she says offhandedly, “Oh, I did see some here yesterday. I don’t know where it got to.” Then she walks out of the room. What is your response?

7 Basic Nursing Skills Think about this question: What might this exercise tell you about residents’ experiences when they were admitted to a facility? 1. Explain admission, transfer, and discharge of a resident

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Remember these guidelines for admission: Prepare the room before the resident arrives. When the resident arrives, note the time the resident’s condition. Introduce yourself, giving your position. Address the resident by his formal name. Do not rush the admission process. Make resident feel welcome. Explain daily operations in the facility. Offer a tour. Introduce resident to everyone. Honor resident preferences when setting up the room. Observe the resident for problems that are missed. Let residents adapt to their new homes at their own pace.

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident REMEMBER: You must keep Residents’ Rights in mind throughout the admission process. The resident must be informed of his or her rights and given a written copy of the rights.

Equipment: may include admission paperwork (checklist and inventory form), gloves and vital signs equipment 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. Admitting a resident

Admitting a resident (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. If the family is present, ask them to step outside until the admission process is over. Maintains resident’s right to privacy and dignity.

Admitting a resident (cont’d.) 5.If part of facility procedure, do these things: Take the resident’s height and weight (see LO 3). Take the resident’s baseline vital signs (LO 2). Baseline signs are initial values that can then be compared to future measurements. Obtain a urine specimen if required (LO 5). Complete the paperwork. Take an inventory of all the personal items.

Admitting a resident (cont’d.) 5.If part of facility procedure, do these things (cont’d.): Complete the paperwork. Take an inventory of all the personal items. Help the resident to put personal items away. Label personal items according to facility policy. Provide fresh water.

Admitting a resident (cont’d.) 6.Show the resident to his/her room and bathroom. Explain how to work the bed (and television if there is one). Show the resident how to work the call light and explain its use. Promotes resident’s safety. 7.Introduce the resident to his roommate, if there is one. Introduce other residents and staff. Makes resident feel more comfortable. 8.Make sure resident is comfortable. Remove privacy measures. Bring the family back inside if they were outside.

Admitting a resident (cont’d.) 9.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 10.Wash your hands. Provides for infection control. 11.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Remember the following about transfers. Residents must be informed of transfers. It is their legal right. Explain the details of the transfer. Pack the resident’s personal items carefully. Residents must always be informed of any room or roommate change, as well.

Transferring a resident Equipment: may include a wheelchair, cart for belongings, the medical record, all of the resident’s personal care items and packed personal items 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Transferring a resident (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Collect items to be moved onto the cart. Take them to the new location. If the resident is going into the hospital, they may be placed in temporary storage. 5.Help the resident into the wheelchair (stretcher may be used). Take him or her to proper area.

Transferring a resident (cont’d.) 6.Introduce new residents and staff. Makes resident feel more comfortable. 7.Help the resident to put personal items away. 8.Make sure the resident is comfortable. 9.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 10.Wash your hands. Provides for infection control.

Transferring a resident (cont’d.) 11.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 12.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident REMEMBER: Always be positive and encouraging during the discharge process.

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident The nurse may provide information on these subjects when a resident is being discharged: Doctor or physical therapy appointments Home care or skilled nursing care Medications Ambulation instructions Medical equipment needed Medical transportation Restrictions on activities Special exercises Special dietary requirements Community resources

Discharging a resident Equipment: may include a wheelchair, cart for belongings, the discharge paperwork, including the inventory list done on admission, all of the resident’s personal care items 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Discharging a resident (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Compare the checklist to the items there. If all items are there, ask the resident to sign.

Discharging a resident (cont’d.) 6.Put the items to be taken onto the cart and take them to pick-up area. 7.Help the resident dress and then into the wheelchair or stretcher, if used. 8.Help the resident to say his goodbyes to the staff and residents. 9.Take resident to the pick- up area. Help him into vehicle. You are responsible for the resident until he is safely in the car and the door is closed.

Discharging a resident (cont’d.) 10.Wash your hands. Provides for infection control. 11.Document procedure using facility guidelines. Include the following: Time of discharge Method of transport Who was with the resident The vital signs at discharge What items the resident took with her (inventory checklist) What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills Define the following term: Vital signs measurements that show how well the vital organs of the body are working; consist of body temperature, pulse, respirations, blood pressure, and level of pain.

7 Basic Nursing Skills Monitor, document, and report on the following vital signs: Temperature Pulse Rate of respirations Blood pressure Pain level 2. Explain the importance of monitoring vital signs

7 Basic Nursing Skills Notify the nurse in any of these cases: Resident has a fever Respiratory or pulse rate is too rapid or slow Blood pressure changes Pain is worsening or unrelieved 2. Explain the importance of monitoring vital signs

7 Basic Nursing Skills Transparency 7-1: Normal Ranges for Vital Signs TemperatureFahrenheit Celsius Oral 97.6-99.6 36.5-37.5 Rectal 98.6-100.6 37.0-38.1 Axillary96.6-98.636.0-37.0 Pulse: 60-100 beats per minute Respirations: 12-20 respirations per minute Blood Pressure: Normal: Systolic 100-119 Diastolic 60-79 Prehypertension: Systolic 120-139 Diastolic 80-89 High:140/90 or above Low:Below 100/60

7 Basic Nursing Skills REMEMBER: Always protect residents’ privacy when taking vital signs. Think about this question: What are practical steps you can take to provide privacy when taking and documenting vital signs? 2. Explain the importance of monitoring vital signs

7 Basic Nursing Skills Remember these things about monitoring body temperature: Age, illness, stress, environment, exercise, and the circadian rhythm all affect temperature. There are four sites for measuring (mouth, rectum, armpit, ear). Oral temperatures cannot be taken on someone who is unconscious, has recently had facial or oral surgery, is younger than 5 years old, is confused, is heavily sedated, is likely to have a seizure, is coughing, is using oxygen, has facial paralysis, has a nasogastric tube, has sores, redness, swelling, or pain in the mouth, or has an injury to the face or neck 2. Explain the importance of monitoring vital signs

7 Basic Nursing Skills Remember when monitoring body temperature (cont’d.): Mercury-free thermometers are safer than mercury glass thermometers and are required in some states. Mercury-free thermometers and glass thermometers operate identically. Rectal temperatures are most accurate, but taking rectal temperature can be dangerous with some residents. Axillary temperatures are considered least accurate. 2. Explain the importance of monitoring vital signs

Measuring and recording oral temperature Do not take an oral temperature on a resident who has smoked, eaten or drunk fluids, chewed gum, or exercised in the last 10–20 minutes. Equipment: clean mercury- free, digital, or electronic thermometer, gloves, disposable plastic sheath/cover for thermometers, tissues, pen and paper 1.Wash hands. Provides for infection control.

Measuring and recording oral temperature (cont’d.) 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

Measuring and recording oral temperature (cont’d.) 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. 6. Mercury-free thermometer: Hold thermometer by the stem. Before inserting thermometer in resident’s mouth, shake thermometer down to below the lowest number (at least below 96°F or 35°C).

Measuring and recording oral temperature (cont’d.) 6.(cont’d.) To shake thermometer down, hold it at the side opposite the bulb with the thumb and two fingers. With a snapping motion of the wrist, shake the thermometer. Stand away from furniture and walls while doing so. Holding the stem end prevents contamination of the blub end. The thermometer reading must be below the resident’s actual temperature.

Measuring and recording oral temperature (cont’d.) 6.(cont’d.) Digital thermometer: Put on the disposable sheath. Turn on thermometer. Wait until “ready” sign appears. Electronic thermometer: Remove probe from base unit. Put on probe cover. 7. Mercury-free thermometer: Put on disposable sheath, if available. Insert bulb end of thermometer into resident’s mouth, under tongue and to one side. The thermometer measures heat from blood vessels under the tongue.

Measuring and recording oral temperature (cont’d.) 7.(cont’d.) Digital thermometer: Insert end of digital thermometer into resident’s mouth, under tongue and to one side. Electronic thermometer: Insert end of electronic thermometer into resident’s mouth, under tongue and to one side. 8. Mercury-free thermometer: Tell resident to hold thermometer in mouth with lips closed. Assist as necessary. Resident should breathe through his nose.

Measuring and recording oral temperature (cont’d.) 8.(cont’d.) Ask the resident not to bite down or to talk. Leave the thermometer in place for at least three minutes. The lips hold the thermometer in position. If broken, injury to the mouth may occur. More time may be required if resident opens mouth to breathe or talk. Digital thermometer: Leave in place until thermometer blinks or beeps.

Measuring and recording oral temperature (cont’d.) 8.(cont’d.) Electronic thermometer: Leave in place until you hear a tone or see a flashing or steady light. 9. Mercury-free thermometer: Remove the thermometer. Wipe with a tissue from stem to bulb or remove sheath. Dispose of the tissue or sheath. Hold the thermometer at eye level. Rotate until line appears, rolling the thermometer between your thumb and forefinger. Read the temperature. Remember the temperature reading.

