© 2009 Delmar, Cengage Learning Chapter 21 Nurse/Nurse Assistant Skills

© 2009 Delmar, Cengage Learning DHO-Chapter 21:1 Admitting, Transferring, and Discharging Patients

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Admitting, Transferring, and Discharging Patients (continued) Protect patient’s or resident’s possessions Orient patient to facility Transfers Discharges Leaving against medical advice (AMA)

© 2009 Delmar, Cengage Learning Admitting Causes extreme anxiety for many Imperative that the HC professional create a positive first impression Give a complete orientation to environment Give clear instructions Allow both patient & family to ask questions Many HC facilities have specific forms & admission procedures to complete

© 2009 Delmar, Cengage Learning Admission/Transfer or Discharges Many HC facilities have specific forms & admission/transfers/ discharge procedures to complete- they can include: –H & P –Advanced Directives –consents –Medication form/ allergies –Emergency contact form –Pt. valuable form –Orientation to room and equipment

© 2009 Delmar, Cengage Learning Admission Procedure Wash hands Set up room for new admission— Open the bed linen by fan folding linen Assemble admission kit Check all room equipment to ensure all equipment is operational; Go pick up the patient Meet, Greet and Identify patient Ensure privacy Assist the patient to change into hospital gown Complete necessary paperwork Ensure comfort and safety

© 2009 Delmar, Cengage Learning What Procedures Will You Perform which we have learned this year so far?

© 2009 Delmar, Cengage Learning Transferring Patients Many HC facilities have a transfer checklist that must be completed and travels with the patient This will include: –Transfer list –Personal belongings/ Valuables list –Wheelchair or stretcher

© 2009 Delmar, Cengage Learning Transfer Procedure Gather equipment & Wash hands Gather patient belongings Assist patient safely into W/C or stretcher Transfer to new unit Introduce patient to new staff members Orient to new surroundings Review personal belonging checklist with new staff member Complete transfer checklist & Obtain signatures Ensure comfort and privacy

© 2009 Delmar, Cengage Learning Discharging Patients Dr. order required for discharges If AMA_ Follow specific protocol Assist pt with gathering belongings Inventory and compare to admission form Check over room Allow RN to give all DC instructions Escort patient Or wait on other transportation

© 2009 Delmar, Cengage Learning Discharge Procedure Be sure an order is written Assemble equipment Wash hands Coordinate discharge time with patient Help patient dress if needed Gather all of the patient belongings Check over room Have RN give all instructions Complete valuable & belongs sheet- pt & staff member sign Assist into WC and escort to lobby/car

© 2009 Delmar, Cengage Learning Documentation Record all information on the patients chart Date Time Whether admission, transfer or discharge How patient tolerated Any other pertinent information Signature Report procedure and all findings to your superior

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning DHO- Chapter 21:1 Positioning, Turning, Moving, and Transferring Patients

© 2009 Delmar, Cengage Learning Positioning, Turning, Moving, and Transferring Patients Improper turning, moving can cause serious injury Enough staff, proper mechanical devices, and good body mechanics are essential

© 2009 Delmar, Cengage Learning Alignment Is defined as positioning body parts in relation to each other to maintain correct body posture Benefits include: –Pressure ulcer prevention aka Decubitus ulcers –Contractures- Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

© 2009 Delmar, Cengage Learning Decubitus or Pressure Ulcers AKA= bedsores Caused by prolonged pressure to an area of the body Interferes with circulation Common areas ( bones close to the skin) –Sacral area –Hips –knees –Heels –elbows

© 2009 Delmar, Cengage Learning Pressure points

© 2009 Delmar, Cengage Learning Stages of Decubitus Ulcers/Bedsores

© 2009 Delmar, Cengage Learning Progression of Pressure Ulcer

© 2009 Delmar, Cengage Learning Sacral, Buttock and Gluteal Areas

© 2009 Delmar, Cengage Learning Elbow, Heels, Ankles, Head

© 2009 Delmar, Cengage Learning Pressure Ulcers

© 2009 Delmar, Cengage Learning Prevention Turning patients every 2 hours Elevate and cushion pressure points at all times Massage high pressure areas to promote circulation Use of egg crates- gel mattress, air mattress Careful observation and documentation of skin condition Good nutrition

© 2009 Delmar, Cengage Learning Contractures Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

© 2009 Delmar, Cengage Learning Contractures

© 2009 Delmar, Cengage Learning Preventive Devices

© 2009 Delmar, Cengage Learning Positioning, Turning, Moving, and Transferring Patients (continued) Turning Dangling Transfers

© 2009 Delmar, Cengage Learning Turning All patients confined to bed must be turned frequently –Stimulated circulation –Exercise –Preventing ulcers & contractures At a MINIMUN – q2h!!!! Turning clock used in most facilities

© 2009 Delmar, Cengage Learning Dangling Should be done when patients has been in bed for a long period of time Recommendation- check pulse rate before, during and after the dangling procedure Dangling_ –Sitting on the side of the bed with legs hanging over the side –Allows for readjustment of BP and pulse rate –Assess of dizziness or weakness, pallor, respiratory changes as well

