Website nurse assistant text

Mary Anne Molinari
GCNS-BC
Contributor and editor
Jackie Kellum, RN
Copyright ©2013

Table of Contents
Professional conduct A (01)
Student will be able to verbalize the concept of professionalism and
work ethics
Infection Control B (01-06)
Student will be able to identify and demonstrate principles of
infection prevention
Communication Impairments
Student will have a better understanding of the impact of
communication impairments related to hearing and visual
impairments, Aphasia, confusion and demonstrate strategies to
deal with the condition
Hearing C (01-04)
Vision (05-13)
Confusion and Anger (14-20)
Body Mechanics D (01-02)
Student will understand importance and be able to demonstrate
proper body mechanics
Immobility E (01)
Student will understand the effects of immobility on different body
systems
Skin
Student will understand the functions, aging changes and be able to
identify abnormal conditions. Will be able to identify factors
contributing to development of pressure ulcers, staging and
preventive measures
Function and Observation F (01-04)
Pressure Ulcers (05-07)
Personal Care
Student will understand the importance of oral care and personal
hygiene and be able to accurately perform bathing , grooming
procedures and oral care .
Oral Hygiene G (01-03)
Personal Hygiene (04-14)
Activity
Student will understand the importance of mobility, and safely
perform range of motion exercises, assist with positioning, transfer
and use of cane , wheelchair and walker
Range of Motion H (01-03)
Positioning and transfer (04-11)
Ambulation and Devices (12- 18)
Moving Techniques ( 19-23)
Pain/Discomfort I (01-05)
Student will be able to recognize signs and symptoms of pain, use
assessment scale and identify possible comfort measures for someone
experiencing discomfort.
Nutrition , Hydration
Student will demonstrate a basic understanding of nutrition and
hydration and importance. Will be able to safely assist or feed a
person
Nutrition and Hydration J (01-07)
Assisting with meals (08)
Tube feeding (09-12)

Elimination
Student will have basic understanding of how to care for persons
with a variety of intestinal and/or urinary conditions.
Gastrointestinal K (1-08 )
Urinary System (09-15)
Vital Signs L (01-05)
Student will understand the importance of vital signs and accurately
take a pulse, temperature, respiratory rate and blood pressure
Medication Administration M (01-11)
Student will understand why medications are given, recognize side
effects and demonstrate safely how to administer via various routes
Wound Care N (01-14 )
Student will be able to identify different wound types, factors
contributing to healing and demonstrate proper procedure for
simple would care and application of heat and cold.
Emergencies 0 (01-17)
Seizures -2,3, Stroke-4, Sprains and Fractures-4,5, Diabetes -7,8,
Nose Bleeds-9, Choking-10, Chest Pain-11, Heart Attacks-13 ,
External Bleeding-14,15, Burns-16,17
Care Giver Promise
I promise to provide safe basic care service in any
setting in which I am employed.
I will:
• Follow safe home and health care guidelines
and refrain from performing any service
for which I am not qualified.
• Treat all persons as individuals and with
respect, dignity and compassion
• Always act in an honest, moral and ethical
manner
• Honor a person’s right to privacy, keeping
personal and medical information
confidential unless required by medical
professionals or not reporting could
result in harm to the person, self or
others.
• Maintain a positive, caring attitude, not bringing
personal problems to the work place.
• Honor my employment commitments and work
cooperatively with others involved in
the employment situation

Professionalism
Definition of terms:
Professional…How one behaves at work.
Ethics…..is the knowledge of right and wrong
Client Rights:
• Right to best care available
• Right to receive correct care
• Right to participate in their own care
• Right to be informed of care options
• Right to make independent choices
• Right to privacy and confidentiality
• Right to dignity, respect and freedom
• Right to security of possessions
• Right to complain
What does it mean ?
• Never abuse a client
• To be personally safe
• Perform care safely
• Involve client in planning
• Respect client’s refusal of
care
• Be truthful in reporting
• Maintain confidentiality
• Respect client’s personal
possessions
• Control emotions
• Desire to learn
• Be honest
• Honor commitments
• Care about quality of work
A-1

Infection
Is a disease caused by germs entering the
body, which grow and multiply there—
What is a microorganism?
A microbe is a very tiny living thing you cannot
see with your eyes
Such as :
• bacteria ** most common
• virus
• fungus
B-11,000,000,000 trillion bacteria in one tsp. poop

How INFECTIONS spread
Must have microbe
Must have place to live and multiply such as
plants ……people
soil…… food
water
Must have way to leave
In humans: nose, mouth, eyes
Cut in skin
Must have a person who
could get sick from germ
Must be a way for microbe to
Enter the person
• Direct contact ..touch, kissing etc.
• Indirect contact.. …contaminated
food, water, supplies
• Water droplets. Does not stay in
air
• Airborne particles…stays in air
Any break in this chain stops infection spread
B-2

Good personal hygiene
Many microbes are in our bodies are helpful and are harmless
Some microbes are harmful …these are the ones that
cause infection.
Sometimes harmless ones turn into harmful ones if they enter a different
part of the body.
• Use protection such as masks and gloves , aprons when
• exposure to infectious agents is possible.
ex. Airborne microbes ….wear masks
• Proper disposal of wastes, garbage and medical supplies
• Treat all bodily fluids ( urine, salvia etc.) as potentially infectious.
• Carry all dirty items , linens away from your body.
There are two types of Infection
Local…attacking a specific part of the body
Symptoms at part of body affected include
• Pain
• Redness
• Swelling
• Bad smelling drainage
• Fever
B-3

Masks and Gloves
Many types of masks
Paper Masks protect against large particles
Good for jobs where there is dust
Viruses are small particles…..
Controversy about how effective are paper masks
against flu and other viruses
Air can get into sides
Possibly better if infected person wore the mask
****cough into sleeve
Wear mask properly
Wear mask if needed when working within 6 feet
of person
Place over nose and mouth
Do not touch mask after it is on face
Removal of mask with gloves on or just touch strings
or elastic
Dispose of mask in trash, never reuse
Wash hands
Respirators Masks
There are seven types of particle filtering face piece respirators.
The best filters at least 95% of airborne particles but is not resistant to oil.
Gowning….use apron to protect clothes best if lines with non-porous material
paper
respirator

GlOVES
Sterile gloves used for surgical procedures
and any other procedure that requires sterile
technique.
Protects you and patient
Special way to put them on your hands
Non-sterile gloves used to mostly protect self doing non-sterile
procedures
Always dispose of gloves after use or if tear
and wash hands
Universal Precautions,
Precautions to preventing the transmission of blood-borne diseases such as AIDS virus,
hepatitis B, and other blood pathogens when health care is provided. Under Universal
Precautions, blood and certain body fluids of all patients are considered potentially
infectious.
Body fluids are any fluid in the body including blood, urine, saliva, sputum, tears, semen,
milk, or vaginal secretions. Body fluids, are widely recognized as vehicles for the
transmission of disease.
Gloves, mask, gowning, waste and needle disposal

Symptoms appear throughout the body include
• Aches
• Chills, Fever
• Nausea
• Vomiting
• Weakness
Systemic ….spread through out the body by the blood
usually a bacteria or virus
Reasons why symptoms of infection are not always present
• People manifest symptoms differently
• Persons may not realize symptom is important
• Persons cannot tell you
• Person may not recognize a symptom is important
B-4

1,000,000,000 trillion bacteria in one tsp of “ poop”

How to Prevent Infection
WASH YOUR HANDS !!!!!!
Whenever they are visibly soiled
After….using toilet, coughing, sneezing or blowing nose
• contact with any body fluids, broken skin or dressings
• handling contaminated items
• contact with objects in room
• Soiled linens
• touching garbage/trash
• picking up anything on the floor
• touching areas on your body such as mouth, hair , nose
Before and after putting on gloves
Before and after handling food
Before and after feeding residents
Before getting clean linen
Before and after you eat
Before and after handling bandages
B-5

The Right Way to Wash Hands
What is the right way to wash your hands?
• Jewelry should be removed from hands during hand washing
• Wet your hands with clean running water (warm or cold) and apply soap.
• Rub your hands together to make a lather and scrub them well; be sure to scrub
the backs of your hands, between your fingers, and under your nails.
• Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy
Birthday" song from beginning to end twice.
• Rinse your hands well under running water.
• Dry your hands using a clean towel or air dry.
What if I don’t have soap, running water ?
Washing hands with soap and water is the best way to reduce the number of germs on them. If
soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60%
alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some
situations, but sanitizers do not eliminate all types of germs.
How should you use hand sanitizer?
• Apply the product to the palm of one hand (read the label to learn the correct amount).
• Rub your hands together.
• Rub the product over all surfaces of your hands and fingers until your hands are dry.
B-6

C-1
Hearing Impairment
Sound
wave
cochleaBrain
Sound wave ear canal ear drum
tiny bones (makes louder)
snail shaped tubing Cochlea
(chemicals cause electric signal)
signal brain ( converts it to sound)
Auditory nerve
Types
Partial or Complete Hearing Loss
Causes:
• Age (Presbycusis)
• Damage to any part of ear
• Infection/ disease/trauma
• Some medications
• Long exposure to loud noise
• Wax build up

C-2
Treatments….. depends on cause
1. Infection-------antibiotics
2. Wax-------------removal, softening drops,
irrigations
3. Operations……to correct certain types of
deformities
4. Injuries
Hearing aides……amplify and modify sound
most are digital with computer chip
that adjusts for comfort level and outside
sounds………but person may have older
models that do not.
Various styles, sizes and placement
Examples:

C-3
Guidelines for Communication with Hearing Impaired
• Determine the degree of hearing loss & if both ears are involved.
• Position yourself at better hearing side .
• Ask the person what is the best way for them to communicate.
• Get person’s attention before speaking. i.e walk in front , gently
tap person on arm or shoulder.
• Minimize background noise.
• Do not stand with your back to a window or bright light.
• Sit or stand at same level and look directly at person , maintain
eye contact.
• Speak clearly, at normal, steady speed, do not shout or
exaggerate , keep pitch low,
• Use simple , short sentences and words, avoid sudden changing
topic, repeat if necessary. ( maybe use different words)
• Keep your hands away from your face and avoid chewing gum or
eating when speaking.
• Make use of gestures and facial expressions.
• Check periodically to see if person understands what is being said.
• Have pen and paper, picture cards available to write needs.

