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Unit 20 Nurse Unit 20 Nurse Assistant SkillsAssistant Skills

Janet J. Nelson, RN,CMA

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What is ADLWhat is ADL

• List what activities are included in List what activities are included in ADL’s.ADL’s.

• Give reasons for providing personal Give reasons for providing personal hygiene.hygiene.– ComfortComfort– Decrease odor Decrease odor – Opportunity to make observationsOpportunity to make observations– Develop relationship with patientDevelop relationship with patient– Psychological improvementPsychological improvement

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20:4 Administering20:4 AdministeringPersonal HygienePersonal Hygiene

• Usually includes the bath, back care, Usually includes the bath, back care, perineal care, oral hygiene, hair care, nail perineal care, oral hygiene, hair care, nail care, and shaving when necessarycare, and shaving when necessary

• Must be sensitive to the patient’s needs Must be sensitive to the patient’s needs and respect the patient’s rights to privacy and respect the patient’s rights to privacy while personal care is administeredwhile personal care is administered

• Controversies with bed baths?Controversies with bed baths?

http://ajcc.aacnjournals.org/content/18/1/31http://ajcc.aacnjournals.org/content/18/1/31

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OBSERVE:OBSERVE:

• ERYTHEMAERYTHEMA• CYANOSISCYANOSIS• JAUNDICE (ICTERUS)JAUNDICE (ICTERUS)• DYSPNEADYSPNEA• VERTIGOVERTIGO• DIAPHORESISDIAPHORESIS• PALLORPALLOR• LETHARGYLETHARGY• WHAT ELSE CAN YOU THINK OF?WHAT ELSE CAN YOU THINK OF?

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Administering PersonalAdministering PersonalHygiene Hygiene (continued)(continued)

• Types of baths: CBB, PBB, Types of baths: CBB, PBB, Tub/Shower, Waterless BathTub/Shower, Waterless Bath

• Oral hygieneOral hygiene• Hair careHair care• Nail careNail care• ShavingShaving• BackrubBackrub• Gowning Gowning

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Administering PersonalAdministering PersonalHygiene Hygiene (continued)(continued)

• Be observant Be observant • Standard precautionsStandard precautions• Respect patient’s rightsRespect patient’s rights• Basic principles for providing oral Basic principles for providing oral

hygienehygiene• Basic principles for administering Basic principles for administering

a complete bed batha complete bed bath

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Mitt with washclothMitt with washcloth

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20: G SHAVING20: G SHAVING• IN the direction of hair growth (Opposite IN the direction of hair growth (Opposite

of what you do) WHY?of what you do) WHY?• Respect patient’s wish with sideburns, Respect patient’s wish with sideburns,

moustache etc.moustache etc.• Hold skin Hold skin tauttaut. HUH?. HUH?• Small areas at a time: WHY?Small areas at a time: WHY?

– One cheek then otherOne cheek then other– Chin & neckChin & neck– Nostril areaNostril area

• Apply pressure if bleedingApply pressure if bleeding• Electric RazorsElectric Razors

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• http://www.youtube.com/watch?v=5http://www.youtube.com/watch?v=5Yik12XWSo0Yik12XWSo0

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Why do a backrub?Why do a backrub?

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SPECIAL ORAL HYGIENESPECIAL ORAL HYGIENE

• Speech Therapist determines patient’s Speech Therapist determines patient’s swallowing ability. If not conscious, or swallowing ability. If not conscious, or post CVA etc…..NO fluid or solid to be post CVA etc…..NO fluid or solid to be in patients mouth. Why?in patients mouth. Why?

• Lemon Glycerin swabs cleans and Lemon Glycerin swabs cleans and refreshes.refreshes.

• KY on lips (Not petroleum base with KY on lips (Not petroleum base with Oxygen)Oxygen)

• Make corrections on check-off.Make corrections on check-off.

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SPECIAL ORAL HYGIENESPECIAL ORAL HYGIENE

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DENTURE CAREDENTURE CARE

• http://www.youtube.com/watch?v=Yn8http://www.youtube.com/watch?v=Yn8ckLPFHLQckLPFHLQ

• Did anything on this demonstration Did anything on this demonstration seem incorrect? Why?seem incorrect? Why?

