1. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 22 Nurse Assistant Skills

2. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:1 Admitting, Transferring, and Discharging Patients Procedures vary slightly in different facilities Basic principles apply to all facilities Alleviate a patient’s anxiety and fear Create a positive first impression Admission forms (refer to Figure 22-1 in text)

3. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:1 Admitting, Transferring, and Discharging Patients Procedures performed on admission – Protect patient’s or resident’s possessions – Orient patient and family members to facility Transfers – May be related to patient’s condition – May be requested by patient

4. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:1 Admitting, Transferring, and Discharging Patients Discharges – Physician’s order usually required – Leaving against medical advice (AMA) Follow facility procedures for discharge or transfer Refer to Procedures 22:1A–1C in text

5. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:2 Positioning, Turning, Moving, and Transferring Patients If done correctly, the procedure provides patient with optimum comfort and care When done correctly, helps worker prevent injury to self and patient Improper moving, turning, or transferring can result in serious injury

6. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:2 Positioning, Turning, Moving, and Transferring Patients If unsure, always ask a supervisor before attempting a procedure Correct body mechanics are essential for any of these procedures If you are unable to move or turn a patient by yourself, always get help

7. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Alignment Positioning body parts in relation to each other to maintain correct body posture Benefits – Prevent fatigue – Prevent pressure ulcers (also called decubitus ulcer, pressure sore, or bedsore) – Prevent contractures

8. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Turning Patients confined to bed must be turned at least every 2 hours Frequent turning – Provides exercise for muscles, stimulates circulation, decreases pulmonary congestion, prevents pressure ulcers and contractures, provides patient comfort

9. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Dangling Sitting with legs hanging down over side of bed Used before transfer of a patient Pulse rate is checked before, during, and after Orthostatic hypotension may occur

10. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Transfers Patients are transferred in wheelchairs, chairs, or stretchers Mechanical lift may be used for transfer of weak or paralyzed patient Never transfer a patient without authorization Watch patient carefully during move/transfer

11. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:3 Bedmaking Correctly made bed provides comfort and protection for patients confined to bed for long periods Care must be taken when beds are made Beds must be free from wrinkles, which can cause discomfort and lead to pressure ulcers

12. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:3 Bedmaking Mitered corners to hold linens in place – Refer to Figure 22-22 in text Types of made beds – Closed bed—Open bed – Occupied bed—Bed cradle

13. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:3 Bedmaking Draw sheets or underpads Observe correct body mechanics PPE and infection control Standard precautions for removal of contaminated linens Refer to Procedures 22:3A–23:3D in text

14. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:4 Administering Personal Hygiene Usually includes bath, back care, perineal care, oral hygiene, hair care, nail care, shaving Must be sensitive to patients’ needs and respect their right to privacy while personal care is administered Reasons for providing personal hygiene

15. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Baths Types of baths – Complete bed bath (CBB) – Partial bed bath – Tub bath or shower – Waterless bath

16. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Oral Hygiene Care of mouth and teeth – At least three times a day Routine oral hygiene Denture care Special oral hygiene

17. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hair Care Often neglected aspect of care Brushing stimulates circulation, helps prevent scalp disease Report any observed signs of disease Shampooing must be physician approved

18. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nail Care Often neglected in personal care of patient Nails may not be cut without physician order – May require licensed or advanced personnel Never cut toenails – Foot injuries are prone to infection and slow healing

19. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Shaving Normal daily routine for most men Use regular or electric razor Follow correct technique to prevent patient injury Physician order required before shaving any patient

20. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Back Rub Given as part of daily bath unless contraindicated Perform at least once every 8 hours for patients confined to bed Takes 4–7 minutes Stimulates circulation, prevents pressure ulcers, relaxes and comforts patient

21. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Changing a Gown or Clothing If a patient has weak/injured arm or is receiving an intravenous solution – Position clothing with care – Unclothe uninjured/untreated arm first Patients in long-term care may wear regular clothing during day

22. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Summary Report – Sores, cut, injuries – Rashes – Color – Swelling or edema – Signs of distress Refer to Procedures 22:4A–22:4J in text

23. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:5 Measuring and Recording Intake and Output Need for balance of fluid taken into body and fluid lost from body Fluid retention: swelling (edema) Fluid loss: dehydration Intake and output (I&O) records/forms vary between facilities

24. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Intake All fluids taken in by patient – Oral – Tube feedings or enteral feedings – Intravenous (IV) fluids – Tubes and drains

25. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Output All fluids eliminated by patient – Bowel movement (BM) – Emesis – Urine – Tubes and drains

26. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Recording Intake and Output (I&O) Records must be accurate – Refer to Figure 22-51 in text Amounts measured in graduates Fluids are measured in milliliters (mL) Agencies have different policies for recording I&O Follow standard precautions Refer to Procedure 22:5 in text

27. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:6 Feeding a Patient Good nutrition is an important part of patient ’ s treatment Make mealtimes as pleasant as possible Mealtimes are regarded as social time Patient preparation before food tray arrives Explain any delay of meals

28. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:6 Feeding a Patient Check food tray against patient name, room number, and diet ordered Check diet order before adding food to tray Allow patient to feed themselves when possible Test food temperature before feeding patient

29. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:6 Feeding a Patient Principles to follow while feeding patient – Refer to Procedure 22:6 in text Observe amount eaten for intake record Record intake if I&O is being kept Be alert for any signs of choking

30. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:7 Assisting with a Bedpan/Urinal Elimination of body waste is essential – Urinate, micturate, or void – Defecate Many patients are sensitive about using bedpan/urinal Refer to Procedures 22:7A–22:7B

31. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:7 Assisting with a Bedpan/Urinal Accurate observations of frequency, amount, and appearance of urine/stool are important Measure and record for I&O Observe standard precautions – Frequent handwashing – Use of gloves

32. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:8 Providing Catheter and Urinary- Drainage Unit Care Catheter – Hollow tube usually made of rubber or plastic Urethral or straight catheter Foley (indwelling or retention) catheter External condom catheter

33. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:8 Providing Catheter and Urinary- Drainage Unit Care Urinary-drainage unit – Bag attached to catheter to collect drained urine – Leg bags for ambulatory patients Carefully observe catheter and drainage unit

34. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:8 Providing Catheter and Urinary- Drainage Unit Care Do not disconnect unit when catheter and urinary-drainage unit in place – If necessary to disconnect catheter, follow agency policy Catheter care to prevent infection in bladder or kidneys

35. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:8 Providing Catheter and Urinary- Drainage Unit Care Observation of urine – Amount, type, color, presence of other substances Bladder training program after removal Follow standard precautions Refer to Procedures 22:8A–22:8B in text

36. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:9 Providing Ostomy Care Ostomy – Surgical procedure in which an opening, called a stoma, is created in abdominal wall Ostomy allows waste to be expelled Performed due to tumors, birth defects, ulcerative colitis, bowel obstruction, injury

37. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:9 Providing Ostomy Care Types of ostomies – Ureterostomy – Ileostomy – Colostomy Bag or pouch worn over stoma to collect drainage

38. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:9 Providing Ostomy Care Stoma and skin care to prevent irritation – Qualifications for routine stoma care Psychological reactions to ostomy Observations while caring for ostomy Observe standard precautions Refer to Procedure 22:9 in text

39. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:10 Collecting Stool/Urine Specimens Laboratory tests are performed on specimens to detect disease Specimens must be collected correctly for tests to be accurate

40. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Routine Urine Specimen One of the most common specimens Usually collected from first voided urine in morning (more concentrated) Bedpan, urinal, specimen collector 120 mL of urine is sufficient Send specimen to lab immediately

41. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Clean-Catch, or Midstream-Voided, Specimen Specimen that is free from contamination Sterile urine-specimen container Cleanse genital area thoroughly Sterile container used to catch sample Place sterile lid on specimen immediately

42. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Catheterization for Sterile Urine Specimen Use of catheter or specimen collection catheter for sterile urine specimen Work under supervision and use sterile technique to prevent contamination of catheter

43. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 24-Hour Urine Specimen Needed for Special tests – Check kidney function Urine is preserved using chemicals and/or cold storage Patient voids, and test begins on empty bladder

44. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Routine Stool Specimen Stool (feces) specimen is examined in laboratory Stool is placed in stool-specimen container Examined within 30 minutes for most accurate results

45. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Stool for Occult Blood Occult blood can be found in feces Use of a special card and developing solution Positive result indicates blood in stool Send results to lab as soon as possible

46. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Summary Label specimens correctly Observe standard precautions Take precautions to prevent spread of infection Refer to Procedure 22:10A–22:10E in text

47. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:11 Enemas and Rectal Treatments Enema – Injection of fluid into large intestine and through rectum to remove feces and flatus Physician’s order is required Retention enemas Nonretention enemas

48. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:11 Enemas and Rectal Treatments Types of enemas – Cleansing – Disposable – Oil retention Patient is placed in Sims’ (left lateral) position to receive enema

49. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:11 Enemas and Rectal Treatments Impactions – May be removed by licensed or advanced care provider Rectal tube used to expel flatus Suppository – Inserted into rectum, melted by body heat

50. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:11 Enemas and Rectal Treatments Enemas and rectal treatments cannot be administered without a doctor’s order Follow correct procedures at all times Observe standard precautions to prevent spread of infection Refer to Procedures 22:11A–22:11D in text

51. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:12 Applying Restraints Used to limit movement – Chemical restraints: medications – Physical restraints: protective devices Follow OBRA legislation for appropriate use Circumstances that may require restraints Refer to Procedures 22:12A–22:12B in text

52. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:12 Applying Restraints Types of physical restraints – Straps or safety belts – Limb restraints – Restraint jackets – Geriatric chair – Hand mitts

53. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:12 Applying Restraints Points to remember when using restraints – Frequently check patients under restraint Complications of restraints Most health care facilities have specific rules and policies regarding the use of restraints Be aware of legal responsibilities

54. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:13 Administering Preoperative and Postoperative Care Three phases of operative care – Preoperative care (pre-op) – Operative care (peri-op) – Postoperative care (post-op) Every patient will have some fears Refer to Procedures 22:13A–22:13D in text

55. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Preoperative Care Operative permit Laboratory tests Enemas/vaginal irrigations Baths Vital signs NPO Valuables Remove prosthetics Remove cosmetics Skin preparation or surgical shave Clothing Name band Voiding Surgical checklist

56. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Anesthesia Pain prevention by way of loss of sensation General anesthesia Local anesthesia Spinal anesthesia

57. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Postoperative Care Vital signs Dressings IV Level of pain Observations Position Cough and deep breath Binders Surgical (elastic) hose Compression hose Montgomery straps Wound VACs

58. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:14 Applying Binders Usually made of heavy cotton or flannelette with elastic sides or supports Used to – Provide support and relief – Hold dressings in place – Limit motion – Apply pressure

59. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:14 Applying Binders Straight binders Breast binders T-binders Applying binders – Refer to Procedure 22:14 in text

60. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:15 Administering Oxygen Check legal responsibilities regarding oxygen administration Blood must have oxygen Signs of oxygen shortage Deficiency of oxygen (hypoxia) Physician’s order usually required

61. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Methods of Administering Oxygen Mask Cannula – Placed in nostrils Tent – Patient is surrounded with high concentration of oxygen

62. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Oxygen Delivery Systems Most hospitals pipe oxygen in through the wall In United States, oxygen is color coded with green label Portable oxygen cylinders or oxygen concentrators May be stored as liquid

63. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Safety Precautions Burning is more rapid/intense if O 2 present – Smoking/open flames are prohibited – Caution patient against smoking – Avoid use of electric equipment – Do not use flammable liquids – Use cotton bed linens – Inspect area frequently

64. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pulse Oximeters Monitor patient receiving oxygen Measures level of O 2 in arterial blood – Photo-detector probe clipped to patient’s finger – Percentage of O 2 appears on monitor screen

65. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Summary Patients receiving oxygen should be checked frequently Note quality of respirations Check safety precautions frequently Refer to Procedure 22:15 in text

66. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:16 Giving Postmortem Care Care given to the body immediately following death Begins when a doctor has pronounced a patient dead Difficult but essential part of patient care Control emotions and support family

67. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:16 Giving Postmortem Care Patients’ rights still apply after death Family members may want to view body Procedure for postmortem care will vary by facility Use of morgue kits

68. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22:16 Giving Postmortem Care Care of patients’ valuables and belongings Two people often work together to complete care Observe agency policy regarding procedures Refer to Procedure 22:16 in text