C-4
Hearing Aides and other devices for the hearing impaired.
Hearing aides
Read directions or have someone explain HOW TO:
Tell if it is working
Keep it clean (usually with alcohol and a clean cloth).
How to check and how to replace batteries.
Do Not Put in Water ….so remove for showers.
Ear molds can be removed from the hearing aids and
cleaned with a mild soap solution.
Turn off when not in use.
Other helpful devices
Amplification devices on phones, clocks etc.
Signal devices such as flashing red lights on phone, door bells etc.
Vibration devices on phones etc.

. Blindness….lacking sight
Impaired Vision ….has some useful sight…usually interferes with ADL
Can occur at any age….primarily elderly**
Common conditions include:
 Presbyopia
 Cataracts
 Glaucoma
 Macular degeneration
 Diabetic Retinopathy
 Stroke
Presbyopia…difficult to focus on close objects
Often age 40+ Often treated with glasses and contacts C-5

C-6
Cataracts…cloudiness of lens poor night vision, halos and
sensitivity to glare
Treatment: eye drops/surgery (removal and replacement of lens)
Glaucoma…increased fluid pressure in the eye leads to pressure on optic nerve
poor night vision, blind spots. If sudden, this is an emergency.!!!
Treatment: eye drops, micro or laser surgery

C-7
Macular Degeneration….damage to macula ( area in retina)
responsible for central vision loss of central vision
Treatment : medication and/or phototherapy
Diabetic Retinopathy believed to be damage to tiny blood vessels
(supplying O2 and nutrients) to retina visual impairment, 2 % blindness
Treat: prevention (blood sugar, blood pressure and cholesterol) laser
surgery

C-8
Stroke….blood supply to part of brain reduced or interrupted
effect on vision depends on length of time and area of brain affected.
It causes different problems:
Other problems such as infection, migraine headaches, tumors,
retinal detachment etc. Some medications may have an affect on the person’s
vision.
Assistance and Safety measures for blind and persons with low vision
Problems with:
1. Depth perception ASSESS THE DEGREE OF VISUAL
2. Contrast IMPAIRMENT
3. Color discrimination
4. Clearness

C-9
CARE FOR PERSON WITH VISIAL IMPAIRMENT
 If the person wears glasses, make sure they are clean.
 Tell the person when you are entering and leaving room.
 Always identify self , speaking as you approach the person.
 Make sure there is proper lighting in the room and face the person when
you are speaking .
 In a normal tone of voice state clearly what you would like to do.
 Use specific words when directing the person, such as “ straight ahead”
 When orienting to a new environment describe the things you see and
use the face and hands of a clock to orientate: i.e the chair is at 2 o’clock
 When ambulating, offer person your arm just above the elbow.
 Walk in a relaxed manner and warn persons of obstacles. Ex. Steps
 Seating: gently place the individual’s hand on the back or arm of the chair or
leg against the seat.
 Use contrast when setting a table ex. dark table cloth, white dish

Other General Safety measures:
• Keep pathways clear, remove obstacles which
could cause falling.
• Do not move personal items or furniture without person’s
permission.
• Leave room doors, cabinet doors and door walls completely
open or completely shut.
• Remove or tape down scatter rugs.
• Place night lights in areas such as kitchen, bathroom
and bedroom.
• Tape electrical cords to floor, move lamps and other
furniture closer to wall.
• If possible pad edges of low items like coffee tables.
• Color code stairs
C-10

DEVICES
resources and devices to help the visually
impaired persons manage safely
LARGE PRINT MATERIALS
Books, clocks, watches, calendars, phones,
keyboards for computers, magazines, TV
remotes, games, blood pressure machines,
stationary
C-11

Magnification
Small spectacles to hand held
magnifiers to large video
and computer magnifiers
C-12

Seek emergency care from a health care provider
if the client / patient is experiencing:
Sudden partial or complete blindness in one or both eyes, even if it is only
temporary.
Double vision, even if it is temporary.
a sensation of a shade being pulled over your eyes or a curtain being
drawn from the side, above, or below.
Blind spots, halos around lights, or areas of distorted vision appear
suddenly.
Has sudden blurred vision with eye pain, especially if the eye is also red.
C-13

Communication : Aphasia, Confusion, Anger
APHASIA….may not be able to express or understand spoken or written words.
Receptive….inability to understand what is being said and /or to follow directions
( not able to receive message)
Expressive…difficulty thinking of words , not able to say what they want, improper
use of words
( not able to express message)
May have one or other, may have both . Most often due to a stroke
Dysarthia impairment caused by such things as stroke / brain injury . Person not
able to control and coordinate speech muscles. Speech slurred or distorted, but
language comprehension not affected.
Speech Impairments vary and well as symptoms.
Difficult communicating may cause person may feel ashamed , frustrated, anger
and/or depression and causes problems with friends, family and society.
C-14

Communication Strategies: Aphasic persons
Make eye contact with person speaking
Reduce background noises such as radio, TV, find quite place
Keep questions simple, phrase questions for simple Yes/No answers
Avoid quick topic changes
Give person time to respond, some find it helpful to speak slowly, don’t
interrupt or finish person’s sentences
Agree on signals , such as nodding of head or raising finger for yes or no
Use pencil, paper if one can write, use gestures or communication board
If acceptable to person
,
If you cannot understand, let person know and politely ask to repeat
communicate caring through smiles, touches, gestures
Patients who cannot speak…..does not mean they cannot hear !!
C-15

C-16
Confusion
Most common cause of severe confusion is Dementia
Most common cause of Dementia is Alzheimer’s disease
but there are other causes.
Symptoms include:
Agitation Anger Depression
Trouble focusing Disorientation Irritability
Decrease short term memory Speech problems
Change in sensation and perception
Communication strategies with Dementia:
• Do not take behavior personally
• Approach person from front, appear calm and don’t rush
• Speak slowly, in low , calm voice
• Always identify yourself, use person’s name and continue to do so
during conversation

C-17
• Use simple words, short sentences ,repeat , using same words as needed
or if not understood try a different word i.e. “ tired” use “ lie down”
• If person repeats words , questions etc. Answer questions each time
• Always describe what you are about to do
• Use signs, pictures and gestures
• Break tasks up into small , simpler ones with step by step instructions
• Get rid of distractions such as televisions
• Always allow person time to respond
• Combine verbal and nonverbal communication ex. “Lets go out” and
hold door open
Watch person’s body language as well as your own.
**Never talk as though the person is not there in front of you

communication
C-18
Situations, the person;
 Wants to say something but cannot
Ask person to point or gesture or use a communication card
 Doesn’t remember how to do a task
Break task up into smaller steps
 Wants to do something not allowed or harmful
Redirect activity
 Hallucinates
redirect or ignore
 Depressed or lonely
Try to involve in an activity, report to appropriate person
Spend time asking questions
 Verbally abusive/bad language
Ignore and redirect
Develop a routine & stick to it, promote self care

Dealing with Anger and /or Combative Behavior
Anger or Combative behavior may be caused by:
Physical discomfort, pain, even things like constipation, infection
Overstimulation
Confusing surroundings
General fear
Complicated tasks
Frustrating interactions , communication problems
Depression
Feeling vulnerable, threatened
***most common trigger for combative or angry behavior is fear,
misunderstanding or misperceiving a threat that isn’t there.
Often occurs at specific times such as late afternoon or evenings
Note when, where, who, what and why.
People, especially dementia, are very sensitive to your behavior
C-19

C-20
Dealing with Anger and /or Combative Behavior
• Remain calm, patient, use lower tone of voice, listen to what the person is saying
• Do not argue or respond to verbal attacks
• Delay personal care when person upset
• Do not accuse of wrong doing
• Do not use gestures which frighten person, speak at eye level
• Try to determine what provoked the person
• Step out of the way or block person if you feel he/she will physically attack
• Never hit or threaten person
• Get help if possible, but don’t “gang up "on person
• Keep noise and distractions to a minimal
• Report behavior to responsible person
• Pay attention to nonverbal
• Remind person who you are and what you are attempting to do.
• Offer choices
Inappropriate behavior:
If you encounter an embarrassing or aggressive behavior, be matter-of-fact and try to distract and
redirect.
If threatened with an object, like a cane…grab a safe object like a pillow
If person grabs your arm/wrist, stroke the lower arm of the grabbing hand or place your hand over the
grabbing hand and squeeze firmly
Communicating with older people or those with emotional problems often requires extra time and
patience because changes of normal aging. Being a caring, kind person is very reassuring to them.