Measuring and recording oral temperature (cont’d.) 9.(cont’d.) Digital thermometer: Remove the thermometer. Read temperature on display screen. Remember the temperature reading. Electronic thermometer: Read the temperature on the display screen. Remember the temperature reading. Remove the probe. 10. Mercury-free thermometer: Rinse the thermometer in lukewarm water and dry. Return it to a plastic case or container.

Measuring and recording oral temperature (cont’d.) 10.(cont’d.) Digital thermometer: Using a tissue, remove and dispose of sheath. Replace the thermometer in case. Electronic thermometer: Press the eject button to discard the cover. Return the probe to the holder. 11.Remove and discard gloves. 12.Wash your hands. Provides for infection control.

Measuring and recording oral temperature (cont’d.) 13.Immediately record the temperature, date, time and method used (oral). Record temperature immediately so you won’t forget. Care plans are made based on your report. 14.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 15.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills Handout 7-2: Thermometer Worksheet

7 Basic Nursing Skills Handout 7-2: Thermometer Worksheet (cont’d.)

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember these points about taking rectal temperature: Explain what you will do before starting. Be reassuring. Hold onto thermometer at all times. Wear gloves. The privacy of the resident is important. Thermometer must be lubricated for this procedure. The privacy of the resident is important.

Measuring and recording rectal temperature Equipment: clean rectal mercury-free or digital thermometer, lubricant, gloves, tissue, disposable sheath/cover, pen and paper 1.Wash your hands. Provides for infection control. 2.Identify yourself by name. Identify resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording rectal temperature (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for residentís privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.If the bed is adjustable, adjust to a safe level, usually waist high. Lock bed wheels. Promotes safety.

Measuring and recording rectal temperature (cont’d.) 6.Help the resident to left- lying (Sims’) position. 7.Fold back linens to expose only the rectal area. 8.Put on gloves. 9. Mercury-free thermometer: Hold thermometer by stem. Shake the thermometer down to below the lowest number. Digital thermometer: Put on the disposable sheath. Turn on thermometer and wait until “ready” sign appears.

Measuring and recording rectal temperature (cont’d.) 10.Apply a small amount of lubricant to tip of bulb or probe cover (or apply pre- lubricated cover). 11.Separate the buttocks. Gently insert thermometer one inch into rectum. Stop if you meet resistance. Do not force the thermometer in the rectum. 12.Replace the sheet over buttocks while holding on to the thermometer. Hold on to the thermometer at all times.

Measuring and recording rectal temperature (cont’d.) 13. Mercury-free thermometer: Hold thermometer in place for at least three minutes. Digital thermometer: Hold thermometer in place until thermometer blinks or beeps. 14.Gently remove the thermometer. Wipe with tissue from stem to bulb or remove sheath. Dispose of tissue or sheath. 15.Read the thermometer at eye level as you would for an oral temperature. Remember the temperature reading.

Measuring and recording rectal temperature (cont’d.) 16. Mercury-free thermometer: Rinse the thermometer in lukewarm water and dry. Return it to plastic case or container. Digital thermometer: Discard probe cover. Replace the thermometer in case. Remove and discard gloves. 16.Wash your hands. Provides for infection control. 17.Assist the resident to a position of safety and comfort.

Measuring and recording rectal temperature (cont’d.) 20.Immediately record the temperature, date, time and method used (rectal). Record temperature immediately so you won’t forget. Care plans are made based on your report. 21.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 22.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember these things about taking typanic and axillary temperature: Tympanic thermometers are fast and accurate. The tympanic thermometer will only go into the ear 1/4 - 1/2 inch. Axillary temperatures are much less reliable. Axillary temperatures can be safer if residents are confused, disoriented, uncooperative, or have dementia.

Measuring and recording tympanic temperature Equipment: tympanic thermometer, gloves, disposable probe sheath/cover, pen and paper 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording tympanic temperature (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. 6.Put a disposable sheath over earpiece of the thermometer. Protects equipment. Reduces risk of contamination.

Measuring and recording tympanic temperature (cont’d.) 7.Position the resident’s head so that the ear is in front of you. Straighten the ear canal by pulling up and back on the outside edge of the ear. Insert the covered probe into the ear canal. Press the button. 8.Hold thermometer in place either for one second until thermometer blinks or beeps (depends on mode). 9.Read temperature. Remember temperature reading.

Measuring and recording tympanic temperature (cont’d.) 10.Dispose of sheath. Return thermometer to storage or to the battery charger if thermometer is rechargeable. 11.Remove and discard gloves. 12.Wash your hands. Provides for infection control. 13.Immediately record temperature, date, time, and method used (tympanic). Record temperature immediately so you won’t forget. Care plans are made based on your report.

Measuring and recording tympanic temperature (cont’d.) 14.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 15.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

Measuring and recording axillary temperature Equipment: mercury-free, digital, or electronic thermometer, gloves, tissues, disposable sheath/cover, pen and paper 1.Wash your hands. Provides for infection control. 2.Identify yourself by name. Identify resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording axillary temperature (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. 6.Remove resident’s arm from sleeve of gown. Wipe axillary area with tissues.

Measuring and recording axillary temperature (cont’d.) 7. Mercury-free thermometer: Hold the thermometer by the stem. Shake the thermometer down to below the lowest number. Digital thermometer: Put on the disposable sheath. Turn on thermometer and wait until “ready” sign appears. Electronic thermometer: Remove the probe from base unit. Put on probe cover.

Measuring and recording axillary temperature (cont’d.) 8. Position thermometer (bulb end for mercury- free) in center of the armpit. Fold resident’s arm over her chest. 9. Mercury-free thermometer: Hold the thermometer in place, with the arm close against the side, for 8 to 10 minutes. Digital thermometer: Leave in place until thermometer blinks or beeps. Electronic thermometer: Leave in place until you hear a tone or see a flashing or steady light.

Measuring and recording axillary temperature (cont’d.) 10. Mercury-free thermometer: Remove the thermometer. Wipe with a tissue from stem to bulb or remove sheath. Dispose of the tissue or sheath. Read the thermometer at eye level as you would for an oral temperature. Remember the temperature reading. Digital thermometer: Remove the thermometer. Read temperature on display screen. Remember the temperature reading.

Measuring and recording axillary temperature (cont’d.) 10.(cont’d.) Electronic thermometer: Read the temperature on the display screen. Remember the temperature reading. Remove the probe. 11.Mercury-free thermometer: Rinse the thermometer in lukewarm water and dry. Return it to plastic case or container. Digital thermometer: Using a tissue, remove and dispose of sheath. Replace the thermometer in case.

Measuring and recording axillary temperature (cont’d.) 11.(cont’d.) Electronic thermometer: Press the eject button to discard the cover. Return the probe to the holder. 12.Remove and discard gloves. 13.Wash your hands. Provides for infection control. 14.Put resident’s arm back into sleeve of gown. 15.Immediately record the temperature, date, time and method used (axillary). Record temperature immediately so you won’t forget. Care plans are made based on your report.

Measuring and recording axillary temperature (cont’d.) 16.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 17.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills Define the following terms: Radial pulse the pulse located on the inside of the wrist, where the radial artery runs just beneath the skin. Brachial pulse the pulse inside the elbow, about 1 to 1 1/2 inches above the elbow.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember these things about monitoring pulse: Pulse is the number of heartbeats per minute. Pulse is commonly taken at the wrist where radial artery runs. Normal rate is 60-100 beats per minute for adults. Normal rate is 100-120 beats per minute for small children, as high as 120-140 for newborns. Pulse may be affected by exercise, fear, anger, anxiety, heat, medications and pain. Rapid pulse may result from fever, infection, or heart failure. Slow/weak pulse may indicate dehydration, infection, or shock.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember these things about counting respirations: A breath includes both inspiration and expiration. Normal adult rate is 12-20 breaths per minute. Normal rate for infants is 30-40 breaths per minute. Do the counting immediately after taking the pulse. Do not let the resident know you are counting breaths.

Measuring and recording radial pulse and counting and recording respirations Equipment: watch with a second hand, pen and paper 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording radial pulse and counting and recording respirations (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Place fingertips on thumb side of resident’s wrist. Locate radial pulse. 6.Count beats for one full minute.

Measuring and recording radial pulse and counting and recording respirations (cont’d.) 7.Keep your fingertips on the resident’s wrist. Count respirations for one full minute. Observe for the pattern and character of the resident’s breathing. Normal breathing is smooth and quiet. Count will be more accurate if resident does not know you are counting his respirations.

Measuring and recording radial pulse and counting and recording respirations (cont’d.) 8.Record pulse rate, date, time and method used (radial). Record the respiratory rate and the pattern or character of breathing. Record pulse and respiration rate immediately so you won’t forget. Care plans are made based on your report. 9.Place call light within resident’s reach. Allows resident to communicate with staff as necessary.