• Did you notice “Clean” & Dirty” area? Did you notice “Clean” & Dirty” area? • For your check off: Ask patient for For your check off: Ask patient for

dentures. How do you get them out of dentures. How do you get them out of their mouth? Return dentures to their mouth? Return dentures to drawer of bedside stand NOT overbed drawer of bedside stand NOT overbed table or top of bedside standtable or top of bedside stand

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Changing a gownChanging a gown

• Remove gown from uninjuried (or IV) Remove gown from uninjuried (or IV) arm first.arm first.

• Place injuried arm in sleeve first when Place injuried arm in sleeve first when dressing.dressing.

• CAUTION with IV, catheters, casts etc.CAUTION with IV, catheters, casts etc.• Never tie top of gown at back of neck.Never tie top of gown at back of neck.• Never tie waist tie…..imagine lying on Never tie waist tie…..imagine lying on

that?that?• Standard Precautions? Standard Precautions?

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TUB & SHOWERTUB & SHOWER

• This is a verbal check-offThis is a verbal check-off

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Summary Summary

• Providing personal hygiene is an Providing personal hygiene is an important part of patient careimportant part of patient care

• Follow correct procedures while Follow correct procedures while providing personal hygieneproviding personal hygiene

• Observe standard precautions at all Observe standard precautions at all timestimes

• Make careful observations during the Make careful observations during the procedures, and report any abnormal procedures, and report any abnormal conditions notedconditions noted

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20:5 Measuring and 20:5 Measuring and Recording Intake and Recording Intake and

OutputOutput• A large part of the body is fluid, so A large part of the body is fluid, so

there must be a balance between the there must be a balance between the amount of fluid taken into the body amount of fluid taken into the body and the amount lost from the bodyand the amount lost from the body

• Swelling and edema Swelling and edema • DehydrationDehydration• I&O forms vary between facilitiesI&O forms vary between facilities

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Measuring and Measuring and Recording Intake and Recording Intake and

Output Output (continued)(continued)• Intake: fluids taken in by patientIntake: fluids taken in by patient• What is included in intakeWhat is included in intake• Output: fluids eliminated by patientOutput: fluids eliminated by patient• What is included in outputWhat is included in output• Records must be accurateRecords must be accurate• Fluids usually measured by metric Fluids usually measured by metric

systemsystem

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Measuring and Measuring and Recording Intake and Recording Intake and

Output Output (continued)(continued)• Agencies follow different policies for Agencies follow different policies for

recording I&Orecording I&O• Careful instructions should be given Careful instructions should be given

to patients on I&Oto patients on I&O• Standard precautionsStandard precautions• Basic principles for completing Basic principles for completing

I&O recordsI&O records

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20:6 Feeding a Patient20:6 Feeding a Patient

• Good nutrition is an important part of Good nutrition is an important part of a patient’s treatmenta patient’s treatment

• Make mealtimes as pleasant as Make mealtimes as pleasant as possiblepossible

• Mealtimes are regarded as social time Mealtimes are regarded as social time • Proper preparation for mealtimeProper preparation for mealtime• Delay of mealsDelay of meals• Check food trayCheck food tray

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Feeding a PatientFeeding a Patient(continued)(continued)

• Allow patient to feed themselves Allow patient to feed themselves whenever possiblewhenever possible

• Test temperature of foodTest temperature of food• Principles to follow while feedingPrinciples to follow while feeding• Relaxed, unhurried atmosphereRelaxed, unhurried atmosphere• Observe amount eaten Observe amount eaten • Observe for any signs of chokingObserve for any signs of choking

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20:7 Assisting with a 20:7 Assisting with a Bedpan/UrinalBedpan/Urinal

• Elimination of body waste is essentialElimination of body waste is essential• TerminologyTerminology• Many patients sensitive about using Many patients sensitive about using

bedpan/urinalbedpan/urinal• Accurate observations importantAccurate observations important• Standard precautionsStandard precautions• Basic principles of assisting with Basic principles of assisting with

bedpan/urinalbedpan/urinal

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20:8 Providing Catheter20:8 Providing Catheterand Urinary-Drainage and Urinary-Drainage