Body Mechanics. Body mechanics is the coordinated use of the body parts
Good body mechanics promotes the efficient and safe use of muscles and conserves energy.
The following principles apply to any moving or lifting activity to reduce back injuries
(1) Face the direction of movement., do not twist, always do a side step or a pivot., keep head upright and solid
wide base of support when lifting. Create a base of support . Stand with your feet at shoulder width apart and
place one foot a half step ahead of the other.
(2) Do not use your back for heavy lifting , use large muscle groups of the legs, arms, and shoulders to lessen the
strain on the back and abdominal muscles.
(3) Bring and keep the object to be lifted or carried as close to the body as possible before lifting.
(4) Bend the knees and keep the back straight when leaning over at work level.
(5) Kneel on one knee, or squat, and keep the back straight when working at the floor level.
(6) Push, pull, slide, or roll a heavy object on a surface to avoid unnecessary lifting. Pushing is better than pulling
(extend arms out and shift weight forward with back straight, pulling, lean back with back straight , keep legs at
wide stance, one behind the other and use arms to pull)
(7) Never lift more than you can comfortable handle. Rule of thumb is no more than ¼ of your bodyweight
8) Work in unison with an assistant, lifting with smooth motion. Give instructions and agree on the signal to start
the activity.
(9) Exhale when lifting
.
D-1

Physical Results of Immobility..
Cardiovascular system
Increase heart work
Blood clots
Drop in blood pressures/ Dizziness when standing up
Swelling of extremities
Respiratory system
Collapse of lung
Pneumonia
Loss of chest wall muscle tone so harder to breath
Shortness of breath
Musculoskeletal system
Muscles lose tone
Joints lose flexibility
Bones lose minerals= osteoporosis
Fractures
Gastrointestinal
Poor digestion
Possible weight gain
Constipation
Urinary system
Kidney / bladder infections ( decreased gravity)
Kidney stones
Incontinence
Skin
Pressure ulcers
E-1

Skin and Pressure Ulcers
3 layers
FUNCTIONS of SKIN:
1. Protection for internal organs and keeps out microorganisms
2. Prevents loss of water
3. Temperature regulation (blood vessels widen to lose heat and
narrow to keep heat) Sweat glands help body loose heat
4. Lubrication from oil glands.
5. Sensation from nerve endings ( heat, cold, touch etc.)
6. Absorption of medications
F-1

Healthy skin needs :
proper nutrition and adequate circulation
F-2
Normal Changings of Aging:
• Thinner, drier and more
fragile
• Less elastic
• Loss of protective fat
• Hair thins, gray
• Wrinkles , brown spots
• Nails more brittle
• Dry itchy skin due to lack of
oil Skin tear

SKIN OBSERVATION and Report
White or reddened areas or purple areas
Rashes
especially under breasts and groin
Cuts, wounds or abrasions
Fluid or blood draining from skin
F-3

Skin Changes Shingles
Burns
Skin , not for book

Swelling
Blisters
Redness or broken area between toes
Dry or flaking skin
Changes in wound (size, drainage color or odor)
Hair or scalp changes
F-4

Skin and Positioning, Pressure Ulcers Prevention
Pressure Ulcer is a wound caused by:
1 Prolonged pressure on a body area that reduces blood
flow to the area so has less oxygen and cells can die.
2 Also caused by friction ( shearing effect)
External Pressure usually over boney prominences
1. Areas of the body where bone lies close to the
skin
F-5
Pressure ulcers

2. Friction ( shearing)
Other Causes:
3. Poor nutrition and hydration
4. Incontinence, moisture reduces skin resistance to trauma, also urine
and stool chemical irritants, increase bacteria
5. Aging skin
6. Mental status ( confusion, coma)
Pressure ulcers-----get bigger----deeper----if-infected, can be life-threatening
They are painful and difficult to heal
F-6

There are Four Stages of Pressure sores
Stage 1 Skin intact, red that doesn’t
go away in 15-30 minutes
Stage 2 Some skin loss , looks like
blister or shallow crater
Stage 3 Full skin loss , tissue damage
down to but not to tissue covering
muscle
Stage 4 Full skin loss , tissue death
and damage to muscle / bone
F-7
Eschar, dead tissue
**Must be removed to heal
Undermining

Oral Hygiene
Oral care is the care of the mouth, teeth, and gums and dentures
Good oral care helps prevent: Tooth and gum disease, mouth odor
Teeth should be brushed twice a day and flossed once a day if possible
Look for sores, loose teeth and pain.
Supplies, soft bristle toothbrush, tooth paste, floss, water, hand towel
Procedure:
• Place person in upright position with towel across chest
• Have good lighting
• Put on gloves
• Moisten toothbrush with water and apply toothpaste
• Clean entire mouth ( including tongue and all tooth surfaces)
use short , circular , gentle movements, work in a pattern so no teeth are missed
• Assist client to rinse mouth , as needed, holding basin under chin
• Wipe person’s lips and face and remove towel when finished.
• Dispose soiled linen, clean and replace supplies to proper storage.
If person can assist, prepare brush and toothpaste and hand to person. If difficulty handling brush ,
make handle bigger. An electric tooth brush may be easier to manage.
Toothettes or moisten gauze pads may not clean teeth completely and may push food further
into spaces between teeth. Use when person has no or just a few teeth .
G-1

G-2
Flossing
• Start with18 inches (45cm) of floss
• Glove
• Use thumb and forefingers to
control floss
• Gently ease floss between teeth ,
using gentle back and forth
movement
• Carefully rub up and down , moving
floss from under gum line to top of
tooth. Keep floss against tooth so
not to injure gums
• Note any bleeding and report

Denture Care
Assess for problems with dentures such as
discomfort, trouble eating, speech problems
Sore spots in mouth
Complaints of loose fitting
G-3
Procedure
Put on gloves
Inspect dentures for cracks, chips and mouth for broken teeth
Line sink /basin with a towel/washcloth
Ask person to remove dentures or gently remove if unable…lower one first
Rinse denture in cool running water
Apply tooth paste or denture cleaner to toothbrush
Brush all surfaces of dentures
Rinse all surfaces
Place dentures in clean cup with cool water or denture solution
Place cup in safe place
++Allow dentures to soak several hours or overnight
Dentures are slippery and can easily break or chip…Take care not to drop
Do not put dentures in hot water…they can warp
To place dentures back in mouth, you may need to use adhesive
full
partial

G-4
Personal Care skills/ Hygiene
….those tasks related to body cleanliness and appearance
Caring for skin, hair ,eyes, ears, nails and feet, oral cavity and perineal area
Purpose of good hygiene
• Comfort and increase circulation/ exercise
• Remove perspiration and dirt, oil and dead skin, odor
• Prevent infections
• Improve self image
Factors affecting personal hygiene
• Culture …ex. daily to weekly bath
• Finances….limited for hygiene products
• Health state…various limitations and abilities
• Personal preference…shower, bath, liquid or bar soap
• Embarrassment… Be sensitive, explain what you are going to do and provide privacy
• Older skin may be dry and fragile, so full bathing may be done only 2-3 times a week
Morning Care
Offer to help, if needed, to bathroom or offer bedpan /urinal
Help wash hands and face
Assist with mouth care before or after breakfast
Evening care
Offer to help, if needed ,to bathroom or offer bedpan /urinal
Help wash hands and face
Offer back rub

Assisting with Bath, or Shower
Assist with bed Bath
1. Ask if person needs any assistance.
2. Provide towels , soap, deodorant, lotion wash cloth and water
in basin if needed.
3. Wash areas person may not be able to wash, such as back, feet.
4. Provide privacy.
Shower
1. Ask what assistance the person may require.
2. Provide towels, soap, deodorant, lotion wash cloth.
3. Make sure shower floor is a nonskid material or mat. If neither,
a towel may work.
4. Turn on water and have person check if temperature is comfortable
5. If there is any unsteadiness, stand close by, especially if there
are no grip bars.
6. A shower chair may be needed or some safe chair.
7. Never leave person alone.
G-5

G-6
Guidelines for assisting with bathing
A partial bath consists of washing face, hands, underarms and perineum
and oral care.
done on days when a complete bed bath, tub or shower is not done
Preparation for Partial or Complete bed bath
• Explain to person what you are about to do.
• Use clean washcloths and towels.
• Gather up all supplies, soap, shampoo, deodorant etc.
• Provide privacy.
• Provide comfortable temperature in room.
• Test temperature of water, use wrist or elbow.
• Adjust bed to safe level if possible, waist level.
• Clean any equipment before and after.
• ALWAYS encourage person to do what they can independently or with assistance.
General Information:
• Assess all areas of skin for redness, bruising, cuts ,swelling or any other changes.
• Assess temperature of skin and any pain upon movement.
• Always change water when it becomes too cool , soapy or dirty.
• Wash all areas of body except face with soap and water.
• If very dry skin , use soap only on underarms and perineal area. Lotions and
creams, may be applied to skin to create a moisture barrier that helps to prevent
drying and chapping. With elderly people, because with aging, the skin secretes a
reduced amount of natural oil, resulting in dryness.

G-7
Procedure for Bed bath
Uncover one part of body at a time, place towel under part being washed
Wash, rinse and dry one part of body at a time
Start at head, work down front then do back portions of body
Always support joints when washing
Cover person with top sheet
Form a mitt around your hand with the washcloth.
Eyes – Have person close eyes. Wash with wet washcloth (no soap), inner aspect to outer
aspect, use another area of the washcloth for any repeat and for other eye
Face –wash without soap, from middle outward, continue, using soap and wash neck, ears . Outer
ears may be cleaned with a cotton tip applicator.
Arms—Wash and dry one arm and axilla at a time. Use long strokes from shoulder to wrist.
Hands—Place hands in a basin, wash hand and fingers. Clean under nails with brush or
cotton tip applicator. Check to see if nails need trimming.
trimming. Soak hands in warm water for about 5 minutes, shape nails with file or emery
board in curve, apply lotion to whole hand. If nails need to be cut, check with
doctor. With some conditions (Diabetes), a professional may be needed.
Chest/ abdomen—Place towel over area with top sheet folded down to waist.. Lift top half
of towel and wash and dry chest. Check under breasts for any redness. Lift lower
end of towel. Fold top sheet to pubic area. Wash and dry. Check groin for any redness.
Legs—Expose one leg, place towel under feet. Place your washcloth-covered hand at the top of the
thigh and stroke downward, toward the foot, using long, firm strokes. Wash the foot.
Repeat for the other leg.