Measuring and recording radial pulse and counting and recording respirations (cont’d.) 10.Wash your hands. Provides for infection control. 11.Report any changes in resident to the nurse. Report to the nurse if the pulse is less than 60 beats per minute, over 100 beats per minute, if the rhythm is irregular, or if breathing is irregular. Provides nurse with information to assess resident.

7 Basic Nursing Skills Define the following terms: Systolic first measurement of blood pressure; phase when the heart is at work, contracting and pushing the blood from the left ventricle of the heart. Diastolic second measurement of blood pressure; phase when the heart relaxes or rests.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember these facts about blood pressure: The two parts are systolic (top number) and diastolic (bottom number). Normal range is: S=100 to 119, D=60 to 79. Blood pressure measurements between 120/80 and 139/89 were once considered normal but are now considered prehypertension. Brachial artery at the elbow is used. Equipment used is stethoscope and sphygmomanometer. An electronic sphymomanometer may be available. If so, you will be trained in its use. The cuff must first be completely deflated.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Facts about blood pressure (cont’d.): Never measure blood pressure on an arm that has an IV, a dialysis shunt, or any medical equipment. Avoid a side with a cast, recent trauma, paralysis from a stroke, burns, or mastectomy. One-step method does not include getting an estimated systolic before beginning. Two-step method does require getting an estimated systolic.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs REMEMBER: It is not always easy to perfect the skill of hearing the first and last sounds of the blood pressure. You may have to do the procedure over and over again before you are comfortable with it.

Measuring and recording blood pressure (one-step method) Equipment: sphygmomanometer (blood pressure cuff), stethoscope, alcohol wipes, pen and paper to record your findings 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording blood pressure (one-step method) cont’d. 3.Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Ask the resdient to roll up his or her sleeve. Do not measure blood pressure over clothing.

Measuring and recording blood pressure (one-step method) cont’d. 6.Position resident’s arm with palm up. The arm should be level with the heart. A false low reading is possible if arm is above heart level. 7.With the valve open, squeeze the cuff. Make sure it is completely deflated.

Measuring and recording blood pressure (one-step method) cont’d. 8.Place blood pressure cuff snugly on resident’s upper arm. The center of the cuff is placed over the brachial artery (1-1½ inches above the elbow toward inside of elbow). Cuff must be proper size and put on arm correctly so amount of pressure on artery is correct. If not, reading will be falsely high or low.

Measuring and recording blood pressure (one-step method) cont’d. 9.Before using stethoscope, wipe diaphragm and earpieces with alcohol wipes. Reduces pathogens, prevents ear infections and prevents spread of infection. 10.Locate brachial pulse with fingertips. 11.Place diaphragm of stethoscope over brachial artery. 12.Place earpieces of stethoscope in ears. 13.Close the valve (clockwise) until it stops. Do not tighten it. Tight valves are too hard to release.

Measuring and recording blood pressure (one-step method) cont’d. 14.Inflate cuff to 30 mmHg above the point at which the pulse is last heard or felt. 15.Open the valve slightly with thumb and index finger. Deflate cuff slowly. Releasing the valve slowly allows you to hear beats accurately. 16.Watch gauge. Listen for sound of pulse. 17.Remember the reading at which the first clear pulse sound is heard. This is the systolic pressure.

Measuring and recording blood pressure (one-step method) cont’d. 18.Continue listening for a change or muffling of pulse sound. The point of a change or the point the sound disappears is the diastolic pressure. Remember this reading. 19.Open the valve. Deflate cuff completely. Remove cuff. An inflated cuff left on resident’s arm can cause numbness and tingling. If you must take blood pressure again, completely deflate cuff and wait 30 seconds.

Measuring and recording blood pressure (one-step method) cont’d. 19.(cont’d.) Never partially deflate a cuff and then pump it up again. Blood vessels will be damaged and reading will be falsely high or low. 20.Record both the systolic and diastolic pressures. Write the numbers like a fraction, with the systolic reading on top and the diastolic reading on the bottom (for example 120/80). Note which are was used. Write “RA” for right arm and “LA” for left arm. Record readings immediately so you won’t forget. Care plans are made based on your report.

Measuring and recording blood pressure (one-step method) cont’d. 21.Wipe diaphragm and earpieces of stethoscope with alcohol wipes. Store equipment. 22.Place call light within resident’s reach. Remove privacy measures. Allows resident to communicate with staff as necessary. 23.Wash your hands. Provides for infection control. 24.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

Measuring and recording blood pressure (two-step method) Equipment: sphygmomanometer (blood pressure cuff), stethoscope, alcohol wipes, pen and paper 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording blood pressure (two-step method) cont’d. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Ask the resident to roll up his or her sleeve. Do not measure blood pressure over clothing.

Measuring and recording blood pressure (two-step method) cont’d. 6.Position resident’s arm with palm up. The arm should be level with the heart. A false low reading is possible if arm is above heart level. 7.With the valve open, squeeze the cuff to make sure it is completely deflated. 8.Place blood pressure cuff snugly on resident’s upper arm. The center of the cuff is placed over the brachial artery (1-1½ inches above the elbow toward inside of elbow).

Measuring and recording blood pressure (two-step method) cont’d. 8.(cont’d.) Cuff must be proper size and put on arm correctly so amount of pressure on artery is correct. If not, reading will be falsely high or low. 9.Locate the radial (wrist) pulse with fingertips.

Measuring and recording blood pressure (two-step method) cont’d. 10.Close the valve (clockwise) until it stops. Inflate cuff slowly, watching gauge. If you inflate the cuff too quickly, you will not be able to identify the point where the pulse stops. 11.Stop inflating when you can no longer feel the pulse. Note the reading. The number is an estimate of the systolic pressure. This estimate helps you to not inflate the cuff too high later in this procedure. Inflating cuff too high is painful and may damage small blood vessels.

Measuring and recording blood pressure (two-step method) cont’d. 12.Open the valve. Deflate cuff completely. An inflated cuff left on resident’s arm can cause numbness and tingling. 13.Write down estimated systolic reading. 14.Before using stethoscope, wipe diaphragm and earpieces of stethoscope with alcohol wipes. Reduces pathogens, prevents ear infections and prevents spread of infection. 15.Locate brachial pulse with fingertips.

Measuring and recording blood pressure (two-step method) cont’d. 16.Place diaphragm of stethoscope over brachial artery. 17.Place earpieces of stethoscope in ears. 18.Close the valve (clockwise) until it stops. Do not tighten it. Tight valves are too hard to release. 19.Inflate cuff to 30 mmHg above your estimated systolic pressure. Inflating cuff too high is painful and may damage small blood vessels.

Measuring and recording blood pressure (two-step method) cont’d. 20.Open the valve slightly with thumb and index finger. Deflate cuff slowly. Releasing the valve slowly allows you to hear beats accurately. 21.Watch gauge. Listen for sound of pulse. 22.Remember the reading at which the first clear pulse sound is heard. This is the systolic pressure.

Measuring and recording blood pressure (two-step method) cont’d. 23.Continue listening for a change or muffling of pulse sound. The point of a change or the point the sound disappears is the diastolic pressure. Remember this reading. 24.Open the valve. Deflate cuff completely. Remove cuff. An inflated cuff left on resident’s arm can cause numbness and tingling. If you must take blood pressure again, completely deflate cuff and wait 30 seconds.

Measuring and recording blood pressure (two-step method) cont’d. 24.(cont’d.) Never partially deflate a cuff and then pump it up again. Blood vessels will be damaged and reading will be falsely high or low. 25.Record both the systolic and diastolic pressures. Write the numbers like a fraction, with the systolic reading on top and the diastolic reading on the bottom (for example 120/80). Note which are was used. Write “RA” for right arm and “LA” for left arm. Record readings immediately so you won’t forget. Care plans are made based on your report.

Measuring and recording blood pressure (two-step method) cont’d. 26.Wipe diaphragm and earpieces of stethoscope with alcohol. Store equipment. 27.Place call light within resident’s reach. Remove privacy measures. Allows resident to communicate with staff as necessary. 28.Wash your hands. Provides for infection control. 29.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Remember the following about pain management: Pain is as important to monitor as vital signs. Pain is an experience that is uncomfortable and different for each person. Take complaints of pain seriously. Observe and report carefully since care plans are based on your reports. Ask questions to get accurate information. Pain is not a normal part of aging.

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Observe and report these signs and symptoms of pain: Increased pulse, respirations, and blood pressure Sweating Nausea Vomiting Tightening the jaw Squeezing eyes shut Holding a body part tightly Frowning Grinding teeth

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs Signs and symptoms of pain (cont’d.): Increased restlessness Agitation or tension Change in behavior Crying Sighing Groaning Breathing heavily Difficulty moving or walking

7 Basic Nursing Skills 2. Explain the importance of monitoring vital signs REMEMBER: Use the methods listed on page 177 of your textbook to help reduce pain.

