Textbook For Nursing Assistants

Textbook For Nursing Assistants
Chapter 39 – Caring for Surgical Patients Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Introduction to Caring for Surgical Patients
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

A person may need surgery for many different reasons Exploratory surgery May be performed when a person has a significant medical problem but the doctors do not know exactly how bad the problem is or exactly what is causing it For example, doctors might want to do exploratory surgery following an accident when the extent of the damage to the person’s internal organs is unknown, or when cancer is suspected but cannot be confirmed by other means Often times, the problem is not only discovered but solved during the same surgery Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Definitive surgery Is performed when the person’s medical problem is known and the best way to address it is through surgery For example, surgeries are performed to repair organ defects or injuries, as in a hernia repair or surgical repair of a fractured bone Surgeries are also performed to remove diseased body parts, as when the cancerous part of the colon is removed as treatment for colon cancer Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Elective Surgery Surgeries are performed on an elective basis when the procedure is planned for and scheduled ahead of time An example of an elective procedure would be cataract surgery or a plastic surgery procedure, such as a face-lift Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Urgent surgeries Are planned and scheduled ahead of time, but usually an effort is made to schedule the procedure as soon as possible to prevent the person’s condition from getting worse Examples of urgent procedures would include a mastectomy (in a person with breast cancer) or cardiac bypass surgery (in a person with coronary artery disease) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Emergent surgery Is one that must be performed immediately to prevent the person from dying or becoming disabled Emergent surgeries are unplanned and unscheduled and are usually the result of an acute illness or injury, such as a ruptured appendix Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Anesthesia Most surgical procedures are done under anesthesia
Anesthesia prevents the person from feeling pain during the surgery, and is accomplished through the use of medications Based on the situation, the doctor may choose to use a General anesthetic Regional anesthetic, or Local anesthetic Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Anesthesia General anesthesia Causes a loss of consciousness
Usually, a combination of inhaled drugs (in the form of a gas) and injected drugs are given to cause general anesthesia The person is “put to sleep” for the duration of the surgical procedure When the procedure is completed, the drugs are stopped and the person “wakes up” The person will be sleepy for several hours after the procedure and may experience some nausea or vomiting during the recovery period Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Anesthesia Regional anesthesia
Causes a loss of sensation in part, but not all, of the body The person remains conscious throughout the procedure A sedative drug may be given in addition to the anesthetic to help the person relax The anesthetic drug is injected near a nerve pathway, causing the part of the body beyond the injection site to become numb After surgery, the sensation returns gradually The person may experience temporary paralysis and weakness of the anesthetized body part until the anesthetic has worn completely off An example of regional anesthesia is “an epidural block,” which numbs the body from the waist down and is often given to women during childbirth Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Anesthesia Local anesthesia
Causes a loss of sensation in only a very small part of the body (the surgical site) As with regional anesthesia, the drug is injected near a nerve pathway, the person remains conscious throughout the procedure, and a sedative may be given to help the person relax The surgical site remains without sensation until the local anesthetic wears off Eye surgeries, breast biopsies, and hernia repairs are examples of surgeries that are often performed under local anesthesia Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Surgery in the Past In the past, people who were having a planned surgical procedure were admitted to the hospital the day before the scheduled surgery The tests required prior to surgery were done, the surgical site was shaved and cleaned, the person and his family members were told what to expect during and after the surgery, and the person was given a sleeping pill to ensure a restful night’s sleep Following the surgery, the person usually stayed in the hospital for several days to recover under the watchful eyes of the hospital staff Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Surgery Today Now, changes in how we pay for health care have led to changes in the lengths of hospital stays People are discharged from the hospital “quicker and sicker” For the surgical patient who is having elective or urgent surgery, this means that most of the tasks that used to be done in the hospital the day before surgery are now done in the surgeon’s office or on an outpatient basis in the days leading up to the surgery The person remains home until the morning of surgery and goes to the hospital or surgical center an hour or two before the surgery is scheduled After the surgery, the person is often discharged from the hospital within a few hours to recover at home, in an extended care facility, or in a long-term care facility Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

The Peri-Operative Period
There are three phases of care for the person having surgery These phases are: The pre-operative phase, or before surgery The intra-operative phase, or during surgery The post-operative phase, or after surgery The term peri-operative period is used to describe all three phases of the surgical process as a whole Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient

Emotional preparation A person facing surgery usually has many fears, concerns, and worries The person may be afraid of not waking up from the anesthesia, dying as a result of the surgery, or experiencing pain during or after the procedure He may worry that the doctor will make a mistake, and remove the wrong organ or limb If the person is having exploratory surgery, the person may be very worried about what the doctor will find (for example, a malignant tumor) Many people worry about how long it will take to recover from the surgery, and what this will mean in terms of time missed from work and lost income needed to support a family Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