G-8
Feet- If possible , place towel under foot, then move basin to the towel,
bend knee and place foot into basin and wash between toes,, rinse, dry and
apply lotion but not in-between toes. Repeat with other leg. Assess condition of feet
As we age, our nails thicken and become yellow. This is especially true of the toenails.
Because the nails are so tough, they are difficult to cut, and the person may be injured
during the process. A professional who works with feet may be necessary. Check and
report discoloration, broken skin, blisters, long ragged toenails,
difference in temperature of feet.
If person can sit up, it might be easier to sit at side of bed with feet in basin on floor
at end of bath.
Back—Assist person to center of bed and to lie on his/her side with back toward you.
Fold top sheet down to waist. Place towel lengthwise to back. Wash, rinse, dry back,
neck and buttocks using long downward strokes.
—Perineal area—( peri-care) In women this refers to cleaning the perineum which
extends from the bottom of the vagina to the anus.
In men extends from the top of the penis to anus
Usually the perineal area is cleansed once a day. But for those with diarrhea or
incontinent of stool or urine, care will be performed more often. Often a cream
/ointment is applied rectal/ perineal area to protect skin
If person is able to wash own perineal area, place basin of clean water and clean
washcloth and towel within reach, provide privacy. If unable, provide in a professional
and private manner.

G-9
Perineal Care –Female
Glove
Provide clean bath water and wash cloth
Take top sheet and place over person’s body with one corner edge pointing toward head,
other between legs , tuck corners around legs, lift corner
In many cases, may just have to place towel or sheet over abdomen.
Have person bend knees
Wash with soap and water working in a downward direction (pubic area to anus) Never clean
from back to front
Use separate quarters of wash cloth for each stroke. (mitt or fold in quarters)
First wipe the center of perineum, then each outside fold side (labia majora)
Next spread labia majora and clean the labia minora, each side and lastly the urinary meatus,
and vaginal opening .
Repeat steps to rinse and dry. (if possible use new wash cloth)
Wash groin
Anus- have person turn on side.
Gloved, remove any fecal material with toilet tissue. Wash, rinse and dry, working from
perineum to anus.
Male
Gloves and clean water
If uncircumcised, pull back foreskin toward base of penis.
Hold penis by shaft and wash tip in circular motion, using clean area of cloth for each stroke ,
wash shaft with down ward strokes, rinse and dry
If uncircumcised, return foreskin to normal position.
Wash scrotum and groin
Have person turn and wash anus

G-10
Grooming…hair care and shaving
 Having clean, well groomed hair is important to everyone. Having clean
groomed hair looks great, increases self esteem,
 Ask the individual if he or she has preferred hair style.
 Encourage the individual to do as much as he or she can for him/herself
 Set up items for person or assist the individual to comb or brush hair
 Use only the individual’s personal comb and brush.
 Clean comb and brush regularly.
 Combs with sharp teeth can injure sensitive scalps.
 Assist with drying wet hair with dryer and applying gels,
hair spray, and other hair products as appropriate.
 Encourage the individual to look in a mirror when finished styling.

G-11
Hair Care
Shampoo Procedure
Ask the individual if he or she has a preference for brands
of shampoo, conditioner and preferred hair style.
Assist as needed in shower.
Shampooing Hair in bed
1. Place waterproof pad under clients head and shoulders.
2. If available a trough or open trash bag under head.
3. Give washcloth to client to protect eyes
4. If using garbage bag cut hole in bottom corner and place in pail
to collect water
5. Wet hair by using pitcher or attachment from trough.
6. Apply small amount of shampoo to your hands and then
massage scalp
7. Rinse hair to clear shampoo.
8. Repeat with conditioner if available.
9. Wrap towel around head and dry face if needed.
10. Dry hair gently with towel or hair dryer.
11. Remove items

G-12
Shaving Body Parts
Cultural differences may be a key to whether an individual shaves or does not shave
It is important to assist and support the individual to shave safely and to avoid nicks and
cuts that can lead to infection.
Some individuals may learn to use an electric razor. Other individuals may be assisted
and supported in using a blade razor.
Shaving steps can be used for facial, leg, or underarm hair.
• An electric razor should not be used in same room where oxygen is used.
• Electric razors should not be used around water.
• Check all types of razors for chips or rust on the blades.
• Always dispose of used razor blades.
• Use only an individual’s personal razor.
• Supervise the use of razors closely for safe and correct handling before individual
shaves independently.
• Encourage the individual to do as much for him or herself as possible.

Shaving with Non-Electric Razor
Teach and assist the individual to wash area to be shaved with warm, soapy
water. (Face, underarms or legs) to remove oil and bacteria from skin
Teach and assist the individual how to apply shaving cream or lather with soap.
Shaving cream softens the skin and helps the razor glide over the skin to
prevent nicking and cutting.
Teach and assist the individual to:
• use the fingers of one hand to hold the skin tight.
• Face, shave in the direction the hair grows to prevent irritating the skin
• Legs, shave opposite direction hair grows.
• rinse the razor often to remove hair and shaving cream.
• use short strokes around chin and lips on the face; front and back of knees on the legs;
and under the arms, this help prevent nicks and cuts.
• rinse off the remaining shaving cream and dry the skin with gentle patting motions.
If shaving the face, offer the individual a mirror to inspect
Teach and assist with applying aftershave or skin lotion if individual chooses.
Alcohol in aftershave acts as an antiseptic for tiny nicks and cuts.
Teach and assist the individual with cleaning razor and storing all shaving items.
Teach and assist the individual to wash rinse, and dry his or her hands after shaving.
G-13

G-14
Shaving with an Electric Razor
Teach and assist the individual to safely turn on the electric razor.
Explain the safety of shaving away from water.
Electrocutions can occur when electric appliances, come into contact with water.
Teach and assist the individual to use a mirror while shaving the
face or under the arms.
Teach and demonstrate how to clean hair from the blades as needed during the shave.
Note:
Be sure razor in turned off and unplugged each time the blades are cleaned.
Injuries can occur when the razor is turned on or plugged into an electrical socket.
Cleaning the blades keeps them sharp and provides for a smoother shave.
Teach and assist with applying aftershave or skin lotion if the individual chooses.
Alcohol in aftershave acts as an antiseptic for tiny nicks and cuts.
Teach and assist the individual with cleaning the razor and storing all shaving items.
.

Range of Motion Exercises (ROM)
Definition: Exercises which put a joint through its
full extent of motion
Types: ACTIVE , person does ROM
independently
ACTIVE-ASSISTED , ROM with some help
PASSIVE, ROM done by care giver
Purpose:
1. Strengthen muscles
2. Increase circulation
3. To prevent contractures
(muscle shortens and freezes
in position) H-1

• Place person in sitting position or lie on back
• Do all ROM exercises smoothly and gently. Never force,
jerk, or over-stretch a muscle. Always support joint.
• Move the joint slowly.. Move the joint only to the point of
resistance.( This is the point where you cannot bend the
joint any further). Put slow, steady pressure on the joint
until the muscle relaxes.
Stop ROM exercises if the person feels pain. Ask the
person to tell you right away if he feels any pain. Watch for
signs of pain if the person is unable to talk.
• Make ROM exercises a part of the person's daily routine.
Do ROM exercises at the same time every day. Repeat
each exercise at least five times
Encourage person to do as much as possible for self
H-2
Procedure and Precautions for ROM
Caution: Always make sure it is medically safe to perform ROM,
so as not to cause injury

H-4
Basic Positioning
Purpose.
1. To promote comfort and relaxation.
2. Improve gastrointestinal /respiratory function.
3. To prevent muscle deformities.(contractures)
4. To stimulate circulation and prevent skin breakdown.
BASIC PRINCIPLES IN POSITIONING OF PATIENTS
• Maintain person in good body alignment, and distribute weight evenly.
• Maintain the patient's safety.
• Reassure the patient to promote comfort and cooperation.
• Properly handle the patient's body to prevent pain or injury.
• Use pillows to keep joints from touching one another.
• Never place pillows directly behind knee, place from mid calf to ankle to prevent
blood clot
• Be careful about positioning with head of bed upright for long periods…pressure
on backside may cause ulcers.
• Lying flat may be a problem for people with difficult breathing. A 30 degree angle
is best unless there is a problem breathing.
• Avoid positioning person directly on hip bone when lying on side, use pillows.
• Keep in mind proper body mechanics
• Do not use donut shaped cushions…interferes with blood flow.
• Obtain assistance, if needed, to move heavy or helpless patients.
• Bedbound persons should be repositioned every 2 hours

Contractures :Effect of immobility on muscles and bones
Person who is immobile (such as complete bed rest) is in danger of losing muscle tone,
strength and size. This is called atrophy . If poorly nourished, the atrophy may
progress at a faster rate. Bones meet together at a joint, allowing for a smooth surface
for bones to move. A capsule encloses the ends of the bone. If immobility is
prolonged, a person is in danger of the muscle shortening and becoming inflexible.
The joint fills in with boney tissue and freezes, developing a permanent “contracture”
Examples:
.
.
Fingers Wrist Ankle= foot drop Toes
Knee and Hip
Treatment: positioning and range of motion
Elbows
H-6
Neck

For all the following moving and transfer techniques
Before: Afterwards:
Wash hands Return pillow
Lower bed if necessary
Provide for privacy If call bell, place within reach
Adjust bed to safe level if possible, lock wheels.
Bed should be flat unless otherwise indicated.
Remove all obstacles (furniture, pillows) Wash hands
that would cause you to bend or twist.
Usual foot stance is 12 inches (30cm) apart.
Always face the direction you are moving.
Moving Techniques
Moving person to side of bed, one assistant
Make sure person is lying as flat as possible.
Ask person to lift head if able.
Ask person to fold arms over chest .
Place your arm under neck, angled down back .
On count of three (3), rock backwards, pull upper body toward you.
Repeat, placing hands under person’s waist and thighs and lastly under
lower legs and ankles
H-7

Moving to Side of bed with Two Assistants
Remove pillow, have person cross arms.
One assistant should be at each side of person.
Roll up a draw sheet close to person’s side, grasp with palms up.
Co-worker position feet about 12 inches ( 50 cm) apart, one foot slightly behind other
One assistant lifts one knee and places it on bed.
Both assistants grasp rolled up draw sheet.
Tighten abdominal muscles, straighten back.
On count of three, move person toward co-worker, lifting the draw sheet
.
H-8
Turning a person toward you
Stand on side of bed to where person will be turned.
Remove pillow .
Make sure person is lying as flat as possible one side of bed, not center
Have person cross arms over chest and cross ankles .
Lift one of your knees onto bed.
Place one hand on shoulder and one on thigh or use draw sheet
Roll person onto side

Log Rolling
H-9
Sometimes a person's spinal column must be kept in strict alignment ( surgery or injury)
Must be done by more than one person.
Place pillow between person’s knees, lengthwise
Cross arms over chest
All assistants stand on the same side of the bed,
the side that the person with be facing after the turn.
Place your hands under shoulder and hips.
Other person places hands on person’s far thigh and lower leg.
Count of three (3) turn person on side toward you, keeping head,
back, legs in straight line.
Position with pillow behind person’s spine to maintain the position.
Check to see if you can place a small pillow or towel under head.

