Transcript DHO-Chapter 21:1 Admitting, Transferring, and Discharging

Chapter 21
Nurse/Nurse Assistant Skills
© 2009 Delmar, Cengage Learning
DHO-Chapter 21:1
Admitting, Transferring,
and
Discharging Patients
© 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)
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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)
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Admitting
• Causes extreme anxiety for many
• Imperative that the HC professional create a
positive first impression
• Give a complete orientation to environment
• Give clear instructions
• Allow both patient & family to ask questions
• Many HC facilities have specific forms &
admission procedures to complete
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Admission/Transfer or Discharges
• Many HC facilities have specific forms &
admission/transfers/ discharge procedures to
complete- they can include:
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H&P
Advanced Directives
consents
Medication form/ allergies
Emergency contact form
Pt. valuable form
Orientation to room and equipment
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Admission Procedure
Wash hands
Set up room for new admission—
Open the bed linen by fan folding linen
Assemble admission kit
Check all room equipment to ensure all equipment
is operational;
Go pick up the patient
Meet, Greet and Identify patient
Ensure privacy
Assist the patient to change into hospital gown
Complete necessary paperwork
Ensure comfort and safety
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What Procedures Will
You Perform which we
have learned this year so
far?
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Transferring Patients
• Many HC facilities have a transfer checklist
that must be completed and travels with the
patient
• This will include:
– Transfer list
– Personal belongings/ Valuables list
– Wheelchair or stretcher
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Transfer Procedure
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Gather equipment & Wash hands
Gather patient belongings
Assist patient safely into W/C or stretcher
Transfer to new unit
Introduce patient to new staff members
Orient to new surroundings
Review personal belonging checklist with new staff
member
• Complete transfer checklist & Obtain signatures
• Ensure comfort and privacy
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Discharging Patients
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Dr. order required for discharges
If AMA_ Follow specific protocol
Assist pt with gathering belongings
Inventory and compare to admission form
Check over room
Allow RN to give all DC instructions
Escort patient
Or wait on other transportation
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Discharge Procedure
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Be sure an order is written
Assemble equipment
Wash hands
Coordinate discharge time with patient
Help patient dress if needed
Gather all of the patient belongings
Check over room
Have RN give all instructions
Complete valuable & belongs sheet- pt & staff member
sign
• Assist into WC and escort to lobby/car
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Documentation
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Record all information on the patients chart
Date
Time
Whether admission, transfer or discharge
How patient tolerated
Any other pertinent information
Signature
Report procedure and all findings to your
superior
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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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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)
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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
(continues)
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DHO- Chapter 21:1
Positioning, Turning,
Moving,
and
Transferring Patients
© 2009 Delmar, Cengage Learning
Positioning, Turning, Moving,
and Transferring Patients
• Improper turning, moving can cause serious
injury
• Enough staff, proper mechanical devices, and
good body mechanics are essential
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Alignment
• Is defined as positioning body parts in
relation to each other to maintain correct
body posture
• Benefits include:
– Pressure ulcer prevention aka Decubitus ulcers
– Contractures• Tightening or shortening of muscle- caused by lack of movement
---- Foot drop prevention
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Decubitus or Pressure Ulcers
• AKA= bedsores
• Caused by prolonged pressure to an area of
the body
• Interferes with circulation
• Common areas ( bones close to the skin)
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Sacral area
Hips
knees
Heels
elbows
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Pressure points
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Stages of Decubitus Ulcers/Bedsores
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Progression of Pressure Ulcer
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Sacral, Buttock and Gluteal Areas
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Elbow, Heels, Ankles, Head
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Pressure Ulcers
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Prevention
• Turning patients every 2 hours
• Elevate and cushion pressure points at all
times
• Massage high pressure areas to promote
circulation
• Use of egg crates- gel mattress, air mattress
• Careful observation and documentation of
skin condition
• Good nutrition
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Contractures
• Contractures
• Tightening or shortening of muscle- caused
by lack of movement ---- Foot drop
prevention
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Contractures
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Preventive Devices
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Positioning, Turning, Moving,
and Transferring Patients
(continued)
• Turning
• Dangling
• Transfers
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Turning
• All patients confined to bed must be turned
frequently
– Stimulated circulation
– Exercise
– Preventing ulcers & contractures
• At a MINIMUN – q2h!!!!
