Nursing Skills Allied Health II Competence l

Nursing Skills Allied Health II

Competence l l l What is competence? Lets use a bubble map to describe some qualities and important factors of competence. We will use the Promethean Board to draw a bubble map and brainstorm about competence.

Competence in Healthcare l l Describe the importance of competence in Healthcare or any profession. We will again use the Promethean Board to draw a bubble or circle thinking map in order to brainstorm about the importance of competence in healthcare.

Alignment l l Positioning body parts in relation to each other to maintain correct body posture. This can prevent: fatigue, discomfort, decubitus ulcers, contractures.

Decubitus Ulcers l l Pressure sore or bed sore. Ways to prevent decubitus ulcers: l l l Keep skin clean Massage Keep linen dry and free from wrinkles Foam padding (egg crate) Special mattresses Change patient’s position every two hours

Stage 1 Decubitus Ulcer l Redness not relieved by removal of pressure or circulatory stimulation.

Stage 2 Decubitus Ulcer l Vesicle, blister, or break in the skin.

Stage 3 Decubitus Ulcer l Full thickness skin loss, epidermis and dermis are gone.

Stage 4 Decubitus Ulcer l Ulcer extends into fascia (layer of tissue under skin), connective tissue (adipose/fat layer), muscle, and maybe down to the bone.

Contracture l l Tightening and shortening of a muscle due to lack of use or movement. Ways to prevent contractures: l l ROM exercises Supports such as: l l Footboards High top shoes Pillows Rolled blankets

Dangling Position l Sitting with the legs hanging down over the side of the bed. l This allows time for a patient to adjust to a new position. (with movement our BP changes)

Mechanical Lifts l l l Used to transfer weak or paralyzed patients. Never use a lift unless you have been instructed on how to use it. Things to remember: l l When moving a pt you should note changes in pulse, respirations, and skin color. Also observe for signs of weakness, dizziness, increased perspiration, or discomfort.

Mechanical Lifts

Skills to be completed l l l l l Moving the patient up in bed. Positions client on side. * Transferring from bed to wheelchair. * Transferring from bed to bedside commode. Transferring to a stretcher. ROM on shoulder. * ROM one knee and one ankle. * * = Testable Nurse Aide skill All students will be assessed using a checklist provided by the NC NA testing agency.

Bedmaking l l A correctly made bed provides comfort and protection. If linen is contaminated, use Universal precautions / Standard precautions. Wash hands before making a clean bed. Gloves do not have to be worn to make a clean bed.

Bedmaking l Closed bed = made following the discharge of a pt but after terminal cleaning. l l Terminal cleaning = disinfection of bed, rails, mattress, overbed table, entire room. Open bed = fanfolding top covers toward the foot of the bed.

Bedmaking l Mitered corners = special folding technique that secures the linen under the nattress.

Bedmaking l Occupied bed making = making a bed with a pt in it, usually after their morning bath.

Bedmaking l Bed with a cradle = bed cradle is placed under top sheet to keep linens off of pt.

Bedmaking l l Draw sheet = half sheet that extends from pts shoulders to knees. It is used to protect bed and lift the pt. Underpad = placed under the pt to protect the bed from being soiled. Can be disposable or washable.

Skills to be completed l Making a closed bed. Making an Occupied bed. * Opening a closed bed. l *= Testable Nurse Aide skill l l

Administering Personal Care l l l Personal care involves bathing, back care, oral care, hair care, nail care, and shaving. CBB = complete bed bath, it is given to a patient who is confined to the bed. CBR= complete bed rest. CBB involves washing the entire body. Partial bed bath = only wash face, arms, hands, back, and perineal area. Make a mitten with your wash cloth so you will not strike the patient.

Mitten l This is done by folding the wash cloth but you can also buy clothes already in mitten form.

Tub baths and showers l l Showers are usually given every other day at the Nursing home. A video is provided so that you can understand what is to be done once we start clinical.

Oral hygiene l l l Care of the mouth and teeth. Dental caries = cavities Halitosis = bad breath Nurse aids can help prevent caries and halitosis with proper oral hygiene. Denture Care = brush dentures if pt is unable to do so. Do not let dentures get damaged. Special mouth care = given to unconscious or semiconscious pt.

Emesis Basin l l Used for pt is spit in after pt has brushed teeth. Also used to hold dentures while you are cleaning them.

Nail Care and Foot Care l l Important because nails harbor bacteria. Nails should be clean and free of sharp edges. Foot care should be completed daily for elderly or diabetic pts. Nurse Aids should not cut toenails.