7 Basic Nursing Skills 3. Explain how to measure weight and height Review the following points about weight: Resident will be weighed repeatedly during his or her stay, and any change in weight should be reported immediately. Some residents will be weighed on a wheelchair scale. The weight of the wheelchair may need to be subtracted from a resident’s weight. Residents may need to be weighed on a bed scale.

Measuring and recording weight of an ambulatory resident Equipment: standing scale, pen and paper to record your findings 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording weight of an ambulatory resident (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Make sure resident is wearing non-skid shoes before walking to scale.

Measuring and recording weight of an ambulatory resident (cont’d.) 6.Start with scale balanced at zero before weighing resident. Scale must be balanced on zero for weight to be accurate. 7.Help resident to step onto the center of the scale. Be sure she is not holding, touching, or leaning against anything. This interferes with weight measurement. 8.Determine resident’s weight. This is done by balancing the scale. Make the balance bar level. Move the small and large weight indicators until the bar balances. Add these two numbers together.

Measuring and recording weight of an ambulatory resident (cont’d.) 9.Help resident off scale before recording weight. Protects against falls. 10.Record weight. Record weight immediately so you won’t forget. Care plans are made based on your report. 11.Remove privacy measures. 12.Place call light within resident’s reach. Allows resident to communicate with staff as necessary.

Measuring and recording weight of an ambulatory resident (cont’d.) 13.Wash your hands. Provides for infection control. 14.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

Measuring and recording height of a resident Some residents will be unable to get out of bed. If this is the case, height can be measured using a tape measure Equipment: tape measure, pencil, pen and paper 1. Wash your hands. Provides for infection control. 2. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Measuring and recording height of a resident (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Position the resident lying straight in bed, flat on his back with arms and legs at his sides. Be sure the bed sheet is smooth underneath the resident. Ensures accurate reading.

Measuring and recording height of a resident (cont’d.) 6.Make a pencil mark on the sheet at the top of the head. 7.Make another mark at the resident’s heel. 8.With the tape measure, measure the distance between the marks. 9.Record height. Record height immediately so you won’t forget. Care plans are made based on your report. 10.Remove privacy measures. Store equipment.

Measuring and recording height of a resident (cont’d.) 11.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 12.Wash your hands. Provides for infection control. 13.Report any changes in resident to the nurse. Provides nurse with information to assess resident. For residents who can get out of bed, you will measure height using a standing scale.

Measuring and recording height of a resident (cont’d.) Equipment: standing scale, pen and paper 1.Wash hands. 2.Identify yourself by name. Identify the resident by name. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4.Provide for resident’s privacy with curtain, screen, or door. 5.Help resident to step onto scale, facing away from the scale.

Measuring and recording height of an ambulatory resident (cont’d.) 6.Ask resident to stand straight. Help as needed. Ensures accurate reading. 7.Pull up measuring rod from back of scale. Gently lower measuring rod until it rests flat on resident’s head. 8.Determine resident’s height. 9.Help resident off scale before recording height. Make sure measuring rod does not hit resident in the head.

Measuring and recording height of an ambulatory resident (cont’d.) 10.Record height. Record height immediately so you won’t forget. Care plans are made based on your report. 11.Remove privacy measures. Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 12.Wash your hands. Provides for infection control. 13.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills Define the following terms: Restraint a physical or chemical way to restrict voluntary movement or behavior. Restraint-free the state of being free of restraints and not using restraints for any reason. Restraint alternatives any intervention used in place of a restraint or that reduces the need for a restraint.

7 Basic Nursing Skills 4. Explain restraints and how to promote a restraint-free environment Restraints were used in the past for the following reasons: Keep person from hurting self or others Keep person from pulling out tubing Keep person from wandering Prevent falls

7 Basic Nursing Skills 4. Explain restraints and how to promote a restraint-free environment REMEMBER: Restraint usage is illegal in many states. Restraints can only be used with a doctor’s order. It is against the law for staff to apply restraints for convenience or discipline.

7 Basic Nursing Skills Transparency 7-2: Problems from Restraint Use Reduced blood circulation Stress on the heart Incontinence Constipation Weakened muscle and bones Loss of bone mass Muscle atrophy Pressure sores Risk of suffocation Pneumonia

7 Basic Nursing Skills Transparency 7-2: Problems from Restraint Use (cont’d.) Less activity leading to poor appetite Sleep disorders Loss of dignity Loss of independence Increased agitation or depression Poor self-esteem Possible injury or death

7 Basic Nursing Skills Handout 7-3: Restraint Alternatives Improve safety measures. Keep call light within reach. Answer call lights promptly. Ambulate the person when he or she is restless. Provide activities for those who wander at night. Encourage activities and independence. Give frequent help with toileting. Offer food or drink. Offer reading materials.

7 Basic Nursing Skills Handout 7-3: Restraint Alternatives (cont’d.) Distract or redirect interest. Decrease the noise level. Use relaxation techniques. Reduce pain levels through medication. Report complaints of pain to the nurse. Offer one-on-one time with a caregiver. Provide familiar caregivers. Use a team approach. There are also pads, belts, special chairs, and alarms that can be used instead of restraints.

7 Basic Nursing Skills 4. Explain restraints and how to promote a restraint-free environment REMEMBER: There are also pads, belts, special chairs and alarms that can be used instead of restraints.

7 Basic Nursing Skills Transparency 7-3: When a Resident is Restrained The resident must be checked at least every 15 minutes. At regular intervals the following must be done: Release the restraint or discontinue use. Offer assistance with toileting. Check for episodes of incontinence and provide care. Offer fluids. Check skin for irritation. Report signs to the nurse immediately. Check for swelling. Reposition the resident. Ambulate resident if able.

7 Basic Nursing Skills 4. Explain restraints and how to promote a restraint-free environment Think about this question: How would it feel to be unable to scratch your nose, go to the bathroom, or even reposition yourself when you are uncomfortable?

7 Basic Nursing Skills Define the following terms: Intake the fluid a person consumes; also called input. Output all fluid that is eliminated from the body; includes fluid in urine, feces, vomitus, perspiration, and moisture in the air that is exhaled. Fluid balance taking in and eliminating equal amounts of fluid.

7 Basic Nursing Skills Transparency 7-4: Conversion Table A milliliter (mL or ml) is a unit of measure equal to one cubic centimeter (cc). 1 oz. = 30 cc or 30 ml 2 oz. = 60 cc 3 oz. = 90 cc 4 oz. = 120 cc 5 oz. = 150 cc 6 oz. = 180 cc 7 oz. = 210 cc 8 oz. = 240 cc ¼ cup = 2 oz. = 60 cc ½ cup = 4 oz. = 120 cc 1 cup = 8 oz. = 240 cc

7 Basic Nursing Skills Nursing assistants need math skills when doing certain tasks, such as calculating intake and output. A basic math review is listed below: Addition Subtraction Handout 7-4: Basic Math 2,90553,138 +174+3,008 3,07956,146 32,542549,233 -8,710-26,903 23,832522,330

7 Basic Nursing Skills Handout 7-4: Basic Math (cont’d.) Multiplication Division 4,96279 x 13x 41 14,88679 +49,620+3,160 64,5063,239 3439 2274814546 -660-420 88126 -88-126 0 0

7 Basic Nursing Skills Handout 7-4: Basic Math (cont’d.) Converting Decimals, Fractions, and Percentages Decimals, fractions, and percentages are different ways of showing the same value. For example, a half can be written in the following ways: As a decimal: 0.5 As a fraction: 1/2 As a percentage: 50%

7 Basic Nursing Skills Handout 7-4: Basic Math (cont’d.) Here are common values shown in decimal, fraction, and percentage forms: DecimalFractionPercentage 0.011/1001% 0.11/1010% 0.21/520% 0.251/425% 0.3331/333 1/3% 0.51/250% 0.753/475% 11/1100%

7 Basic Nursing Skills Handout 7-4: Basic Math (cont’d.) Follow these rules for converting decimals, fractions, and percentages: To convert from decimal to a percentage, you will multiply by 100, and add a percent sign (%). 0.25 x 100 = 25% To convert from a percentage to decimal, you will divide by 100, and delete the percent sign (%). 80% ÷ 100 = 0.8

7 Basic Nursing Skills To convert a fraction to a decimal, you will divide the top number by the bottom number. 2/3 = 2 ÷ 3 = 0.67 To convert a decimal to a fraction, write the decimal over the number 1. Then multiply top and bottom by 10 for every number after the decimal point (10 for 1 number, 100 for 2 numbers, and so on.) The resulting fraction is 5/10 (or 1/2 if you simplify the fraction). Handout 7-4: Basic Math (cont’d.) Step 10.5 1 Step 20.5x 10=5 1 =10

Measuring and recording urinary output Equipment: I&O sheet, graduate (measuring container), gloves, pen and paper 1.Wash hands. Provides for infection control. 2.Put on gloves before handling bedpan/urinal. 3.Pour the contents of the bedpan or urinal into measuring container. Do not spill or splash any of the urine. 4.Measure the amount of urine at eye level on a flat surface. Helps get accurate reading.