• Turning clock used in most facilities
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Dangling
• Should be done when patients has been in
bed for a long period of time
• Recommendation- check pulse rate before,
during and after the dangling procedure
• Dangling_
– Sitting on the side of the bed with legs hanging over the
side
– Allows for readjustment of BP and pulse rate
– Assess of dizziness or weakness, pallor, respiratory
changes as well
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Dangling
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Transfers
• Patients are frequently moved in the hospital
environment
• Before moving
– check doctor order
– mode of transportation
– utilize the necessary staff
• During the move
– Assess and constantly observe patient
– Any changes in pulse, RR, color, weakness, dizziness, pain
must be reported STAT
– RETURN To Comfortable position
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Transportation & Mechanical Lifts
• Many modes of transportation are used
– Wheelchairs
– Stretchers
– Mechanical lift
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Wheelchairs
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Stretchers
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Mechanical Lifts
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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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DHOChapter 21:2
BEDMAKING
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21:3 Bed making
• 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)
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Bed making
(continued)
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Mitered corners
Types of beds
Draw sheets
Body mechanics
Infection control
Standard precautions
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Bed making
(continued)
• Mitered corners
– Used to hold the linen in place
– If fitted sheets are used– you should
only miter the top sheets & blankets
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Types of Beds You Will Make
• Types of beds
• Closed bed
– Done after a patient is discharged
– After terminal cleaning of a unit
• Open bed
– This is a closed bed converted to an open bed by
fan folding (pleating) the top sheets back
– Done to welcome a patient or for patient who are
OOB for short periods of time
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Types of Beds ( continued)
• Occupied Bed
– A bed made while the patient is still in it
– Done after a bath or whenever linen is soiled and
requires changing
• Bed Cradle
– A device placed on a bed under the top sheets to
prevent bed linen from touching parts of the
patient’s body
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Bed Cradle Images
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Linens
• Draw sheets
– Aka half sheet, pull sheet or lift sheet
– Placed between a patients shoulders and knees
– Used to protect the mattress
– Can be easily changed if soiled without the need
of making the entire bed
– Some institutions will also use either a washable
or disposable impervious pad to protect bed
linens
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Bed making
• Body mechanics
– To prevent injury always use proper body
mechanics while changing/making a bed
– Use common sense--- attempt to have the
linen in the correct order of use to
minimize time and conserve energy
– Make the bed in its entirety of one side--then move to the opposite side
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Infection Control with Bed Making
• Infection control
– If linen is contaminated with blood and /or body fluids
– Observe STANDARD PRECAUTIONS
• Standard precautions
– Hands should be washed prior to making and after
making a bed
– Always wear gloves to handle soiled linens
– Follow the policy of the healthcare facility for disposal of
linen
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Contaminated Linen
• Contaminated linen
– is always handled differently than linen that is
just “ dirty”
• Heavily contaminated lined
– is doubled red bagged a discarded for cleaning
separately
• Double bagging
– prevents leakage of contaminated linen
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Summary
• Follow correct procedures for bed
making
• 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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Summary
• Follow correct procedures for bed making
• 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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END
• END OF
PRESENTATION FOR
CLINICAL 1
• students
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Personal Hygiene
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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)
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Administering Personal Hygiene
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Types of baths
Oral hygiene
Hair care
Nail care
Shaving
Backrub
Gowning
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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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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)
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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)
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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
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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
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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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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
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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)
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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 never to disconnect unit
• If necessary to disconnect catheter, follow
agency policy
• Catheter care
(continues)
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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
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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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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)
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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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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)
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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
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21:11 Enemas and Rectal Treatments
• Enemas
– Retention enemas
– Nonretention enemas
• Types of enemas
– Cleansing
– Disposable
– Oil retention
(continues)
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Enemas and Rectal Treatments
(continued)
• Impactions—removed by licensed or
advanced care provider
• Rectal tube
• Suppositories
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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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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)
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Applying Restraints
(continued)
• Most health care facilities have specific rules
and policies regarding the use of restraints
• Be aware of legal responsibilities
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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)
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Administering Pre- and
Postoperative Care
(continued)
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Preparing a postoperative unit
Postoperative care
Binders
Surgical (elastic) hose
Montgomery straps
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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)
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Applying Binders
(continued)
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Straight binders
Breast binders
T-binder replacements
Precautions while using binders
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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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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)
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Administering Oxygen
(continued)
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Safety precautions
Pulse oximeters
Points to check while oxygen in use
Legal considerations
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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)
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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)
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Giving Postmortem Care
(continued)
• Morgue kits
• Care of valuables and belongings
• Two people often work together to
complete care
• Observe agency policy
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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
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