H-10
Remove pillows
If capable, allow to move, but stand nearby
Person can assist. The helping person should:
1. Place pillow at head of bed upright, side rail down on your side.
2. Stand by bed, feet apart, face person
3. Place one arm under shoulder blades at angle from neck.
4. Place other arm under thighs, back straight, knees bent.
5. Have person bend knees and brace arm on mattress .
6. On count of 3, help move while person pushes with feet.
Moving person unable to assist, with 2 people
1. Place pillow upright at head of bed.
2. One person stand on each side of bed.
3. Roll up draw sheet on both sides close to person.
4. Have person arms crossed over chest and legs crossed at ankles.
5. Position one bent leg toward direction of lift.
6. On count of 3 pull person toward head of bed.
Moving a Person up in Bed

H-11
Dangle
Sitting upright with feet over side of bed to give person time to adjust to being in an
upright position after lying down .
Raise head of bed to sitting position if possible.
Place one arm under person’s shoulder blades and another under the thighs
Slowly turn person to sitting position with legs hanging over side of bed.
Have person hold onto edge of mattress for a few minutes.
If person dizzy for more than a minute, lay the person back down and take vital signs
and report
Falls
Falls can result in minor bruising to broken bones or worse.
More common in older adults, bones are more fragile.
Causes:
Unsafe environment (slippery floors)
Impaired abilities such as vision, balance, weakness and confusion
Disease and /or medication
Preventive measures:
1. Keep walkways free of clutter
2. Have bell near person so they can ask for help if needed
3. Person should wear non skid footwear
4. Keep frequently used items close by
5. Mark uneven flooring or steps with colored tape
6. Provide good lighting
7. Offer frequent trips to bathroom
8. Always assist unsteady person or use standby technique
9. If person starts to fall, Never try to catch, use your body to slide person to floor
10. If person falls….see emergencies

Ambulation ….means to walk
Ambulation helps meet a person’s need for exercise, prevent complications of immobility and
helps keep the person independent as possible.
Always assess persons ability to walk safely unattended.
Check to see whether they will need assistive devices.
Make sure person has on nonskid footwear.
Ask if there is any dizziness, if in bed long time always sit up and then dangle.
One person assist:
Person may walk well with care person walking along side (standby assist) .
Some persons may need the assistance of the care giver for stability when walking
Others need assistive devices such as canes, wheelchairs or walkers.
Two person assist without gait belt .
Make sure person’s arms are not around assistants’ necks
Ambulation/mobility
H-12
Ambulation with out gait belt

Gait belt
Before Using a gait/transfer belt, make sure the person can safely wear the belt
You may be unable to use it if the person :
• Has an ostomy (ex. colostomy, hernias or severe respiratory conditions )
• Monitoring equipment , such as tubes or IV lines, fragile bones.
• Has had recent (last 6-8 weeks) surgery in the abdomen and back areas
• Is pregnant.
***If in doubt check with medical person.
Procedure:
• Tell the person what you are going to do.
• Position the person upright.
• Place gait belt around the person’s waist, making sure it fits, always over clothes
• Pass metal tip through the teeth of the buckle and then through the other side
of the buckle
• Adjust it so it is snug , but not uncomfortable. You should be able to
place an open hand between the belt and the person .
• Tuck the end through the waist band
• ALWAYS check the proper closure before use
• You should walk slightly behind the person with hand under belt
Transferbelt is a safety device used to assist a weak or unsteady person. When it is used to
help a person walk it is called a gait belt. It should be used to assist but not to lift a person
Newer type gait belt
H-13

Use of walker
Walker
1. Person must be able to bear some weight on legs.
2. Have bed in lowest position, put walker in front of bed or chair.
3. Assist person to sit on edge of bed/chair for a few minutes, feet flat on floor.
4. Assist with putting on shoes, preferably flat and nonskid.
5. Stand in front and face person.
6. Assist person to standing position.
7. If weak knee, brace it against your knee.
8. Make sure walker has rubber tips, may have wheels (replace tips when worn)
9. Position person into frame of walker no more than 30cm (12 inches) in front
10. Make sure walker is right size ( about the height of person’s lower hip bones)
H-14
4 wheel
Semi-wheeled
Person uses walker when support is needed on both sides

11. Place both hands on walker, both arms should be slightly flexed.
12. Remind person to keep upright posture, DO NOT lean over
13. All four feet or wheels should be on level ground before person steps forward into walker.
14. If weak leg, move first, then strong leg.
15. Take short steps and keep head up and eyes forward, do not lean forward.
16. Walker should not be moved again until person has moved both feet and is steady.
To walk backwards
Person takes step back with strong leg, then weak leg, then walker.
Have person feel for arm of chair or mattress with hand or
legs feel edge of chair or bed before sitting.
Assist to sit or lie down
Slide weaker leg forward and shift weight to stronger leg
Have person switch hands from walker arms to chair or
assist on weaker side and sit down slowly.
Curbs and sidewalks ***Do not use on stairs
Look for a mini ramp
Curb- walk as close as possible up against the edge of the curb.
Lift walker up onto sidewalk , then lift foot firmly on the curb.
Push down on the hand grips, placing weight on hands and step up onto curb.
Reverse steps to step down off curb.
H-15

Cane Used to improve balance
• Person must have weight bearing on both legs.
• Be sure cane in good condition, check rubber tip.
• Check height is correct (elbow should be flexed 15-20 degrees ) standing.
• Encourage to wear non-skid shoes, securely fastened ex. tennis shoe.
• Check floor (clean dry and well lit) Remove small floor rugs.
• Cane should be placed on the stronger side of body, elbow slightly bent.
Stay near the person, on the weak side.
• Have person look straight ahead, keep upright posture when walking, keep cane
close to body.
• Person places cane about 12 inches in front of stronger leg, at the same time bring
weaker leg even with cane.
• Then bring stronger leg forward beside the cane, repeat.
• Weak leg + cane…..strong leg above cane….weak leg + cane…strong leg in front of
cane
H-16

H-17
Ambulating Up and Down stairs with cane
Stairs
Going up
Step up with strong leg first.
Have person hold handrail if one available, if not support weak side.
Place cane forward onto step, holding cane on stronger side.
Step up with weak leg while leaning on cane.
Repeat
Going down
Place cane forward onto step in front.
Cane should be held with the hand of stronger side.
Step forward with the weaker leg, leaning on cane for strength.
Step down with the stronger leg.
Repeat

Ambulation and Wheelchair
Wheelchairs
1. Manual
2. Electric
Parts
• Arm rests & foot rests, most removable
• Brakes-one on each side
• Wheels
• Seat belts
• Tilt rods
most have 2 rods close to ground
serve as foot pedals for pushers and
prevent tipping backwards
H-18
• Always lock wheels before helping person in or out of wheelchair.
• Always enter a room or elevator backwards, pulling w/c toward you.
• Remove arm or foot rests as needed.
• Connect seat belt if available.

Assisting an individual with movement in and out of bed will vary
Some people require very little assistance and others require a lot of assistance.
The following techniques assume there is at least one strong leg.
Transfer Techniques : Bed to Chair/Wheelchair
Wheelchair/chair to bed
General Guidelines for transfer:
1. Plan the move and be aware of what you can and cannot do
2. KNOW YOUR LIMITS If person more than ¼ your body weight …get help.
3. Assess the person’s strength and how much they can do for them selves.
4. Explain entire process , then repeat each step as you go along.
5. Encourage person to do as much as possible for self.
6. NEVER let person put their arms around your neck or grab you.
7. Always use your legs to lift NOT your back
8. Work at person’s speed, check for pain.
9. Avoid sudden jerking movements.
10. Do not grab, pull or lift person’s arm joints ( elbows, shoulder, wrists).
11. Use a gait belt when needed , if possible.
12. Have the person wear nonslip foot wear.
13. Clear area
H-19

Transfer Bed to Wheelchair or Chair
• Lock the wheels of the chair, remove foot rest and side arm if possible.
• If lying down, place one arm under the shoulder of person and the other arm
supporting the thigh on the opposite side. You will be facing them.
• Bring person to edge of bed
• Position chair/wheelchair as close as possible next to bed, facing the foot of bed
Place chair so person will move toward the chair strong side first then place chair.
• Allow to sit for a few minutes and put on foot wear.
• Use transfer belt if necessary. If no belt, stand in front of
person and place your arms around their chest (like a bear hug)
• Encourage the person to place one of their arms on your shoulder and the other
one on the bed to assist you in lifting.
• Widen the position of your feet about 12 inches (30cm.
• Place your right foot forward and next to person’s left foot (where little toe is)
H-20

