Unit 20 Nurse Assistant Skills
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20:1 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
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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
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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
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20:2 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
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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
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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
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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
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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
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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
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20:3 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
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Bedmaking(continued)
Mitered corners Types of beds Draw sheets Body mechanics Infection control Standard precautions
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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
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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
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20:4 AdministeringPersonal 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
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Administering PersonalHygiene (continued)
Types of baths Oral hygiene Hair care Nail care Shaving Backrub Gowning
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Administering PersonalHygiene (continued)
What to observe Standard precautions Respect patient’s rights Basic principles for providing oral hygiene Basic principles for administering a
complete bed bath
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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
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20:5 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 I&O forms vary between facilities
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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
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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
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20:6 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
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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
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20:7 Assisting with a Bedpan/Urinal
Elimination of body waste is essential Terminology Many patients sensitive about using
bedpan/urinal Accurate observations important Standard precautions Basic principles of assisting with
bedpan/urinal
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20:8 Providing Catheterand 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
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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
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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
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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
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20:9 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)
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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
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20:10 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
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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
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Collecting Stool/Urine Specimens (continued)
Basic principles for collecting stool specimens
Label all specimens correctly Observe standard precautions
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20:11 Enemas andRectal Treatments
Enemas Impactions Rectal tube Suppositories Standard precautions Basic principles for giving enemas Basic principles for inserting a rectal tube
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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
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20:12 Applying Restraints
Chemical restraints Physical restraints Conditions that may require restraints Types of physical restraints Points to remember when using restraints Complications of restraints
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Applying Restraints (continued)
Most health care facilities have specific rules and policies regarding the use of restraints
Basic principles for applying restraints
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20:13 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
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Administering Pre- and Postoperative Care (continued)
Anesthesia Postoperative unit Basic principles for preparing a
postoperative unit Postoperative care Surgical or elastic hose
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20:14 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
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Applying Binders (continued)
T-binders Precautions while using binders Basic principles for applying binders Montgomery straps
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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
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20:15 Administering Oxygen
Blood must have oxygen Signs of oxygen shortage Deficiency of oxygen Methods of administration of oxygen Humidifier Safety precautions
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Administering Oxygen (continued)
Pulse oximeters Points to check while oxygen in use Legal considerations Basic principles of administering oxygen
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20:16 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
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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
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Giving Postmortem Care (continued)
Care of valuables and belongings Two people often work together to
complete care Basic principles for giving
postmortem care