Measuring and recording urinary output (cont’d.) 5.After measuring urine, empty measuring container into toilet. Do not splash. Reduces risk of contamination. 6.Rinse measuring container. Pour rinse water into toilet. 7.Rinse bedpan/urinal. Pour rinse water into toilet. Use disinfectant if ordered. 8.Place bedpan/urinal and container in proper area for cleaning or clean it according to facility policy. 9.Remove and discard gloves.

Measuring and recording urinary output (cont’d.) 10.Wash hands before recording output. Provides for infection control. 11.Record contents of container in output column on sheet. Record amount immediately so you won’t forget. Care plans are made based on your report. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen. 12.Report any changes in resident to the nurse. Provides nurse with information to assess resident.

7 Basic Nursing Skills Define the following terms: Specimen a sample. “Hat” in health care, a collection container that is sometimes inserted into a toilet to collect and measure urine or stool. Mid-stream specimen a type of urine specimen in which the first and last urine are not included in the sample.

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) Remember these things about collecting specimens: NAs must wear gloves for these procedures. Tagging and storing specimens correctly is important. Be sensitive to the fact that residents may find it embarrassing or uncomfortable to have others handling their body wastes. If you feel the task is unpleasant, do not make it known. Remain professional. Remind students after they discard their gloves after collecting specimens, they must wash their hands.

Collecting a routine urine specimen Equipment: urine specimen container and lid, label (labeled with resident’s name, room number, date and time), gloves, bedpan or urinal (if resident cannot use portable commode or toilet), “hat” for toilet (if resident can get to the bathroom), 2 plastic bags, washcloth, towel, paper towel, supplies for perineal care, lab slip, if required 1.Wash your hands. Provides for infection control.

Collecting a routine urine specimen (cont’d.) 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 3.Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

Collecting a routine urine specimen (cont’d.) 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. Prevents you from coming into contact with body fluids. 6.Help the resident to the bathroom or commode, or offer the bedpan or urinal. 7.Have resident void into “hat,” urinal, or bedpan. Ask the resident not to put toilet paper in with the sample. Provide a plastic bag to discard toilet paper. Paper ruins the sample.

Collecting a routine urine specimen (cont’d.) 8.After urination, help as necessary with perineal care. Help resident wash his or her hands. Make the resident comfortable. 9.Take bedpan, urinal, or commode pail to the bathroom. 10.Pour urine into the specimen container. Specimen container should be at least half full. 11.Cover the urine container with its lid. Do not touch the inside of container. Wipe off the outside with a paper towel. Prevents contamination.

Collecting a routine urine specimen (cont’d.) 12.Place the container in a plastic bag. Provides for safe transport. 13.If using a bedpan or urinal, discard extra urine. Rinse equipment. Place in proper area for cleaning or clean it according to facility policy. 14.Remove and discard gloves. 15.Wash your hands. Provides for infection control.

Collecting a routine urine specimen (cont’d.) 16.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 17.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 18.Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of urine. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) Remember these things about collecting a routine urine specimen: Do not include toilet paper with sample. Help with perineal care after urination if necessary. Fill container at least half full. Do not touch the inside of container. Complete label accurately. Wash your hands after completing the procedure.

Collecting a clean catch (mid-stream) urine specimen Equipment: specimen kit with container and lid, label (labeled with resident’s name, room number, date and time), cleaning solution, gauze or towelettes, gloves, bedpan or urinal (if resident cannot use portable commode or toilet), plastic bag, washcloth, paper towel, towel, supplies for perineal care, lab slip, if required 1.Wash hands. Provides for infection control.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 2.Identify yourself to resident by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. Prevents you from coming into contact with body fluids. 6.Open the specimen kit. Do not touch the inside of the container or lid. Prevents contamination. 7.If the resident cannot clean his or her perineal area, you will do it.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 7.(cont’d.) See bed bath procedure in Chapter 6 for reminder on how to give perineal care. Improper cleaning can infect urinary tract and contaminate the sample. 8.Ask the resident to urinate into the bedpan, urinal, or toilet, and to stop before urination is complete.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 9.Place the container under the urine stream. Have the resident start urinating again. Fill the container at least half full. Have the resident finish urinating in bedpan, urinal, or toilet. 10.Cover the urine container with its lid. Do not touch the inside of the container. Wipe off the outside with a paper towel. 11.Place the container in a plastic bag. Provides for safe transport.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 12.After urination, assist as necessary with perineal care. 13.If using a bedpan or urinal, discard extra urine. Rinse and clean equipment. Place in proper area for cleaning or clean it according to facility policy. 14.Remove and discard gloves. Wash your hands. Help resident wash his hands. Promotes infection control.

Collecting a clean catch (mid-stream) urine specimen (cont’d.) 15.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 16.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 17.Take specimen and lab slip to proper area. Document procedure using facility guidelines. Note amount and characteristics of urine. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

Collecting a stool specimen Equipment: specimen container and lid, label (labeled with resident’s name, room number, date, and time), 2 tongue blades, 2 pairs of gloves, bedpan (if resident cannot use portable commode or toilet), “hat” for toilet (if resident uses toilet or commode), 2 plastic bags, toilet tissue, washcloth or towel, supplies for perineal care, lab slip, if required 1.Wash your hands. Provides for infection control.

Collecting a stool specimen (cont’d.) 2.Identify yourself to resident by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

Collecting a stool specimen (cont’d.) 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Put on gloves. Prevents you from coming into contact with body fluids. 6.When the resident is ready to move bowels, ask him not to urinate at the same time. Ask him not to put toilet paper in with the sample. Provide a plastic bag for toilet paper. Urine and paper ruin the sample.

Collecting a stool specimen (cont’d.) 7. Fit hat to toilet or commode, or provide resident with bedpan. Ask the resident to signal when he is finished with the bowel movement. Make sure call light is within reach. 8.Remove and discard gloves. Wash your hands. Leave the room. Promotes infection control. Promotes resident’s privacy and dignity. 9. When called, return to room. Put on clean gloves.

Collecting a stool specimen (cont’d.) 10.Help as necessary with perineal care. Help resident wash his or her hands. 11.Using the two tongue blades, take about two tablespoons of stool and put it in the container. Cover it tightly. 12.Place the container in a clean plastic bag. 13.Wrap tongue blades in toilet paper. Put them in plastic bag with used toilet paper. Discard bag in proper container. Empty the bedpan or container into the toilet.

Collecting a stool specimen (cont’d.) 13.(cont’d.)Rinse equipment. Place in proper area for cleaning or clean it according to facility policy. 14.Remove and discard gloves. 15.Wash your hands. Provides for infection control. 16.Place call light within resident’s reach. Allows resident to communicate with staff as necessary.

Collecting a stool specimen (cont’d.) 17.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 18.Take specimen and lab slip to proper area. Document procedure. Note amount and characteristics of stool. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills Handout 7-5: Collecting a Sputum Sample Equipment: specimen container and lid with label (labeled with resident’s name, room number, date and time), tissues, plastic bag, gloves, mask 1.Wash your hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity.

7 Basic Nursing Skills Handout 7-5: Collecting a Sputum Sample (cont’d.) 5.Put on mask and gloves. If the resident has known or suspected TB or another infectious disease, wear a mask when collecting a sputum specimen. Coughing is one way TB droplets can enter the air. Stand behind the resident if the resident can hold the specimen container by himself. Provides for infection control. 6.Ask the resident to cough deeply, so that sputum comes up from the lungs. To prevent the spread of infectious material, give the resident tissues to cover his or her mouth. Ask the resident to spit the sputum into the container. 7.When you have obtained a good sample (about two tablespoons of sputum), cover the container tightly. Wipe any sputum off the outside of the container with tissues. Discard the tissues. Put the container in the plastic bag and seal the bag.

7 Basic Nursing Skills Handout 7-5: Collecting a Sputum Sample (cont’d.) 8.Remove and dispose of gloves and mask. 9.Wash your hands. Provides for infection control. 10.Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 11.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 12.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills Define the following terms: Catheter a thin tube inserted into the body used to drain or inject fluids. Straight catheter a catheter that does not remain inside the person; it is removed immediately after urine is drained. Indwelling catheter a catheter that remains inside the bladder for a period of time; the urine drains into a bag Condom catheter catheter that has an attachment on the end that fits onto the penis; also called an external or “Texas” catheter.

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) REMEMBER: NAs never insert, irrigate, or remove catheters.

