Chapter 22 Nurse Assistant Skills Copyright 2017 Cengage

Chapter 22 Nurse Assistant Skills 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) 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 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: 1 A– 1 C in text 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 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 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 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 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 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, 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 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 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 – Occupied bed —Open bed —Bed cradle 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: 3 A– 23: 3 D in text • • 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 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 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 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 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 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 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 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 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: 4 A– 22: 4 J in text 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 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 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 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 (m. L) Agencies have different policies for recording I&O Follow standard precautions Refer to Procedure 22: 5 in text 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 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 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 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: 7 A– 22: 7 B 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 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 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 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 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: 8 A– 22: 8 B in text 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 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 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 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 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 m. L of urine is sufficient • Send specimen to lab immediately 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 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 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 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 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 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: 10 A– 22: 10 E in text 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 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 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 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: 11 A– 22: 11 D in text 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: 12 A– 22: 12 B in text 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 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 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: 13 A– 22: 13 D in text 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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.