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Chapter 21
Nurse Assistant Skills
© 2009 Delmar, Cengage Learning
Career Highlight
• Nurse assistants are important members
of the health care team
• Education—health occupations programs
• Certification or registration requirements
• Knowledge and skills
© 2009 Delmar, Cengage Learning
21:1 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
(continues)
© 2009 Delmar, Cengage Learning
Admitting, Transferring, and
Discharging Patients
(continued)
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Protect patient’s or resident’s possessions
Orient patient to facility
Transfers
Discharges
Leaving against medical advice (AMA)
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:2 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
(continues)
© 2009 Delmar, Cengage Learning
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
(continues)
© 2009 Delmar, Cengage Learning
Positioning, Turning, Moving,
and Transferring Patients
(continued)
• Turning
• Dangling
• Transfers
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:3 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
(continues)
© 2009 Delmar, Cengage Learning
Bedmaking
(continued)
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Mitered corners
Types of beds
Draw sheets
Body mechanics
Infection control
Standard precautions
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:4 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
(continues)
© 2009 Delmar, Cengage Learning
Administering Personal Hygiene
(continued)
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Types of baths
Oral hygiene
Hair care
Nail care
Shaving
Backrub
Gowning
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:5 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
• Intake and output (I&O) forms vary
between facilities
(continues)
© 2009 Delmar, Cengage Learning
Measuring and Recording
Intake and Output
(continued)
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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
(continues)
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:6 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
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:7 Assisting with a Bedpan/Urinal
• Elimination of body waste is essential
• Terminology
• Many patients sensitive about using
bedpan/urinal
• Accurate observations important
• Standard precautions
• Use of gloves important
© 2009 Delmar, Cengage Learning
21:8 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
• Leg bags for ambulation
(continues)
© 2009 Delmar, Cengage Learning
Providing Catheter and
Urinary-Drainage Unit Care
(continued)
• Careful observation of catheter and
drainage unit
• When catheter and urinary-drainage unit in
place, preferable never to disconnect unit
• If necessary to disconnect catheter, follow
agency policy
• Catheter care
(continues)
© 2009 Delmar, Cengage Learning
Providing Catheter and
Urinary-Drainage Unit Care
(continued)
• Observation of urine
• Follow correct procedure to empty drainage
unit to prevent contamination and infection
• Bladder training program
• Keep records
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:9 Providing Ostomy Care
• Ostomy: surgical procedure in which an
opening, called a stoma, is created in the
abdominal wall
• Reasons for an ostomy
• Ostomies can be for draining urine from
the bladder or for emptying the bowel
(stool or feces)
(continues)
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:10 Collecting Stool/Urine Specimens
• Laboratory tests are performed on specimens
to detect disease
• Specimens must be collected correctly for
tests to be accurate
• Routine urine specimen
• Clean-catch or midstream-voided urine
(continues)
© 2009 Delmar, Cengage Learning
Collecting Stool/Urine Specimens
(continued)
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Sterile catheterized urine specimen
24-hour urine specimen
Routine stool (feces) specimen
Stool for occult blood
Label all specimens correctly
Use standard precautions
© 2009 Delmar, Cengage Learning
21:11 Enemas and Rectal Treatments
• Enemas
– Retention enemas
– Nonretention enemas
• Types of enemas
– Cleansing
– Disposable
– Oil retention
(continues)
© 2009 Delmar, Cengage Learning
Enemas and Rectal Treatments
(continued)
• Impactions—removed by licensed or
advanced care provider
• Rectal tube
• Suppositories
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:12 Applying Restraints
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Chemical restraints—medications
Physical restraints—protective devices
Conditions that may require restraints
Types of physical restraints
Points to remember when using restraints
Complications of restraints
(continues)
© 2009 Delmar, Cengage Learning
Applying Restraints
(continued)
• Most health care facilities have specific rules
and policies regarding the use of restraints
• Be aware of legal responsibilities
© 2009 Delmar, Cengage Learning
21:13 Administering Pre- and
Postoperative Care
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Three phases of operative care
Every patient will have some fears
Preoperative care
Skin preparation or surgical shave
Anesthesia
– General
– Local
– Spinal
(continues)
© 2009 Delmar, Cengage Learning
Administering Pre- and
Postoperative Care
(continued)
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Preparing a postoperative unit
Postoperative care
Binders
Surgical (elastic) hose
Montgomery straps
© 2009 Delmar, Cengage Learning
21:14 Applying Binders
• Usually made of heavy cotton or flannelette
with elastic sides or supports
• Where applied
• Functions of binders
• Application of binders
(continues)
© 2009 Delmar, Cengage Learning
Applying Binders
(continued)
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Straight binders
Breast binders
T-binder replacements
Precautions while using binders
© 2009 Delmar, Cengage Learning
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
© 2009 Delmar, Cengage Learning
21:15 Administering Oxygen
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Blood must have oxygen
Signs of oxygen shortage
Deficiency of oxygen (hypoxia)
Methods of administration of oxygen
Ways of providing oxygen to the patient
Humidifier
(continues)
© 2009 Delmar, Cengage Learning
Administering Oxygen
(continued)
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Safety precautions
Pulse oximeters
Points to check while oxygen in use
Legal considerations
© 2009 Delmar, Cengage Learning
21:16 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
(continues)
© 2009 Delmar, Cengage Learning
Giving Postmortem Care
(continued)
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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
(continues)
© 2009 Delmar, Cengage Learning
Giving Postmortem Care
(continued)
• Morgue kits
• Care of valuables and belongings
• Two people often work together to
complete care
• Observe agency policy
© 2009 Delmar, Cengage Learning
Summary
• The nursing assistant provides quality
personal care for patients
• Many skills are required to perform
approved procedures
• Standard precautions must be observed
• Record observations carefully
• Know your legal responsibilities
© 2009 Delmar, Cengage Learning