© 2009 Delmar, Cengage Learning Dangling

© 2009 Delmar, Cengage Learning Transfers Patients are frequently moved in the hospital environment Before moving –check doctor order –mode of transportation –utilize the necessary staff During the move –Assess and constantly observe patient –Any changes in pulse, RR, color, weakness, dizziness, pain must be reported STAT –RETURN To Comfortable position

© 2009 Delmar, Cengage Learning Transportation & Mechanical Lifts Many modes of transportation are used –Wheelchairs –Stretchers –Mechanical lift

© 2009 Delmar, Cengage Learning Wheelchairs

© 2009 Delmar, Cengage Learning Stretchers

© 2009 Delmar, Cengage Learning Mechanical Lifts

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning DHO- Chapter 21:2 BEDMAKING

© 2009 Delmar, Cengage Learning 21:3 Bed making 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)

© 2009 Delmar, Cengage Learning Bed making (continued) Mitered corners Types of beds Draw sheets Body mechanics Infection control Standard precautions

© 2009 Delmar, Cengage Learning Bed making (continued) Mitered corners –Used to hold the linen in place –If fitted sheets are used– you should only miter the top sheets & blankets

© 2009 Delmar, Cengage Learning Types of Beds You Will Make Types of beds Closed bed –Done after a patient is discharged –After terminal cleaning of a unit Open bed –This is a closed bed converted to an open bed by fan folding (pleating) the top sheets back –Done to welcome a patient or for patient who are OOB for short periods of time

© 2009 Delmar, Cengage Learning Types of Beds ( continued) Occupied Bed –A bed made while the patient is still in it –Done after a bath or whenever linen is soiled and requires changing Bed Cradle –A device placed on a bed under the top sheets to prevent bed linen from touching parts of the patient’s body

© 2009 Delmar, Cengage Learning Bed Cradle Images

© 2009 Delmar, Cengage Learning Linens Draw sheets –Aka half sheet, pull sheet or lift sheet –Placed between a patients shoulders and knees –Used to protect the mattress –Can be easily changed if soiled without the need of making the entire bed –Some institutions will also use either a washable or disposable impervious pad to protect bed linens

© 2009 Delmar, Cengage Learning Bed making Body mechanics –To prevent injury always use proper body mechanics while changing/making a bed –Use common sense--- attempt to have the linen in the correct order of use to minimize time and conserve energy –Make the bed in its entirety of one side--- then move to the opposite side

© 2009 Delmar, Cengage Learning Infection Control with Bed Making Infection control –If linen is contaminated with blood and /or body fluids –Observe STANDARD PRECAUTIONS Standard precautions –Hands should be washed prior to making and after making a bed –Always wear gloves to handle soiled linens –Follow the policy of the healthcare facility for disposal of linen

© 2009 Delmar, Cengage Learning Contaminated Linen Contaminated linen –is always handled differently than linen that is just “ dirty” Heavily contaminated lined –is doubled red bagged a discarded for cleaning separately Double bagging –prevents leakage of contaminated linen

© 2009 Delmar, Cengage Learning Summary Follow correct procedures for bed making Observe infection control methods and standard precautions at all times Use correct body mechanics to prevent injury Be alert to patient safety and comfort

© 2009 Delmar, Cengage Learning Summary Follow correct procedures for bed making Observe infection control methods and standard precautions at all times Use correct body mechanics to prevent injury Be alert to patient safety and comfort

© 2009 Delmar, Cengage Learning END END OF PRESENTATION FOR CLINICAL 1 students

© 2009 Delmar, Cengage Learning

Personal Hygiene

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Administering Personal Hygiene (continued) Types of baths Oral hygiene Hair care Nail care Shaving Backrub Gowning

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 21:11 Enemas and Rectal Treatments Enemas –Retention enemas –Nonretention enemas Types of enemas –Cleansing –Disposable –Oil retention (continues)

© 2009 Delmar, Cengage Learning Enemas and Rectal Treatments (continued) Impactions—removed by licensed or advanced care provider Rectal tube Suppositories

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Applying Restraints (continued) Most health care facilities have specific rules and policies regarding the use of restraints Be aware of legal responsibilities

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Administering Pre- and Postoperative Care (continued) Preparing a postoperative unit Postoperative care Binders Surgical (elastic) hose Montgomery straps

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Applying Binders (continued) Straight binders Breast binders T-binder replacements Precautions while using binders

© 2009 Delmar, Cengage Learning 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

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Administering Oxygen (continued) Safety precautions Pulse oximeters Points to check while oxygen in use Legal considerations

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning 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)

© 2009 Delmar, Cengage Learning Giving Postmortem Care (continued) Morgue kits Care of valuables and belongings Two people often work together to complete care Observe agency policy

© 2009 Delmar, Cengage Learning 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