Unit CareUnit Care• Catheters: hollow tubes usually Catheters: hollow tubes usually

made of rubber or plasticmade of rubber or plastic• French or straight catheterFrench or straight catheter• Foley catheterFoley catheter• External condom catheterExternal condom catheter• Urinary-drainage unitsUrinary-drainage units

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Providing Catheter and Providing Catheter and Urinary-Drainage Unit Urinary-Drainage Unit

Care Care (continued)(continued)• Careful observation of catheter and Careful observation of catheter and

drainage unitdrainage unit• When catheter and urinary-drainage When catheter and urinary-drainage

unit in place, preferable to never unit in place, preferable to never disconnect unitdisconnect unit

• Catheter careCatheter care• Observation of urineObservation of urine

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Providing Catheter and Providing Catheter and Urinary-Drainage Unit Urinary-Drainage Unit

Care Care (continued)(continued)• Follow correct procedure to empty Follow correct procedure to empty

drainage unit to prevent drainage unit to prevent contamination contamination and infectionand infection

• Bladder training programBladder training program• Principles of providing catheter carePrinciples of providing catheter care• Basic principles for emptying a Basic principles for emptying a

urinary-drainage uniturinary-drainage unit

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Summary Summary

• Assisting patient with intake and Assisting patient with intake and output important part of careoutput important part of care

• Provide privacy and respect Provide privacy and respect patient’s rights at all timespatient’s rights at all times

• Observe standard precautionsObserve standard precautions• Follow correct proceduresFollow correct procedures

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20:9 Providing Ostomy 20:9 Providing Ostomy CareCare

• Ostomy: surgical procedure in which Ostomy: surgical procedure in which an opening, called a stoma, is an opening, called a stoma, is created in the abdominal wallcreated in the abdominal wall

• Why ostomies are doneWhy ostomies are done• Ostomies can be for draining urine Ostomies can be for draining urine

from the bladder or for emptying the from the bladder or for emptying the bowel (stool or feces)bowel (stool or feces)

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Providing Ostomy Care Providing Ostomy Care (continued)(continued)

• Can be permanent or temporary Can be permanent or temporary depending on conditiondepending on condition

• Types of ostomiesTypes of ostomies• Ostomy bags or pouchesOstomy bags or pouches• Care of ostomyCare of ostomy• Psychological reactions to ostomyPsychological reactions to ostomy• Observations while caring for Observations while caring for

ostomyostomy• Observe standard precautionsObserve standard precautions

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20:10 Collecting Stool/20:10 Collecting Stool/Urine SpecimensUrine Specimens

• Laboratory tests are performed on Laboratory tests are performed on the specimensthe specimens

• Specimens must be collected Specimens must be collected correctly in order for tests to be correctly in order for tests to be accurateaccurate

• Routine urine specimenRoutine urine specimen• Clean-catch or midstream-voided Clean-catch or midstream-voided

specimenspecimen

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Collecting Stool/Urine Collecting Stool/Urine Specimens Specimens (continued)(continued)

• Sterile urine specimenSterile urine specimen• 24-hour urine specimen24-hour urine specimen• Basic principles for collecting urine Basic principles for collecting urine

specimensspecimens• Routine stool specimenRoutine stool specimen• Stool for occult bloodStool for occult blood

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Collecting Stool/Urine Collecting Stool/Urine Specimens Specimens (continued)(continued)

• Basic principles for collecting stool Basic principles for collecting stool specimensspecimens

• Label all specimens correctlyLabel all specimens correctly• Observe standard precautionsObserve standard precautions

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20:11 Enemas and20:11 Enemas andRectal TreatmentsRectal Treatments

• EnemasEnemas• ImpactionsImpactions• Rectal tubeRectal tube• SuppositoriesSuppositories• Standard precautionsStandard precautions• Basic principles for giving enemasBasic principles for giving enemas• Basic principles for inserting a rectal Basic principles for inserting a rectal

tubetube

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Summary Summary

• Enemas and rectal treatments Enemas and rectal treatments cannot be administered without a cannot be administered without a doctor’s orderdoctor’s order

• Follow correct procedures at all Follow correct procedures at all timestimes

• Observe standard precautions to Observe standard precautions to prevent spread of infectionprevent spread of infection