• Your left foot should be placed back a ways
• Slightly bend your knees, instruct person to push off from the bed.
• With your legs, try to brace person’s legs.
• On count of 3, slowly help the person to rise to
standing position.
• Instruct person to grasp the far arm rest .
• When the person’s back of legs touch the chair,
lower body to chair.
• Make sure the person is all the way back in chair.
• Remove transfer belt , if used.
• Attach wheelchair foot rests and place feet on them. Replace arm rest.
H-21

Transfer Wheelchair/chair to Bed
• Raise head of bed if possible, or place pillows at head.
• Position chair/ wheelchair with person’s strong side close to bed.
• Lock wheelchair wheels, remove foot rests.
• Apply transfer belt if indicated or if no belt, use hug technique
Have person place arms on your shoulders and place your
arms around person’s trunk.
• Bracket person’s feet with your feet,
bend your knees slightly
• Using your legs muscles, stand up and bring person upward.
• Pivot and seat person on bed. Remove foot wear.
• If needed, place one of your arms around person's shoulders and one
arm under legs and swing legs onto bed, then position for comfort. H-22

Two man lift
Only attempt this technique with light weight
persons
• Secure chair or lock wheel chair, remove feet, arm rests.
• Have person cross arms over chest if possible.
• One assistant places arms, through person’s arms around
chest, above waist and grasps person’s arms.
Lean forward a little.
• Second assistant, back straight and squats , placing arms
under knees and ankles of person.
• On count of 3, both assistants lift person onto bed and
position person comfortably.
• Reverse for getting out of bed to chair
There are situations when a mechanical device is used
to lift. Always get properly trained to use these, as
different types work differently.
H-23

Pain and Comfort Measures
Pain has been defined as “an unpleasant sensory or emotional
experience associated with actual or potential tissue damage.
A body mechanism that indicates there is a problem.
Pain is “ Whatever the person says it is and exists wherever he/she)
says it does.”
Two Main Types of Pain
Acute…usually rapid onset, mild, severe, disappears when
cause resolved with healing ex. Cut, sore throat, or surgery
Chronic …may be continuous or on and off ( intermittent)
May be times symptoms go away and then come back. May disrupt
daily activities
Ex. Back or knee pain, cancer, un-healing wounds
I-1

I-2
Terms
Referred pain ..starts in one part but felt somewhere
else. Ex. heart attack
Phantom pain ..is pain that feels like it's coming from
a body part that's no longer there occurs often in
people who've had an arm or leg removed, may also
occur after surgeries to remove other body parts,
such as the breast, eye, gallbladder.
Intractable pain…that is not relieved by ordinary
medical, surgical, and nursing measures
FACTORS INFLUENCING PAIN:
PAIN
Cultural/ ethnic
Genetic
Religious
Age, gender
Economic
Psychological
Lifestyle

I-3
Pain is unique to each person so assessing pain is very important
Assessment:
 Where is the pain located?
Does it extend or move to another area?
Point to area (if cannot speak)
 Describe the pain to me.
(sharp, dull, burning crushing, throbbing, constant etc.?)
 Is the pain mild, moderate or severe?
Two common scales used
Ask person to rate on scale 1-10
Ask person to choose the face that best
describes how they are feeling

I-4
 What were you doing when it started?
( active, inactive, stressed)
 Was onset sudden , gradual or comes and goes?
 Is there anything that makes the pain better or feel worse?
Is it relieved with rest?
 Are there any other symptoms such as nausea?
 How long does the pain last and how often does it occur?
Watch for nonverbal behaviors, especially when a person cannot
communicate or is confused.
Increase pulse, respirations (heavy breathing) and blood pressure
• Sweating Grinding teeth
• Vomiting Increased restlessness
• Tightening of jaw Agitation/tension
• Squeezing eyes shut Crying/Groaning/moan
• Holding body part Decrease concentration
• Frowning Less appetite
Difficulty moving and walking

I-5
Measures to Reduce Pain
1. Position body in good alignment
2. Give back massage
3. Ask if person would like warm bath or shower.
4. Encourage slow deep breathing
5. Try distraction such as TV, reading
6. Apply heat or cold or give medication if ordered by doctor
7. Frequent rest periods
8. Check and see if medication works.
9. Provide calm, quiet environment, music
10. Be patient, caring , gentle and kind.
Report complaints
of pain or unrelieved
pain

NUTRITION and HYDRATION
Nutrition is how the body uses food for growth, and fuel for energy,
that keeps the body healthy and functioning properly.
To do this the body needs balanced diet of nutrients and hydration.
A nutrient is substance found in food that:
1) Provides energy
2) Promotes growth
3) Regulates many function
There are 6 nutrients needed by the body
1. PROTIEN--tissue growth and repair and energy
Seafood, poultry, meat, beans, eggs, milk, cheese ,
nuts, soy, peas and whole grain foods such as rice, breads
2. CARBOHYDRATES--fuel for body’s energy
Two types
Complex = bread, cereal, pasta, rice,
potatoes, fruits and vegetables
Simple = sugar, syrups, jellies J-1

J-2
3. FATS = stores body energy, protects organs and
insulates body
Butter, margarine, salad dressings, oils, animal fat,
dairy products, fish and fowl
4. VITAMINS = helps body perform many functions
Vitamin A,D,E,K and B and C
Most are gotten through food
5. MINERALS = Provide energy and help perform
many body processes
6. WATER Most important nutrient for life.
One can live only few days without. Helps with
digestion, elimination, body temperature, moistens
tissues such liver function, dissolves nutrients to make
available to tissue, carries oxygen and nutrients to
cells, lubricates joints
Most foods have several nutrients, no one food has all
of them.

J-3
Guide to healthy eating called food pyramid
Individualized, according to age, gender, and activity
Largest portion of daily diet should be:
1. Grains
(All foods made from wheat, rice, oats, corn, and
other grains ) * ½ should be whole grains 6 -11 servings.
2. Vegetables (fresh, frozen, canned and dried and vegetable juice) 3-5
servings.
3. Milk products, (All milk products and foods made from milk) 3 servings.
4. Fruits ( all fresh, frozen, canned and dried and fruit juice) 2-4 servings.
5. Meat and beans ( meat, poultry, fish, eggs , nuts and seeds) 2-3
servings.
6. Small amounts of fats. 2-3 servings
7. Sweets 5 servings or less a week

Examples of one Food Guide Serving are:
Vegetables and Fruit
125 mL (½ cup) fresh, frozen or canned vegetable or fruit
½ cup of vegetable or fruit juice
250 mL (1 cup) leafy raw vegetables or salad
1 piece of fruit or 2 small fruits, like plums or kiwi
¼ cup dried fruit
10-12 berries, grapes or cherries
1 medium or 2 small potatoes
Grain Products
1 slice bread or ½ large bagel
1 pita or tortilla wrap
125 mL (½ cup) cooked rice, pasta, noodles or couscous
175 mL (¾ cup) hot cereal
Milk and Alternatives
250 mL (1 cup) milk or fortified soy beverage
(¾ cup) yogurt
(1 ½ oz.) cheese
(1/2 cup) cottage cheese
1 portion of pudding
Meat and Alternatives
(2 ½ oz.)/125 mL ) cooked fish, shellfish, poultry or lean meat
175 mL (¾ cup) cooked beans
2 eggs
30 mL (2 Tbsp.) peanut butter
1/3 cup nuts
Fats and oils 1 tsp of soft margarine , vegetable oil, 1 Tbsp. mayonnaise
Sweets 1 Tbsp sugar, jelly or jam
J-4

J-5
Factors that Influence Food Choices/ Nutrition
Family, Culture, Religion, Region , Ethnic group , Disease,
Emotional state, Medication, Finances, Socialization,
Allergies, Ability to eat ( dentures)
Vegetarians ( Vegans) choose not to eat animal products
Special diets
Low Sodium………………..Heart or kidney disease
Fluid restricted…. ……….Severe heart or kidney disease
Low Protein………………….Kidney disease
Low Cholesterol……………People at risk for cardiac disease
because of high blood cholesterol
Modified Calorie………….Weight management
Controlled Carbohydrates…Diabetes
Soft diet..soft or chopped foods, easier to chew and swallow.
Pureed..chop /grind to thick paste like baby food
Nutritional supplements

Hydration
When amount of water leaving body is greater
than amount taken in = dehydration
The body does not have enough water to function normally. Usually
water is lost when you breathe, sweat and go to the bathroom.
Possible Causes:
• Person not drinking enough fluids
confusion, trouble swallowing, tired, forgets
• Any condition which causes diarrhea, vomiting,
fever(sweating)
• Increase in exercise , very hot weather
• Older adults more at risk…brain loses ability to sense
thirst
• ** onset and treatment does not usually occur
quickly..It takes time for body to get back in balance.
Water is your body's most important nutrient, and makes up
70- 75% of your total body weight. Every cell and organ in
your body needs water to function properly.
J-6

Symptoms of dehydration include: Dry mouth, cracked lips
**Little or no urine, or darker than usual Extreme thirst
Fatigue , Feeling dizzy Poor skin turgor
Confusion , headache Blood pressure low, pulse high
Complaints of abdominal pain
Treatment/Prevention
Water is best choice
Recommended {6} 8oz (320 ml) glasses /day {about 1.5 liters}
Some need more: exercise, certain medications or infections
( bladder) conditions causing lose of fluid ( diarrhea)
Other fluid choices are: fruit and vegetables and juices, milk, soup broths,
herbal tea, special high electrolyte drinks, gelatin, ice chips and popsicles,
ice cream., yogurt. Best to limit caffeine .
A fluid is any substance that melts at room temperature.
Determine preference and offer fluids often
Keep water within reach
Assist with drinking if needed
Keep tract of fluid intake
.
J-7