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) Remember these guidelines for catheter care: Keep drainage bag lower than the resident’s hips or bladder to prevent infection. Keep the drainage bag off the floor. Prevent kinks and twists in tubing. Keep genital area clean.

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) Observe and report when providing catheter care: Bloody urine Catheter bag does not fill after several hours Catheter bag fills suddenly Catheter is not in place Urine leaks from catheter Resident reports pain or pressure Odor

7 Basic Nursing Skills 5. Define fluid balance and explain intake and output (I&O) REMEMBER: Always wear gloves and wash hands when dealing with catheters.

Providing catheter care Equipment: bath blanket, protective pad, bath basin with warm water, soap, bath thermometer, 2-4 washcloths or wipes, 1 towel, gloves 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Providing catheter care (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Adjust bed to a safe working level, usually waist high. Lock bed wheels. Prevents injury to you and to resident.

Providing catheter care (cont’d.) 6.Lower head of bed. Position resident lying flat on her back. 7.Remove or fold back top bedding. Keep resident covered with bath blanket. Promotes resident’s privacy. 8.Test water temperature with thermometer or your wrist and ensure it is safe. Water temperature should be 105°F. Have resident check water temperature. Adjust if necessary.

Providing catheter care (cont’d.) 8.(cont’d.) Resident’s sense of touch may be different than yours; therefore, resident is best able to identify a comfortable water temperature. 9.Put on gloves. Prevents you from coming into contact with body fluids. 10.Ask the resident to flex her knees and raise the buttocks off the bed by pushing against the mattress with her feet. Place clean protective pad under her buttocks. Keeps linen from getting wet.

Providing catheter care (cont’d.) 11.Expose only the area necessary to clean the catheter. Avoid overexposure of resident. Promotes resident’s privacy. 12.Place towel or pad under catheter tubing before washing. Helps keep linen from getting wet. 13.Apply soap to wet washcloth. Clean area around meatus. Use a clean area of the washcloth for each stroke.

Providing catheter care (cont’d.) 14.Hold catheter near meatus. Avoid tugging the catheter. 15.Clean at least four inches of catheter nearest meatus. Move in only one direction, away from meatus. Use a clean area of the cloth for each stroke. Prevents infection. 16.Dip a clean washcloth in the water. Rinse area around meatus, using a clean area of washcloth for each stroke.

Providing catheter care (cont’d.) 17.Rinse at least four inches of catheter nearest meatus. Move in only one direction, away from meatus. Use a clean area of the cloth for each stroke. 18.With towel, dry at least four inches of catheter nearest meatus. Move in only one direction, away from meatus. 19.Remove towel or pad from under catheter tubing. Replace top covers. Remove bath blanket.

Providing catheter care (cont’d.) 20.Dispose of linen in proper containers. 21.Empty, rinse, and wipe basin. Place in proper area for cleaning or return to storage. 22.Remove and discard gloves. 23.Wash your hands. Provides for infection control. 24.Return bed to lowest position. Remove privacy measures. Lowering the bed provides for safety.

Providing catheter care (cont’d.) 25.Place call light within resident’s reach. Allows resident to communicate with staff as needed. 26.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 27.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills Define the following terms: Combustion the process of burning. Flammable easily ignited and capable of burning quickly.

7 Basic Nursing Skills 6. Explain care guidelines for different types of tubing Remember these guidelines for oxygen safety: Remove fire hazards. Post “No Smoking” and “Oxygen in Use” signs. Do not allow smoking around oxygen equipment. Do not allow flames around oxygen (this includes candles). Learn how to turn oxygen off in case of fire if facility allows this. Never adjust oxygen level. Report skin irritation.

7 Basic Nursing Skills 6. Explain care guidelines for different types of tubing Remember your role in caring for a resident with an IV: NAs never insert or remove IV lines. NAs do not care for the IV site. NAs only observe the site for changes or problems and report if Needle falls out Tubing disconnects Dressing is loose Blood is in tubing

7 Basic Nursing Skills 6. Explain care guidelines for different types of tubing NA’s role in caring for a resident with an IV (cont’d.): Site is swollen or discolored Resident complains of pain IV bag breaks or fluid level does not decrease IV fluid not dripping IV fluid nearly gone Pump beeps Pump is dropped

7 Basic Nursing Skills 6. Explain care guidelines for different types of tubing In caring for residents with IVs, DO NOT Take blood pressure on an arm with an IV Get the site wet Pull or catch the tubing in anything Leave the tubing kinked Lower the IV bag below the IV site Touch the clamp Disconnect IV from pump or turn off alarm

7 Basic Nursing Skills 6. Explain care guidelines for different types of tubing REMEMBER: Do not get an IV site wet or lower the bag below the IV site. Special care is needed when performing some care procedures on a resident with an IV. Never pull or catch on IV tubing when assisting with care.

7 Basic Nursing Skills Handout 7-6: Emptying the Catheter Drainage Bag Equipment: graduate (measuring container), alcohol wipes, paper towels, gloves 1.Wash your hands. 2.Identify yourself by name. Identify the resident by name. 3.Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4.Provide for resident’s privacy with curtain, screen, or door. 5.Put on gloves. 6.Place paper towel on the floor under the drainage bag. Place measuring container on the paper towel. 7.Open the drain or spout on the bag. Allow urine to flow out of the bag into the measuring container. Do not let spout touch the measuring container.

7 Basic Nursing Skills Handout 7-6: Emptying the Catheter Drainage Bag (cont’d.) 8.When urine has drained, close spout. Using alcohol wipe, clean the drain spout. Replace the drain in its holder on the bag. 9.Note the amount and the appearance of the urine. Empty into toilet. 10.Clean and store measuring container. 11.Remove and dispose of gloves. 12.Wash your hands. 13.Document procedure and amount of urine.

7 Basic Nursing Skills Handout 7-7: Warm and Cold Applications Some states allow nursing assistants to prepare and apply warm and cold applications. Never perform a procedure you are not trained or allowed to do. Only perform procedures that are assigned to you. Applying heat or cold to injured areas can have several good effects. Heat relieves pain and muscular tension. It reduces swelling, elevates the temperature in the tissues, and increases blood flow. Increased blood flow brings more oxygen and nutrients to the tissues for healing. Cold applications can help stop bleeding. They help prevent swelling, reduce pain, and bring down high fevers.

7 Basic Nursing Skills Handout 7-7: Warm and Cold Applications (cont’d.) Types of moist applications are: Compresses (warm or cold) Soaks (warm or cold) Tub baths (warm) Sponge baths (warm or cold) Sitz baths (warm) Ice packs (cold) Types of dry applications are: Aquamatic K-pad ® (warm or cold) Electric heating pad (warm) Disposable warm pack (warm) Ice bag (cold) Disposable cold pack (cold)

7 Basic Nursing Skills Handout 7-7: Warm and Cold Applications (cont’d.) Application TemperatureTimingSpecial Considerations Warm compresses 105°-115°FRemove after 20 minutes. Cover with plastic wrap. Warm soaks105°-110°FCheck temp every 5 minutes. Observe for redness. Soak 15-20 minutes. Aquamatic K-PadPre-setRemove after 20 minutes. Tubing should not hang below bed. Check water level and refill when necessary. Sitz bath100°-104°F or 105°-110°F 20 minutes onlyFill 2/3 full. Provide privacy. Ice packsCheck after 10 minutes. Remove after 20 minutes. Fill bag 2/3 full of ice. Cover bag; watch for blisters and white or pale skin.

7 Basic Nursing Skills 7. Discuss a resident's unit and related care REMEMBER: A resident’s unit is his or her home and must be treated with respect. Always knock on the door and wait for permission to enter. A resident’s items must not be moved without permission.

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Equipment usually found in a resident’s unit includes the following: Electric or manual bed Bedside stand Urinal/bedpan and covers Wash basin Emesis basin Soap dish and soap Bath blanket

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Equipment usually found in a resident’s unit (cont’d.): Toilet paper Personal hygiene items Overbed table Chair Call light Privacy screen or curtain

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Certain items may not be placed on an overbed table: Soiled items Bedpans Urinals

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Remember the following about call lights: They must always be placed within residents’ reach. They must be answered immediately, no matter how many times a resident has used the call light. NAs should respond kindly each time a resident uses his or her call light.

7 Basic Nursing Skills 7. Discuss a resident's unit and related care REMEMBER: Privacy curtains promote residents’ right to privacy. They should be used every time care is performed. Privacy curtains do no block sound, so keep voices low during conversations and care.

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Remember these guidelines for caring for a resident’s unit: Clean the overbed table after each use. Keep equipment clean and in good condition. Report problems with equipment to nurse or according to facility guidelines. Keep call light within reach. Remove meal trays promptly, then remove crumbs and straighten linens. Change linens if they are wet, soiled, or wrinkled.