To help reduce a person’s anxiety about the upcoming surgery The health care team spends time talking with the person and his family members about the procedure, its benefits and possible risks, and what can be expected during the post-operative recovery period These conversations, which occur during the pre-operative phase, are commonly called pre-operative teaching Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Pre-operative teaching begins with the doctor’s explanation of why she feels the procedure is the best treatment option for the person The doctor tells the person what complications can occur as a result of the procedure, what will actually occur during the procedure, and what other treatment options, if any, are available Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Informed consent must be given by the person and documented in the person’s medical record. If the person is not able to make an informed decision on his own, informed consent must be obtained from the person’s family members. The nurse is responsible for making sure that informed consent has been obtained and that the person signs a form giving permission for the procedure to take place. Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Once informed consent for the procedure is obtained, the nurse continues the pre-operative teaching by explaining what will need to be done both before and after the surgery The nurse explains the pre-operative procedures that are done to physically prepare the person for surgery, as well as the purpose of any medications or tests that are required during the pre-operative period The nurse also explains what will happen during the post-operative period, and teaches the person how to do any exercises that may be necessary to prevent complications following the surgery Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Nursing assistants reinforce what the nurse has told the person, and keep the nurse informed of any questions the person may have about the procedure If the person asks you a question about an aspect of pre- or post-operative care that you are directly involved with, such as the reason for the NPO status prior to the procedure or the purpose of taking vital signs frequently after the procedure, you can answer the question yourself But if you do not know the answer to the person’s question, or if the question is about the surgical procedure itself, please tell the nurse immediately that the person has a question Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Nursing assistants can: Recognize the person’s fears Listen to the person’s questions and concerns Take action to get those questions or concerns addressed These are all very important things that nursing assistants do to help a person to prepare emotionally for the upcoming surgery. Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

