Nurse Assistant Skills Chapter 21 Nurse Assistant Skills

Career Highlight Nurse assistants are important members of the health care team Education—health occupations programs Certification or registration requirements Knowledge and skills

21:1 Admitting, Transferring, and Discharging Patients Procedures may vary slightly in different facilities Basic principles apply to all facilities Alleviating anxiety and fear Admission forms Procedures performed on admission (continues)

Admitting, Transferring, and Discharging Patients (continued) Protect patient’s or resident’s possessions Orient patient to facility Transfers Discharges Leaving against medical advice (AMA)

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

21:2 Positioning, Turning, Moving, and Transferring Patients Responsibility of health care assistant If procedure done correctly, provides patient with optimum comfort and care Also helps worker prevent injury to self and patient Improper moving, turning, or transferring can result in serious injury to patient (continues)

Positioning, Turning, Moving, and Transferring Patients (continued) Correct body mechanics essential for any of these procedures If you are unable to move or turn a patient by yourself, always get help Alignment (continues)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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