7 Basic Nursing Skills 7. Discuss a resident's unit and related care Guidelines for caring for a resident’s unit (cont’d.): Report signs of insects or pests immediately. Re-stock personal supplies as needed. Keep water pitchers filled. Notify housekeeping department if trash needs to be emptied. Do not move residents’ belongings. Clean equipment and return it to proper storage. Tidy the area.

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Lack of sleep can cause the following problems: Decreased mental function Reduced reaction time Irritability Decreased immune system function

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Think about these factors that affect sleeping patterns: Fear Stress Noise Diet Medications Illness Sharing a room with another person

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Think about these questions: How do you feel when you do not get enough sleep? How does it affect you during the day? What (in addition to the items listed on the last slide) might cause sleep problems for residents in a facility?

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Watch for these things when a resident is not sleeping well: Sleeping too much during the day Consuming too much caffeine Dressing in night clothes during the day Eating too late at night Refusing medication ordered for sleep Taking new medications TV, radio, or light on late at night Pain

7 Basic Nursing Skills Define the following terms: Occupied bed a bed made while a person is in the bed. Unoccupied bed a bed made while nobody is in the bed. Closed bed a bed completely made with the bedspread and blankets in place. Open bed a bed made with linen fanfolded down to the foot of the bed.

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Consider these reasons for careful bedmaking: Damp and wrinkled sheets keep the resident from sleeping well. Microorganisms thrive in moist, warm places and damp, unclean bedding may cause infection or disease. Sheets that are not flat increase risk for pressure sores.

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Remember these guidelines for bedmaking: Keep linens wrinkle-free and tidy. Wash hands before handling clean linen. Hold soiled linens away from your body. If dirty linen touches your uniform, your uniform becomes contaminated. Do not shake linen or clothes. Put on gloves before removing bed linens. Look for personal items before removing linens. When removing linens, fold or roll linen so the dirtiest area is inside.

7 Basic Nursing Skills 8. Explain the importance of sleep and perform proper bedmaking Guidelines for bedmaking (cont’d.): Bag soiled linen at point of origin and do not take it to other residents’ rooms. Sort soiled linen away from care areas. Place wet linen in leak-proof bags. Disposable bed protectors or pads are used for incontinent residents. Change them as soon as they are soiled or wet and dispose of them properly.

Making an occupied bed Equipment: clean linen - mattress pad, fitted or flat bottom sheet, waterproof bed protector if needed, cotton draw sheet, flat top sheet, blanket(s), bath blanket, pillowcase(s), gloves 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Making an occupied bed (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair). Prevents contamination of linen.

Making an occupied bed (cont’d.) 6.Adjust bed to a safe working level, usually waist high. Lower head of bed. Lock bed wheels. When bed is flat, resident can be moved without working against gravity. Adjusting bed level and locking wheels prevents injury to you and resident. 7.Put on gloves. Prevents you from coming into contact with body fluids. 8.Loosen top linen from the end of the bed on working side. Unfold bath blanket over the top sheet. Remove top sheet.

Making an occupied bed (cont’d.) 9.You will make the bed one side at a time. Raise side rail on far side of bed. After raising side rail, go to other side. Help resident to turn onto her side, moving away from you toward raised side rail. 10.Loosen bottom soiled linen, mattress pad and protector, if present, on the working side. 11.Roll bottom soiled linen toward resident. Tuck it snugly against resident’s back. Rolling puts dirtiest surface of linen inward, lessening contamination.

Making an occupied bed (cont’d.) 11.(cont’d.) The closer the linen is rolled to resident, the easier it is to remove from the other side. 12.Place and tuck in clean bottom linen. Finish with bottom sheet free of wrinkles. Make hospital corners to keep bottom sheet wrinkle-free. Hospital corners prevent a resident’s feet from being restricted by or tangled in linen when getting in and out of bed.

Making an occupied bed (cont’d.) 13.Smooth the bottom sheet out toward the resident. Be sure there are no wrinkles in the mattress pad. Roll the extra material toward the resident. Tuck it under the resident’s body. 14.If using a waterproof pad, unfold it and center it on the bed. Tuck the side near you under the mattress. Smooth it out toward the resident. Tuck as you did with the sheet.

Making an occupied bed (cont’d.) 15.If using a draw sheet, place it on the bed. Tuck in on your side, smooth, and tuck as you did with the other bedding. 16.Raise side rail nearest you. Go to the other side of the bed. Lower side rail. Help resident to turn onto clean bottom sheet. Protect the resident from any soiled matter on the linens. 17.Loosen soiled linen. Check for any personal items. Roll linen from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag.

Making an occupied bed (cont’d.) 17.(cont’d.) Always work from cleanest (head of bed) to dirtiest (foot of bed) area to prevent spread of infection. Rolling puts dirtiest surface of linen inward, lessening contamination. 18.Pull and tuck in clean bottom linen, just like the other side. Finish with bottom sheet free of wrinkles. 19.Ask resident to turn onto her back. Help as needed. Keep resident covered and comfortable, with a pillow under the head. Raise side rail.

Making an occupied bed (cont’d.) 20.Unfold the top sheet. Place it over the resident. Ask the resident to hold the top sheet. Slip the bath blanket out from underneath. Put it in the hamper or bag. 21.Place a blanket over the top sheet. Tuck the bottom edges of top sheet and blanket under the bottom of the mattress.

Making an occupied bed (cont’d.) 21.(cont’d.) Make hospital corners on each side. Loosen the top linens over the resident’s feet. At the top of the bed, fold the top sheet over the blanket about six inches. Loosening the top linens over the feet prevents pressure on the feet, which can cause pressure sores. 22.Remove pillow. Do not hold it near your face. Remove the soiled pillowcase by turning it inside out. Place it in the hamper or bag.

Making an occupied bed (cont’d.) 23.Remove and discard gloves. Wash your hands. Provides for infection control. 24.With one hand, grasp the clean pillowcase at the closed end. Turn it inside out over your arm. Next, using the same hand that has the pillowcase over it, grasp one narrow edge of the pillow. Pull the pillowcase over it with your free hand. Do the same for any other pillows. Place them under resident’s head with open end away from door.

Making an occupied bed (cont’d.) 25.Make resident comfortable. 26.Return bed to appropriate position. Lower side rails if raised. Remove privacy measures. Lowering the bed provides for safety. 27.Place call light within resident’s reach. Allows resident to communicate with staff as necessary.

Making an occupied bed (cont’d.) 28.Take laundry bag or hamper to proper area. 29.Wash hands. Provides for infection control. 30.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 31.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

Making an unoccupied bed Equipment: clean linen - mattress pad, fitted or flat bottom sheet, waterproof bed protector if needed, blanket(s), cotton draw sheet, flat top sheet, pillowcase(s), gloves 1.Wash hands. Provides for infection control. 2.Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair). Prevents contamination of linen.

Making an unoccupied bed (cont’d.) 3.Adjust bed to a safe working level, usually waist high. Put bed in flattest position. Allows you to make a neat, wrinkle-free bed. 4.Put on gloves. Prevents you from coming into contact with body fluids.

Making an unoccupied bed (cont’d.) 5.Loosen soiled linen. Roll soiled linen (soiled side inside) from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag. Always work from cleanest (head of bed) to dirtiest (foot of bed) area to prevent spread of infection. Rolling puts dirtiest surface of linen inward, lessening risk of contamination. 6.Remove and discard gloves. Wash your hands. Provides for infection control.

Making an unoccupied bed (cont’d.) 7.Remake the bed. Spread mattress pad and bottom sheet, tucking under mattress. Make hospital corners to keep bottom sheet wrinkle-free. Put on mattress protector and draw sheet. Smooth and tuck under sides of bed. 8.Place top sheet and blanket over bed. Center these, tuck under end of bed and make hospital corners. Fold down the top sheet over the blanket about six inches.

Making an unoccupied bed (cont’d.) 8.(cont’d.) Fold both top sheet and blanket down so resident can easily get into bed. If resident will not be returning to bed immediately, leave bedding up. 9.Remove pillows and pillowcases. Put on clean pillowcases. Replace pillows. 10.Return bed to lowest position.

Making an unoccupied bed (cont’d.) 11.Take laundry bag or hamper to proper area. 12.Wash your hands. Provides for infection control. 13.Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills 9. Discuss dressings and bandages REMEMBER: NAs do not change sterile dressings,which cover open or draining wounds. Non-sterile dressings are for wounds that have less chance of infection. NAs may assist with non-sterile dressing changes.

Changing a dry dressing using non-sterile technique Equipment: package of square gauze dressings, adhesive tape, scissors, 2 pairs of gloves 1.Wash hands. Provides for infection control. 2.Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Changing a dry dressing using non-sterile technique (cont’d.) 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4.Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5.Cut pieces of tape long enough to secure the dressing. Hang tape on the edge of a table within reach.