In addition, the doctor may request blood work
Care of the Pre-operative Patient - Physical Preparation - In the Days Leading up to the Surgery Typically, a person who is having surgery will need to have several tests done before the surgery to assess her level of health Tests to assess the functioning of the person’s cardiovascular, respiratory, and urinary systems are typically done In addition, the doctor may request blood work Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation -
The Evening Before Surgery A Person on NPO status A person who is scheduled for surgery will usually be on NPO status for 6 to 8 hours before surgery This is necessary to ensure that the person’s stomach is empty during and after the procedure It is common for a person who has had general anesthesia to vomit as the anesthesia is given or starts to wear off Vomiting while in a semi-conscious state puts the person at risk for aspiration (the inhalation of foreign material into the lungs) Aspiration puts the person at risk for developing pneumonia Going into the procedure with an empty stomach helps to reduce the risk of aspiration and pneumonia Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation -
The Evening Before Surgery Helping a person who is on NPO status Tell the person, as well as any visitors, that NPO means that the person may not have anything by mouth, including water, ice, gum, and mints Show visitors to an area outside of the person’s room where they can enjoy their snacks and beverages, away from the person who is on NPO status Remember to remove the water pitcher and the drinking glass from the bedside table Frequent mouth care helps to keep the person on NPO status comfortable The person is usually allowed to brush her own teeth as long as no water is swallowed Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Many things are done the day of surgery to prepare the person
Care of the Pre-operative Patient - Physical Preparation - The Morning of Surgery Many things are done the day of surgery to prepare the person Tasks that you may be involved with include the following: Administering an enema or vaginal douche Bathing Grooming Dressing Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Administering an enema or vaginal douche
Care of the Pre-operative Patient - Physical Preparation - The Morning of Surgery Administering an enema or vaginal douche A cleansing enema is given before many procedures to empty the bowel For example, an enema may be given if the person is scheduled for intestinal surgery, to prevent feces from contaminating the abdominal cavity during the surgery If a woman is having a vaginal procedure, the doctor may order vaginal irrigation (a douche) prior to the surgery to clean the vagina When vaginal irrigation is ordered, a special solution is placed in the vagina and then allowed to drain out Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation - The Morning of Surgery
Bathing You may need to help the person to bathe and wash his hair prior to the surgery Bathing and shampooing reduces the number of microbes on the skin In some cases, the doctor may order a special anti-microbial soap to be used Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Grooming Make-up, including nail polish, is not permitted during surgery Prosthetic devices, glasses, contact lenses, hearing aids, dentures, wigs, jewelry, and hair ornaments may also be removed prior to the surgery Although the person may want or need to wear some of these items up until the very last minute, you should let the person know about these restrictions and encourage him to leave all but the most necessary items at home Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Dressing If the person will be going to the hospital or surgical center the day of the surgery, have him wear clothing that is loose and comfortable This will make changing into a hospital gown before the procedure easier, and it will also ensure that when the person goes home, the clothing will fit over any bulky dressings or casts that may have been applied during the procedure Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation - Immediately Before the Surgery - Outpatients Once the person arrives at the hospital or surgical center, she will go to a preparation area next to the operating room The person will be shown to a private area and asked to undress and put on a clean hospital gown and surgical cap A nurse will check that all paperwork has been properly completed, and will answer any questions that the person has The person will then be asked to void, and may be given an anti-emetic drug (to prevent nausea) and a sedative (to help relieve anxiety) After these drugs have been given, the side rails must remain up on the bed or stretcher and the person must not get up without assistance, because the sedative may make the person drowsy and weak Make sure the call light control is within easy reach, and that the person is comfortable and warm Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation - Immediately Before the Surgery - Outpatients If the surgery will be performed under general anesthesia, the person’s glasses or contact lenses, hearing aids, dentures, prosthetic devices, jewelry, and hair ornaments may be removed at this time If the surgery will be performed under regional or local anesthesia, the doctor may request that the person wear hearing aids or dentures during the surgery, to make communication easier Items that are removed from the person are documented and given to the person’s family or placed in the facility safe Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation - Immediately Before the Surgery - Outpatients The surgical site (the area of the body being operated on) may be prepared at this time, or this may be done in the operating room Preparation of the surgical site may or may not involve removal of the body hair If hair removal is ordered, there are several ways to remove hair from the surgical site The hair may be shaved, clipped with an electric clipper, or removed with a chemical depilatory (hair-removing) lotion If one of your duties is to perform pre-operative hair removal, make sure you have been instructed in the proper technique Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Lastly, a pre-operative checklist is completed
Care of the Pre-operative Patient - Physical Preparation - Immediately Before the Surgery - Outpatients Lastly, a pre-operative checklist is completed The checklist is used to confirm that all pre-operative tests and procedures have been completed The nursing assistant is often responsible for completing and recording many of the tasks on the checklist Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Pre-operative Patient - Physical Preparation - Immediately Before the Surgery – Inpatients If the person was admitted to the hospital prior to the surgery, the tasks that are completed immediately before the surgery may be completed in the person’s room, before taking her to the operating room In addition, you may need to help your patient from the bed onto the stretcher when it is time to go to the operating room Let the person’s family members know where they can wait while the person is in surgery Please remember that family members are often anxious and nervous about the surgery Refer any questions family members may have about the procedure or the person’s condition to the nurse Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Post-operative Patient

Preparing a surgical bed to receive the patient after surgery
Care of the Post-operative Patient Immediately after surgery, the person is taken to the post-anesthesia care unit (PACU), also known as the recovery room While in the PACU, the person is closely monitored by the health care team to make sure that he is recovering without complications from the surgery or the anesthesia While the person is in surgery, you will most likely be responsible for preparing the person’s room for his arrival post-operatively Preparing a surgical bed to receive the patient after surgery Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Equipment for taking vital signs and a flow sheet for recording the vital signs An intravenous (IV) pole A towel and washcloth An emesis basin A bed protector Suction to connect to drainage devices Supplemental oxygen Pillows or other positioning aids to elevate the extremities Warmed blankets Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

When the person is returned to his room, you will need to assist in transferring the person from the stretcher to the bed The nurse assesses the person’s overall condition, checks for blood on the dressing and for the presence of drains and catheters, and adjusts the IV flow rate While the nurse is doing this, you may be asked to measure and record the person’s vital signs Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Post-operatively, routine vital sign measurements, including temperature, are usually taken every 15 minutes for the first hour, every 30 minutes for the next 1 to 2 hours, every hour for the next 4 hours, and then every 4 hours as ordered Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Post-operative Patient - Preventing Complications
People who have had surgery are at risk for developing complications, especially related to breathing and circulation In addition, the surgical site may become infected or the wound may not stay closed As a nursing assistant, there are several things that you will do to prevent complications from developing Also, if one of your patients develops a complication from surgery, you may be the first one to notice Reporting your observations to the nurse promptly helps to ensure that action will be taken quickly to prevent the person’s condition from getting worse Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Post-operative Patient -Preventing Complications
Respiratory complications The combined effects of general anesthesia, the drugs given to relieve post-operative pain, and a painful incision make it difficult for a person who is recovering from surgery to clear the lungs and airways of fluid and mucus If the person also has a chronic respiratory disorder, such as asthma or chronic obstructive pulmonary disease (COPD), or if the person smokes, then her risk of developing a respiratory complication increases even more Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Common respiratory complications of surgery include pneumonia (fluid fills the alveoli) and atelectasis (the alveoli collapse) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