ADLs l l Activities of Daily Living When helping pts with ADLs be sure to look for abnormalities and report them.

Skills to be completed l l l Complete bed bath. Gives back rub. Shampooing hair in bed. Gives modified bath. * Provides perineal care for female. * Provides mouth care. * Cleans upper and lower denture. * Giving special mouth care. Dresses client with affected right arm. * Provides fingernail care. * Provides foot care. *

Feeding a Patient l l l l l Allow pt to wash hands. Provide oral care if pt desires. Position in high fowlers, dangling, or in a chair. Clear overbed table. Assist pt as needed. Hot liquids can be checked on you inner wrist. If feeding is necessary, alternate foods with sips of liquid. Use straws. Use tip of utensil. Record intake.

Skills to be completed l l Feeds client who can not feed self. * Assists with dining. Providing supplemental nourishment. Providing fresh drinking water.

Intake and Output l l l l There must be a balance of fluid in the body. Edema = swelling, excessive fluid is retained. Dehydration = excessive fluid is lost. Intake and Output = I&O, record of fluid taken in and fluid put out (urine, emesis, diarrhea, sweat) 30 ml = 1 ounce 5 ml = 1 teaspoon 15 ml = 1 tablespoon 240 ml = 1 cup (8 ounces)

Skills to be completed l l l Measures and records urinary output. * Empty a urinary drainage unit. Measuring and recording I&O.

Assisting with Bedpan l l l l Urinate, micturate, void = to empty the bladder. Defecate = bowel movement. Stool = feces. When assisting with bedpan or urinal provide privacy. Check to see if a specimen is needed. Use standard/universal precautions. Record output. Record any abnormalities.

Bedpans l l Women need bedpans if they have to urinate or defecate. Men need a urinal if they only need to urinate, but if they must defecate then they will need a bedpan.

Skills to be completed l Assists with use of bedpan. *

Catheter Care l l l Catheter – hollow tube. Urinary Catheter – hollow tube inserted into the urinary bladder so that urine will drain into a urinary drainage bag. Urinary Drainage Unit – bag attached to catheter to collect urine.

Why is it important to clean catheters everyday? l To reduce the incidence of bladder infections. l Female – clean perineum front to back. Wash, rinse, pat dry. Hold cath at meatus and clean 4 inches out the cath. Male – Clean from the meatus down the penis toward the body. Then hold cath at meatus and clean 4 inches out the cath. l

Skills to be completed l l Cleans urinary catheter * Apply a condom catheter

Specimens l l l Lab will usually supply appropriate containers. Clean catch or midstream urine specimen – clean perineum front to back then start to urinate, stop flow, place container in proper location, start flow again. All specimens must be labeled properly.

24 hour urine specimen l l l Collect all urine for a full 24 hour period. Lab will provide container. Specimen must be kept on ice. Urine needs to be tested when it is fresh or we need to cool it on ice or in a frig.

Stool specimens l l l Stool = feces Routine stool specimen check feces for worms or eggs. Specimen must be properly labeled and sent immediately to the Lab. Occult blood specimen – a special card is provided and a small amount of stool is placed in a certain area. Lab will add chemical solution to check for blood.

Skills to be completed l l Collect specimen under transmission based precautions. Collect stool specimen.

Restraints l l l Protective device that limits movement. OBRA – legislation that states restraints can only be used to protect pts from harming themselves or others. Must document: l l Pt behavior that requires restraints Alternatives tried and result of each l Example: electronic bed and chair alarms Family must give written consent Physician must write specific orders

Restraints l l l Try least restrictive type of restraint first. If that one doesn’t work then progress to more restrictive restraints. Never apply restraint without proper written consent. Conditions that necessitate use of restraints: l l Irrational or confused pts Prevent falls Skin conditions Paralysis or limited muscular coordination

Restraints l l Straps or safety belts Mittens Limb restraints Restraint vest or jacket

Points to remember l l l Use only when all other means fail Restraint should be unnoticeable to pt Allow as much movement as possible Pt should be told why if they ask why they are being restrained Discontinue use of restraints as soon as possible

Check restraints frequently l l l Limb restraints should be checked every 15 minutes. Restraints on the trunk of the body should be checked every 2 hours. Checking restraints = l l l Removing restraint Check circulation (skin color, temp) Do ROM Complete skin care (may need lotion) Check for broken or red skin

Complications l l l Physical and mental frustration Impaired circulation Decubitus ulcers Loss of muscle tone, joint stiffness, and discomfort Respiratory or breathing problems

Skills to be completed l l Applying restraints Applying safety belt restraint