Changing a dry dressing using non-sterile technique (cont’d.) 5.(cont’d.) Open four-inch gauze square package without touching gauze. Place the open package on a flat surface. 6.Put on gloves. Protects you from coming into contact with body fluids. 7.Remove soiled dressing by gently peeling tape toward the wound. Lift dressing off the wound. Do not drag it over wound. Observe dressing for any odor or drainage. Notice color and size of the wound. Dispose of used dressing in proper container.

Changing a dry dressing using non-sterile technique (cont’d.) 7.(cont’d.) Remove and discard gloves. Avoids disturbing wound healing. Reduces risk of contamination. 8.Wash your hands. Provides for infection control. 9.Put on new gloves. Touching only outer edges of new four-inch gauze, remove it from package. Apply it to wound. Tape gauze in place. Secure firmly. Keeps gauze as clean as possible.

Changing a dry dressing using non-sterile technique (cont’d.) 10.Remove and discard gloves. 11.Wash your hands. Provides for infection control. 12.Remove privacy measures. 13.Place call light within resident’s reach. Allows resident to communicate with staff as necessary.

Changing a dry dressing using non-sterile technique (cont’d.) 14.Report any changes in resident to the nurse. Provides nurse with information to assess resident. 15.Document procedure according to facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

7 Basic Nursing Skills 9. Discuss dressings and bandages Remember these points: Non-sterile bandages hold dressings in place, secure splints, and support and protect body parts. They may decrease swelling from an injury. NAs may assist with use of an elastic bandage. Some states allow NAs to apply and remove elastic bandages. Follow your facility’s policy.

7 Basic Nursing Skills 9. Discuss dressings and bandages Remember these guidelines for elastic bandages: Keep area clean and dry. Apply snugly enough to control bleeding but make sure not to wrap too tightly, as this can decrease circulation. Wrap bandage evenly. Do not tie the bandage; use special clips. Remove bandage as often as indicated in care plan.

7 Basic Nursing Skills 9. Discuss dressings and bandages Guidelines for elastic bandages (cont’d.): Check bandage often to be sure it doesn’t become wrinkled or loose. 15 minutes after bandage is applied check for signs of poor circulation; loosen if any of these signs are present: Swelling Bluish (cyanotic) skin Shiny, tight skin Skin cold to touch Sores Numbness Tingling Pain or discomfort

7 Basic Nursing Skills Chapter Exam Multiple Choice. 1.Which of the following is the normal temperature range for the oral method? (A)97.6 - 99.6 degrees F (B)96.6 - 98.6 degrees F (C)93.6 - 97.9 degrees F (D)98.6 - 100.6 degrees F 2.What can an overbed table be used for? (A)Placement of dirty linens (B)Placement of bedpans (C)Placement of meals (D)Placement of urinals

7 Basic Nursing Skills Chapter Exam (cont’d.) 3.Which of the following thermometers is used to take a temperature from the ear? (A)Oral thermometer (B)Rectal thermometer (C)Tympanic thermometer (D)Axillary thermometer 4.Which temperature site is considered to be the most accurate? (A)Oral (B)Rectal (C)Axillary (D)Tympanic

7 Basic Nursing Skills Chapter Exam (cont’d.) 5.What should be done with soiled bed linens? (A)They should be shaken out to be sure none of the residents’ personal belongings are put in the wash. (B)They should be rolled up with the dirty side in. (C)They should be rolled up with the clean side in. (D) They should be left in a pile outside the resident’s door for housekeeping to pick up. 6.Under which of the following conditions should a nursing assistant not take an oral temperature on a person? (A)The person has influenza. (B)The person almost certainly has a fever. (C)The person is over six years old. (D)The person is confused or disoriented.

7 Basic Nursing Skills Chapter Exam (cont’d.) 7.Where should the call light be placed when a nursing assistant leaves a resident’s room? (A)On the bedside table beside the telephone (B)Next to the television remote (C)Within the resident’s reach (D) On a chair next to the resident’s bed 8.Which of the following should a nursing assistant do during a resident’s admission? (A)Rush the admission process. (B)Make sure not to bother the resident with introductions to other residents and staff. (C)Handle the resident’s personal items with care. (D)Tell the resident he’ll be able to figure out the daily routines on his own.

7 Basic Nursing Skills Chapter Exam (cont’d.) 9.Which of the following statements is true of taking rectal temperatures? (A)The NA does not need to explain the procedure before starting to take a rectal temperature. (B)Rectal temperatures can only be taken with digital thermometers. (C)The NA must hold on to the thermometer at all times while taking a rectal temperature. (D)The NA does not need the resident’s cooperation to take a rectal temperature. 10.The most common site to take the pulse is the (A)Radial pulse (B)Brachial pulse (C)Carotid pulse (D)Pedal pulse

7 Basic Nursing Skills Chapter Exam (cont’d.) 11.The normal respiration rate for adults ranges from (A)18-30 breaths per minute (B)15-25 breaths per minute (C)12-20 breaths per minute (D)8-10 breaths per minute 12.Why should respirations be counted immediately after taking the pulse? (A)It’s less work for the nursing assistant to count respirations right after taking the pulse. (B)People may breathe more quickly if they know they are being observed. (C)The chest will not rise and fall if the rate is not counted immediately. (D)It does not matter when respirations are counted.

7 Basic Nursing Skills Chapter Exam (cont’d.) 13.What is an NA’s responsibility during transfer of a resident? (A)Decide that the resident must be transferred. (B)Keep the fact that a transfer will occur a secret. (C)Pack all of the resident’s belongings. (D)Tell the resident’s roommate about the transfer. 14.Which of the following blood pressures falls within the normal range? (A)119/75 (B)135/90 (C)91/70 (D)140/80

7 Basic Nursing Skills Chapter Exam (cont’d.) 15.Hypertension is: (A)High fever (B)High blood pressure (C)High pulse rate (D)Low blood pressure 16.Which way is an example of a correct way to write a blood pressure reading? (A)120/75 (B)120+75 (C)120-75 (D)120*75

7 Basic Nursing Skills Chapter Exam (cont’d.) 17.Which of the following statements is true of pain? (A)Everyone experiences pain in the same way. (B)Everyone will express freely when they are in pain. (C)Pain is a different experience for each person. (D)Pain levels do not need to be monitored. 18.Which of the following can help reduce pain? (A)Pounding the resident on the back (B)Jumping jacks (C)Squeezing the body part hard (D)Change of position

7 Basic Nursing Skills Chapter Exam (cont’d.) 19.Which of the following is true of non-sterile dressings? (A)They cover open wounds. (B)They are applied to dry wounds. (C)They cover draining wounds. (D)Nursing assistants never assist with them. 20.Which of the following statements is true of IVs? (A)Nursing assistants insert IV lines. (B)Nursing assistants will observe the IV site for problems. (C)Nursing assistants will remove IV lines. (D)Nursing assistants will change IV lines when the bag is empty.

7 Basic Nursing Skills Chapter Exam (cont’d.) 21.Which is true about nursing assistants and catheters? (A)NAs remove but do not insert catheters. (B)NAs insert but do not remove catheters. (C)NAs irrigate catheters only when the nurse tells them to do so. (D)NAs observe and report regarding catheters. 22.Which of the following statements is true of catheters? (A)The genital area should not be cleaned when a catheter is in use. (B)The location of the drainage bag is not important. (C)It is not a problem for urine to flow from the bag or tubing back into the bladder. (D)The drainage bag must be kept lower than the hips or bladder.

7 Basic Nursing Skills Chapter Exam (cont’d.) 23.Which type of urine specimen does not include the first and last urine in the sample? (A)Routine (B)Clean catch (C)Stool (D)36-hour 24.Eight ounces is equal to ______ milliliters. (A)180 (B)240 (C)210 (D)120

7 Basic Nursing Skills Chapter Exam (cont’d.) 25.To convert ounces to milliliters multiply by (A)30 (B)20 (C)60 (D)15 26.Restraints can be applied: (A)As punishment from staff when a resident is not behaving properly (B)Only with a doctor’s order (C)When a staff member does not have time to watch a resident closely (D)When a nursing assistant judges a resident is a danger to himself or others

7 Basic Nursing Skills Chapter Exam (cont’d.) 27.A serious problem that may result from restraints is: (A)Jaundice (B)Headache (C)Increased activity (D)Pressure sores 28.An example of a restraint alternative is: (A)Tying the resident to the bed (B)Removing the resident’s call light (C)Locking the resident’s door from the outside (D)Giving the resident a repetitive task

7 Basic Nursing Skills Chapter Exam (cont’d.) 29.If a restraint is applied, a nursing assistant must (A)Tie the restraint to the side rails (B)Leave the area so she won’t hear the resident complain (C)Ask other residents to check on the restrained resident (D)Check on the resident every 15 minutes

7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Think about the many emotional adjustments and changes residents may.

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7 Basic Nursing Skills 1. Explain admission, transfer, and discharge of a resident Think about the many emotional adjustments and changes residents may.

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