Assisting a Person With Meals
Persons will need different levels of help eating
Some will not need any help, while others will need some assistance or
complete assistance.
• Assess how much help is needed, encourage to do as much as he/she can do
• Treat person as adult not a child
• Help person clean hands, Help put on clothing protector if needed
• Check to see if dentures are needed and if they fit or eye glasses
• Make sure food is not too hot, don’t touch
• Person should be in an upright, sitting position, NEVER feed a person lying down.
• Sit at eye level, if person has one sided weakness, sit on stronger side.
• Place food where it can be easily seen, offer to cut food into bite-size pieces.
• Ask what person would like to eat first, then alternate foods.
• Offer sips of beverage throughout meal.
• Don’t rush, allow for plenty of time to chew and swallow, Make sure person’s mouth is empty before each next bite
or sip.
• If person has any difficulty chewing swallowing, encouraged to "swallow" twice to make sure that residual food
does not stay in the mouth cheek area.
• Wipe food from person’s mouth and hands as needed, have napkin available. Wash person’s hands when finished
• Person should remain upright for 20-30 minutes after finishing meal.
J-8

Gastric Feeding Tubes
When a person is unable to swallow or cannot get enough fluids and
food, he/she may be fed through a tube that goes directly into the stomach.
If needed for a short time , a nasogastric tube is inserted into
the nose and goes to the stomach
If feedings are needed for a long time, a tube is placed directly
through the skin, into the stomach. This is commonly called a PEG tube
( percutaneous endoscopic gastrostomy) The hole is called a STOMA
Only qualified health care workers can insert, remove
tubes or do the feedings.
Feedings
Each person is different so the doctor will decide the type ,amount, and how
often the liquid food ( called formula) is to be given.
Mouth often becomes dry…Do frequent mouth care as directed
J-9

Guidelines for PEG tubes and Skin Care
Always follow directions from a physician or licensed nurse.
Common care measures:
• Check frequently to make sure the tube is not kinked or lying underneath person
• After feeding person should remain in upright sitting position ( 45 degrees)
for at least 30 minutes to prevent fluid going into the lungs.
• Check to see if person is allowed anything by mouth, if not make sure
everyone knows not to feed or give person any fluid or food.
• Follow doctor’s directions about how to dress and tape the tube in place.
*This will depend on the type of tube used.
Usually a piece of gauze surrounds
the tube and then taped. Should be secure but
not too tight to cause indentation on skin.
J-10

It is important for the area around the gastrostomy tube to be kept
clean and dry.
General skin care around a feeding tube consists of:
• Wash hands and glove to remove old dressing
( sometimes there is no dressing)
• Look at area where tube enters the skin
check for redness , swelling, drainage
( small clear tan drainage may be normal)
• Using a clean soft wash cloth or gauze square moistened with
warm soapy water, gently wash skin around the tube
• Clean around the PEG tube to remove crust or drainage.
• Rinse the area around the stoma with a water moistened washcloth.
• Dry skin thoroughly
If the doctor has prescribed an antibiotic ointment/cream, this should
be applied carefully around the hole, not into the hole.
J-11

Observation and Reporting:
Call the doctor if there is
 diarrhea , constipation, nausea ,
 vomiting or dehydration
 pain
 fever
 abdominal swelling
 redness or unusual drainage around the stoma
 If the tube comes out, call doctor immediately
Bathing: Get instructions from the doctor or licensed nurse
when the person can take a shower. Clean and dry stoma after shower
If stomach problems exist , sometimes a tube
is placed past the stomach into the jejunum
for feedings.
J-12

GASTR0-INTESTINAL SYSTEM
esophagus
Stomach
Large intestine
Small intestineRectum
Functions:
Digestion break down
food (chewing and by
chemicals) for body use
Elimination is expelling of
waste, not used by body
K-1

Abnormal Conditions of Elimination
Constipation
Unable to have a bowel movement or difficult, painful elimination with
hard stools
Symptoms
• Abdominal swelling
• Gas
• No bowel movements for several days
Can Fecal impaction …Hard stool stuck in rectum
Symptoms
• No bowel movements for several days
• Abdominal cramping and swelling
• Rectal pain
• Oozing of liquid stool
Causes
• Not enough fluids
• Not enough activity
• Low fiber diet
• Medications
• Disease
• Not going to bathroom when feeling the urge
K-2
grains, skins of fruits

Treatment and Prevention
Increase:
Fluids Grains ( fiber foods)
Activity, if
possible
Medication..maybe
Nurse or Doctor must remove
fecal impaction
Enema
suppository
K-3

Diarrhea and bowel incontinence
Diarrhea ….frequent elimination of liquid or semi solid stool
causes Other Symptoms
infections abdominal cramps
irritating foods urgency
medications nausea and vomiting
Bowel Incontinence
Inability of anal muscle to control bowel movements.
++++Usually caused by disease
Treatment:
Diarrhea: change diet, medication, fluids for hydration
Note when bowel movements occur…toilet frequently
Can be embarrassing !!!
Provide prompt good skin care (stool irritation skin breakdown)
Report any skin changes.
Use proper technique for cleaning to avoid urinary infection.
Change any soiled linen. Use adult briefs as needed.
K-4
vasoline

Summary
What to Report:
1. No bowel movement in several days
2. Hard stools
3. Loose stools
4. Watery stool
5. Blood in stool/ toilet paper
6. Small amounts of liquid stool ( impaction)
7. Abdominal cramps ( pain)
8. Complaints of gas/ pressure
Collection of stool
• The stool sample should be collected in a clean dry
screw-top container.
• Collection of stool: tell person not to urinate,
• If person cannot collect stool, use bedpan, or spread clean cloth across toilet
• Glove and place about 2 tablespoons ( 30ml) of stool in collection
container. Can scrape from a adult brief or toilet tissue
• Label container with name and date and time and bag.
• Make sure you get information about storage.
• Make arrangements to be sent to lab
K-5
Urine will contaminate

Ostomy Care
An Ostomy is an operation to create an opening from an area inside
the body to outside .
The terms ileostomy and colostomy refer to the part of the
intestine that is brought out of the body through an artificial
opening in the abdomen.
The opening is called a stoma and stool, feces are eliminated
through the stoma hole rather than through the anus.
It may be necessary due to bowel disease or trauma.
Stool from an ileostomy will be liquid
Stool from a colostomy will be more formed.
A pouch is placed over the stoma to collect the stool.
There are two types of pouches
1. Non drainable Disposable and thrown away after use
2. Drainable which stays in place for 3-7 days , cleaned
and re-clamped.
*** It is emptied when about 1/3 full K-6

Care of Colostomy / Ileostomy
• Explain what you are about to do
• Wash hands before and after providing care
• Provide privacy and bed protector
• Glove
• If using disposable bag, gently remove pouch by pushing
the skin down on skin barrier. With other
hand, pull pouch up and away from the stoma
• Dispose of ostomy bag in a trash bag
• May wipe fecal material with toilet paper
• Clean around the stoma with warm water and washcloth
or cotton swab.
• Wash the area in one direction away from stoma, dry skin well
• Place new bag over stoma. May or not be directly attached to skin
• You may have to cut the hole to fit the stoma,
usually ¼ space around the stoma
K-7

• There are many products for ostomy care…Do not use any
skin cleaning products unless directed by doctor or licensed nurse.
• If using non-drainable pouches, unclip or open valve at
bottom of pouch and expel fecal contents
• You may irrigate the bag with a bulb syringe and warm water
• Re-clip the bag. Clip should follow shape of leg.
• Always note color consistency and amount of stool
• Observe the color of the stoma , small amount of bleeding
may be normal, color dark pink to red. Report excessive
bleeding and color changes and abnormal swelling around stoma.
• Observe skin around stoma for irritation or infection.
Types of Pouch
Closed Pouch
Drainable Pouch
Two-piece system
One piece system
K-8

ELIMINATION - URINARY SYSTEM
Anatomy
Female
Male
Kidney
Ureter
Bladder
Urethra
Bladder
Urethra
ureter
prostate
If prostate gets larger, it blocks urine from
leaving body = infection
K-9

What is Normal Urine?
Normal Urine should be:
• Pale yellow to amber
• Slight odor
• Clear
Blood
Cloudy
Color changes due to:
• Drugs
• Disease, blood Possible infection
Color/Odor changes
Food…ex. beets,
blackberries, and
rhubarb can temporarily
turn urine pink or red,
K-10

Urinary Tract Infection
Normally….urine comes from kidneys ureters bladder urethra
Urinary tract infection (UTI) is a bacterial infection that affects part of the
urinary tract.
Bladder, ureters, urethra, kidneys
The main causal agent of is Escherichia coli, found in large intestine and in stool
May go up urethra bladder ureters kidneys
Common Reasons for Infection
• Bed bound…harder for urine to drain out
• Low mobility…poor muscle tone
• Not emptying bladder and not urinating regularly
• Improper hygiene
• Low amount of fluids (dehydration)
***women more often (short urethra)
K-11

Urinary Incontinence
Partial or complete
Person not able to control muscles of the bladder
leakage of urine
Causes:
• Bed bound
• Illnesses
• Paralysis
• Mental confusion,
• Lack of feeling
• Age
Ways to reduce / control
incontinence
• Frequent toileting
• Reduce fluids at night
• Medication
• Pads or adult briefs
K-12

Use of briefs ( diapers) / incontinent pads
Change frequently
Examine skin
• Redness
• Rash
• Open areas
Wash area and dry completely
report
Important
Prevent
Skin breakdown from
irritation
Infection from germs K-13