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20:12 Applying 20:12 Applying RestraintsRestraints

• Chemical restraintsChemical restraints• Physical restraintsPhysical restraints• Conditions that may require Conditions that may require

restraintsrestraints• Types of physical restraintsTypes of physical restraints• Points to remember when using Points to remember when using

restraintsrestraints• Complications of restraintsComplications of restraints

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Applying Restraints Applying Restraints (continued)(continued)

• Most health care facilities have Most health care facilities have specific rules and policies regarding specific rules and policies regarding the use the use of restraintsof restraints

• Basic principles for applying Basic principles for applying restraintsrestraints

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20:13 Administering Pre- 20:13 Administering Pre- and Postoperative Careand Postoperative Care

• Three phases of operative careThree phases of operative care• Every patient will have some fearsEvery patient will have some fears• Preoperative carePreoperative care• Basic principles for administering Basic principles for administering

preoperative carepreoperative care• Skin preparation or surgical shaveSkin preparation or surgical shave• Basic principles for shaving the Basic principles for shaving the

operative areaoperative area

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Administering Pre- and Administering Pre- and Postoperative Care Postoperative Care

(continued)(continued)• AnesthesiaAnesthesia• Postoperative unitPostoperative unit• Basic principles for preparing a Basic principles for preparing a

postoperative unitpostoperative unit• Postoperative carePostoperative care• Surgical or elastic hoseSurgical or elastic hose

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20:14 Applying Binders20:14 Applying Binders

• Usually made of heavy cotton or Usually made of heavy cotton or flannelette with elastic sides or flannelette with elastic sides or supportssupports

• Where appliedWhere applied• Functions of bindersFunctions of binders• Application of bindersApplication of binders• Straight bindersStraight binders• Breast bindersBreast binders

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Applying Binders Applying Binders (continued)(continued)

• T-bindersT-binders• Precautions while using bindersPrecautions while using binders• Basic principles for applying bindersBasic principles for applying binders• Montgomery strapsMontgomery straps

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Summary Summary

• In order to properly care for a surgical In order to properly care for a surgical patient, it is essential for health care patient, it is essential for health care assistants to know and understand all assistants to know and understand all aspects of care that have been orderedaspects of care that have been ordered

• Good operative care can mean a faster Good operative care can mean a faster recovery with fewer complications for recovery with fewer complications for the patientthe patient

• Follow standard precautionsFollow standard precautions

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20:15 Administering 20:15 Administering OxygenOxygen

• Blood must have oxygenBlood must have oxygen• Signs of oxygen shortageSigns of oxygen shortage• Deficiency of oxygenDeficiency of oxygen• Methods of administration of oxygenMethods of administration of oxygen• HumidifierHumidifier• Safety precautionsSafety precautions

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Administering Oxygen Administering Oxygen (continued)(continued)

• Pulse oximetersPulse oximeters• Points to check while oxygen in usePoints to check while oxygen in use• Legal considerationsLegal considerations• Basic principles of administering Basic principles of administering

oxygenoxygen

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20:16 Giving Postmortem 20:16 Giving Postmortem CareCare

• Care given to the body immediately Care given to the body immediately following deathfollowing death

• Begins when a doctor has Begins when a doctor has pronounced the patient deadpronounced the patient dead

• Difficult, but essential part of patient Difficult, but essential part of patient carecare

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Giving Postmortem Care Giving Postmortem Care (continued)(continued)

• Dealing with death and dyingDealing with death and dying• Patient’s rights apply after deathPatient’s rights apply after death• Family member may want to view Family member may want to view

bodybody• Procedure for postmortem care will Procedure for postmortem care will

vary with different facilitiesvary with different facilities• Morgue kitsMorgue kits

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Giving Postmortem Care Giving Postmortem Care (continued)(continued)

• Care of valuables and belongingsCare of valuables and belongings• Two people often work together to Two people often work together to

complete carecomplete care• Basic principles for giving Basic principles for giving

postmortem carepostmortem care

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REVIEWREVIEW

• ErythemaErythema• CyanosisCyanosis• JaundiceJaundice• IcterusIcterus• DyspneaDyspnea• VertigoVertigo• DiaphoresisDiaphoresis

• lethargy• CBB• PBB• halitosis