Nurse Assistant Skills Admitting Transferring and Discharging Patients

Nurse Assistant Skills

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Admitting, Transferring, and Discharging Patients (continued) § § § § Protect patient’s or resident’s possessions Orient patient to facility Transfers Discharges Basic principles for admitting patient Basic principles for transferring patient Basic principles for discharging patient Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

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 § Basic principles of aligning the patient Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

Positioning, Turning, Moving, and Transferring Patients (continued) § Moves and turns § Basic principles of moving patient to head of bed § Basic principles for turning patient § Dangling § Basic principles for dangling patient Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7

Positioning, Turning, Moving, and Transferring Patients (continued) § Transfers § Basic principles for transferring patient to chair, wheelchair, or stretcher § Basic principles for transferring a patient with a mechanical lift Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Bedmaking (continued) § § § Mitered corners Types of beds Draw sheets Body mechanics Infection control Standard precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

Bedmaking (continued) § Basic principles of making a closed bed § Basic principles for making an occupied bed § Basic principles for opening a closed bed § Basic principles for placing a bed cradle Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15

Administering Personal Hygiene (continued) § § § § Types of baths Oral hygiene Hair care Nail care Shaving Backrub Gowning Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16

Administering Personal Hygiene (continued) § § § What to observe Standard precautions Respect patient’s rights Basic principles for providing oral hygiene Basic principles for administering a complete bed bath Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18

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 § I&O forms vary between facilities Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20

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 § Basic principles for completing I&O records Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 21

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23

Assisting with a Bedpan/Urinal § Elimination of body waste is essential § Terminology § Many patients sensitive about using bedpan/urinal § Accurate observations important § Standard precautions § Basic principles of assisting with bedpan/urinal Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25

Providing Catheter and Urinary. Drainage Unit Care (continued) § Careful observation of catheter and drainage unit § When catheter and urinary-drainage unit in place, preferable to never disconnect unit § Catheter care § Observation of urine Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26

Providing Catheter and Urinary. Drainage Unit Care (continued) § Follow correct procedure to empty drainage unit to prevent contamination and infection § Bladder training program § Principles of providing catheter care § Basic principles for emptying a urinary-drainage unit Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28

Providing Ostomy Care § Ostomy: surgical procedure in which an opening, called a stoma, is created in the abdominal wall § Why ostomies are done § Ostomies can be for draining urine from the bladder or for emptying the bowel (stool or feces) Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 29

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 30

Collecting Stool/ Urine Specimens § Laboratory tests are performed on the specimens § Specimens must be collected correctly in order for tests to be accurate § Routine urine specimen § Clean-catch or midstream-voided specimen Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 31

Collecting Stool/Urine Specimens (continued) § Sterile urine specimen § 24 -hour urine specimen § Basic principles for collecting urine specimens § Routine stool specimen § Stool for occult blood Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 32

Collecting Stool/Urine Specimens (continued) § Basic principles for collecting stool specimens § Label all specimens correctly § Observe standard precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 33

Enemas and Rectal Treatments § § § § Enemas Impactions Rectal tube Suppositories Standard precautions Basic principles for giving enemas Basic principles for inserting a rectal tube Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 35

Applying Restraints § § § Chemical restraints Physical restraints Conditions that may require restraints Types of physical restraints Points to remember when using restraints Complications of restraints Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 36

Applying Restraints (continued) § Most health care facilities have specific rules and policies regarding the use of restraints § Basic principles for applying restraints Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 37

Administering Pre- and Postoperative Care § § Three phases of operative care Every patient will have some fears Preoperative care Basic principles for administering preoperative care § Skin preparation or surgical shave § Basic principles for shaving the operative area Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 38

Administering Pre- and Postoperative Care (continued) § Anesthesia § Postoperative unit § Basic principles for preparing a postoperative unit § Postoperative care § Surgical or elastic hose Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39

Applying Binders § Usually made of heavy cotton or flannelette with elastic sides or supports § Where applied § Functions of binders § Application of binders § Straight binders § Breast binders Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40

Applying Binders (continued) § § T-binders Precautions while using binders Basic principles for applying binders Montgomery straps Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 41

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42

Administering Oxygen § § § Blood must have oxygen Signs of oxygen shortage Deficiency of oxygen Methods of administration of oxygen Humidifier Safety precautions Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43

Administering Oxygen (continued) § § Pulse oximeters Points to check while oxygen in use Legal considerations Basic principles of administering oxygen Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44

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 Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 45

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 § Morgue kits Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46

Giving Postmortem Care (continued) § Care of valuables and belongings § Two people often work together to complete care § Basic principles for giving postmortem care Copyright © 2004 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 47