To prevent fluid and mucus from collecting in the person’s lungs, you may need to assist the person with frequent repositioning and with performing respiratory exercises Commonly used respiratory exercises include coughing and deep breathing and incentive spirometry Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Coughing and deep breathing The person is helped into a comfortable position and then instructed to take a few deep breaths and cough forcefully If the person has had abdominal or chest surgery, you may need to support the incision site with a small pillow or folded towel while the person coughs Incentive spirometry The person forcefully inhales through a special device called an incentive spirometer If your patient has orders to perform respiratory exercises, these exercises will need to be done every few hours, or as directed Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Cardiovascular complications Anesthetic agents, pain medications, and general immobility after surgery can cause the body’s circulation to slow down, leading to pooling of the blood in the legs When blood flow slows and blood pools, a thrombus, or blood clot, may form Surgical patients who are elderly or have a history of circulatory problems are at the most risk for developing thrombi Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Preventing embolism Sequential compression device (SCD) Anti-embolism (TED) stockings Leg exercises Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Sequential compression device (SCD) A sequential compression device (SCD) is a device that is applied to the calves to help prevent pooling of blood in the lower legs Disposable plastic sleeves are wrapped around the person’s lower legs The sleeves, which have several different compartments, are connected to an air pump via tubing Air is pumped into the first compartment (the one closest to the foot) to inflate it Then the next compartment inflates, then the next, helping to move the blood from the lower legs toward the heart When the top-most compartment has been inflated, all the compartments deflate and the cycle begins again at the bottom The inflating and deflating action massages the veins, pushing the blood through the veins and back to the heart Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Anti-embolism (TED) stockings Anti-embolism (TED) stockings are made of a tight-fitting elastic fabric The stockings, which may be knee-high or thigh-high, are specially fitted for the person by the nurse or the physical therapist The elastic fabric applies pressure, compressing the veins and helping to return blood to the heart This helps to prevent pooling of blood in the legs Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Care of the Post-operative Patient - Other Tasks
Assisting with positioning Assisting with nutrition Assisting with elimination Assisting with hygiene Assisting with walking (ambulation) Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Assisting with positioning During the post-operative period, most people will need assistance with repositioning themselves every 1 to 2 hours Frequent repositioning is necessary for the person’s comfort In addition, it helps to prevent the post-operative complications of pneumonia and embolism Depending on where the incision is, moving may be very painful for the person Use a lift sheet to help reposition the person, and move him gently and slowly Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Assisting with nutrition A person who is recovering from surgery usually needs intravenous (IV) therapy until she is able to take fluids orally and is no longer nauseated If the person has had surgery involving the digestive system, then she may have a nasogastric tube The nasogastric tube is connected to suction to keep the stomach empty These patients may need to remain on IV fluids for several days Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Assisting with elimination Following surgery, the person may have difficulties related to elimination Some people may need to use a bedpan or a urinal after surgery The person’s NPO status, pain medications, and immobility can lead to constipation A full bladder can increase pain from an abdominal incision, making voiding difficult and necessitating catheterization Your responsibilities will include reporting the person’s first voiding after surgery Often, you will also need to measure and record the person’s intake and output (I&O) for a period of time following surgery as well Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Assisting with hygiene People who are recovering from surgery may need help with personal hygiene. Assisting with frequent oral care, helping the person to wash his face and hands, and changing soiled gowns promptly are all things you can do to help promote comfort. Many people will not be able to take a bath or a shower for a few days following surgery, because the incision cannot get wet. These people will need your help in the form of either partial or complete bed baths. Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Assisting with walking (ambulation) Early and frequent ambulation is helpful in preventing many of the complications that can result from surgery Many times, a person who has had surgery is able to get out of bed within a few hours of returning to his room Because the person will be weak and unsteady, he will need your help when ambulating Allow the person time to sit on the edge of the bed (“dangle”) before getting out of bed If the person complains of feeling dizzy or lightheaded while he is dangling, help the person to lie back down and call the nurse Otherwise, check the person’s pulse and blood pressure and then help the person to stand Usually, you and the person will walk only a short distance to begin with As the person’s strength returns, you can go for longer walks Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

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