Indwelling Catheter
Thin tube inserted into the body to drain fluids into a bag
Most common when person cannot urinate, holding in urine
***Infection possible if used for incontinence
Care:
• Keep bag off floor
• Keep tubing straight and secured at leg
• Check connections are secure
• If you must disconnect, keep ends sterile with gauze
• Keep bag below level of body
• Clean peri-area thoroughly ( around area at entrance of tube)
daily and after each bowel movement
• Note volume of urine
• Note color, odor, any unusual appearance
• Report pain
K-14

What to report
Report to family member, nurse, whoever is in charge
• Very frequent urination
• Burning/Pain when urinating
• New incontinence
• Large decrease in amount
• No urine in 8-10 hour period
• Wanting to urinate, but cannot
• Change in color, odor, clearness
• Swelling in bladder area
• Low back pain
• Urine specimen collection
• Glove, have person or assist with perineal care
• Open container ( do not touch inside)
• Ask person to urinate into bedpan, toilet, urinal the stop before
urination complete
• You or person place container under urine stream. Fill to about ½ way .
• Have person finish urinating .
• Label container with name, date and time
• Place in bag and refrigerate and make arrangements to send to lab K-15

VITAL SIGNS
Tell how well the important organs of the body are working.
Temperature
Body temperature is the balance of the heat the body makes and loses the body
Normal body temperature is 36C---37.5C 97---99.5F
Increased body temperature called Fever. In most adults, an oral temperature above 100F
(37.8C) or a rectal or ear temperature above 101F (38.3C)
Symptoms:
Shivering, shaking, chills Rapid (fast)heart rate
Aching muscles and joints Hot and, flushing skin
Headache, weakness Feeling faint, dizzy, or lightheaded
Intermittent sweats (on and off)
With very high temperature (> 104 F/40 C), convulsions, hallucination, or confusion is
possible. Seek medical attention.
Factors which affect temperature:
Gender/age Old and very young sensitive to temp changes ( control mechanism problem)
Higher--Hot weather, infection, diseases, such as arthritis
Lower-- Exposure to cold temperatures, some diseases
Medications--Antibiotics elevate body temperature, others, such as Tylenol, reduce fever
Time of Day- Body temperature is at its lowest point early in the day. As the day progresses,
body temperature rises.
There are four ways to take a temperature
Oral ( by mouth) Axillary ( under arm) Tympanic ( ear) Rectal
L-1

Procedure for taking Temperatures
Oral
Not for people with oral surgery or seizures or mouth conditions
Wait 30 minutes after eating or drinking hot or cold foods, smoking or chewing gum
If glass, shake down, if digital apply sheath ( cover)
Place thermometer far back, under tongue
Leave for 2-3 minutes ( glass) Digital may wait for beep
Remove and read thermometer, and record.
If glass shake down and wash with soap and water
(if another family member using, soak with 70% isopropyl alcohol, rinse for reuse)
If digital remove sheath ( cover) and discard in trash.
Axilla
Place glass or covered digital thermometer under axilla (arm pit)
Have person bring down arm against body
Wait 4-5 minutes if glass or digital beep
Remove, read, discard cover and record.
It is generally assumed that there is a degree of difference with rectal, oral and
axillary methods. Do not just add or subtract. Identify the route you used
Ex. 37C (98.6) Axillary Often if oral or axillary suddenly high will do rectal,
considered more accurate

Tympanic
Apply probe cover on tip
Insert into external ear, using gentle pressure, tightly enough to seal opening.
Angle down toward person’s jaw.
Pull pinna (top of ear)up and back
Push (trigger) button.
Wait about 10 seconds
Note reading, discard probe cover in trash and record.
Rectal
Not for infants (questionable for young children under 5 yrs.) or persons
with rectal surgery or problems, diarrhea
Place person on side lying position
Lubricate thermometer (glass) or cover (digital)
Insert into rectum through anus 1.5 inches ( 3.5 cm) in adult
I inch (2.5) for a child
Stay with person, keep on side (glass), digital, hold in place
Remove after about three (3) minutes
Wipe off (glass) with tissue, remove cover (digital)

Respirations
Respirations movement of air in and out of lungs
Breathing
Normal range for adult is 12-20 per minute
A variety of problems can cause abnormal respiration,
including heart problems, central nervous system
problems, and respiratory system problems such as
asthma.
After taking pulse, place hand over chest keep holding
hand and count respirations.
When to report:
( too fast or too slow), periods of no breathing, difficulty
or, noisy breathing.
L-2
Pulse ox
Measures oxygen in blood

The pulse rate is the rate of the heart beat
The normal rate is for adult is 60-100 , average is 80/minute
****Children may be faster
The normal rhythm is beat-beat-beat
Factors which affect rate:
Exercise
Fear, anger, anxiety usually goes up
Heat
Medications (may go up or down)
Abnormal may signal illness
Ex. Rapid = infection, heart problem
Slow = dehydration
Many sites, radial most common, carotid most accurate
L-3

Circulation of the Body
Heart—large arteries( tubes)
to smaller arteries
smaller arterioles
Your heart pumps blood with each beat
Heart beats are due to an electrical system
Abnormal electrical firing causes irregular heart beat.

Procedure:
Gently place tips of 2-3 fingers on the artery.
Do not use your thumb, because it has its own pulse that you may feel.
Press lightly with your fingers until you feel the blood pulsing beneath your fingers.
Use a watch with a second hand, or look at a clock with a second hand.
Count the beats you feel for 30 seconds. Multiply this number by two to get heart
rate (pulse) per minute.
***Count one whole minute if pulse is irregular
Types of beat
Beat---beat---beat---beat = normal N
Beat-beat---beat-beat---beat = regular irregular RI
Beat---beat- beat---beat---beat---beat-beat = irregular irregular II
Write down the pulse rate and if it was regular or not
Pulse rates sometimes goes up because people nervous about seeing doctor or
getting a treatment.
L 4

Blood pressure is the force of blood against blood vessels from heart and helps measure how well the
heart is working. Values are recorded in mmHg ( millimeters of mercury)
Normal blood pressure for adults <120/systolic ( heart contracting and pushing blood )
< 80/diastolic( heart relaxing)
Blood pressure between 120/80 and 139/89 = pre-hypertensive. Higher blood pressure is called
Hypertension
Lower Blood pressure is called Hypotension
Factors influencing blood pressure:
Age, disease, stress, food intake ( salt) , weight , exercise, caffeine, medications
Blood pressure is typically lower in morning and continues to rise during the day, usually peaking in the
middle of the afternoon
What can happen with high or low blood pressure?
High… forces heart to work harder , may cause damage to heart and other organs ( stroke)
Low…. Tissues not getting enough blood (Fainting)
Blood pressures are taken with a stethoscope , cuff with a gauge or electronically
Stethoscope is an instrument used to hear sounds in the chest or other parts of the body
Electronic devices , follow manufacture instructions
Blood Pressure
Ear tips
diaphragm bell L-5

Blood pressure
A Manual Manometer is an instrument to measure pressure
consists of cuff and a bulb which when squeezed pumps air into cuff
Need to have right size cuff
too tight…too high reading too big…..to low reading
Procedure:
1.Make sure the person is relaxed, sitting upright , legs uncrossed
2.Choose the correct cuff size, squeeze out all air, turn valve clockwise to close it
3.Position arm at level of heart, palm side up. Below heart higher BP
4.Wrap BP cuff snugly on arm one inch above the elbow, arrow at brachial artery
around bare upper arm points to the brachial artery, ( should be able to insert one finger under cuff)
do on place over clothes
5.Feel for the brachial artery pulse( inner bend ) at elbow. Always use fingers , not thumb ( pulse in thumb)
6.Inflate BP cuff by pumping the cuff bulb . Inflate until you cannot feel it anymore
7.Note the number ( rough idea of systolic) ex. 130
8.Wait a few minutes and place the stethoscope diaphragm where you
felt the brachial pulse and place ear tips in your ears, facing your nose.
9.Inflate cuff 20 more points higher than what you palpated ex. 150
10.Slowly deflate the cuff. Loosening the valve counterclockwise. 2-3 mmHg per second
11.Listen carefully and watch the needle gauge for points when you hear the first thumping sound.
This is the systolic , Remove stethoscope from ears
12. Note the value and continue to slowly deflate until the sound stops. This is the diastolic
13. Deflate cuff immediately and record numbers, remove cuff
14. Clean the diaphragm of stethoscope
**Do not re-inflate the cuff during reading. This will result in an inaccurate reading .If you need to
repeat, deflate and wait 15 seconds , exercise arm and repeat. L-6

M-1
Medication Administration
A medication is a substance that modifies body function and used to
treat or prevent disease when taken in by the body.
Sources- plants, animals/humans, minerals or synthetic/chemical
Reasons for taking medications
To:
 control a medical condition….hypertension, arthritis, diabetes
 cure a medical condition……….infection
 support while person recovers….blood, pain control
 relieve symptoms, not curative…..high doses of narcotics
 prevent complications ……… antibiotic, anticoagulant
Always have someone ( client, nurse or doctor) explain the
reason for the medications you are responsible for giving and
any special precautions or side effects.

M-2
Adverse Reactions
Any undesired response to a drug . . . . can effect any
body system with varying degrees of intensity. Reactions range from
irritating or mild side effects such as nausea and vomiting, diarrhea,
constipation, even change color of urine to life-threatening
anaphylaxis. ( shock) Some may be reversible –gastro-intestinal upset
irreversible—hearing loss.
Adverse Side Effects
Expected, Undesirable nearly unavoidable reactions
produced at therapeutic doses. ex. Drowsiness with a medication
used for allergies
Idiosyncratic, Highly unusual and often unpredictable response ex.
Excitable with a tranquillizer
Tolerance, Response to a particular drug given
repeatedly becomes less intense. Ex. pain medication

Allergy Drug allergies are a group of symptoms caused by an
allergic reaction to a drug (medication). May be a skin reaction or
progress to anaphylactic reaction…Extremely small quantities of a
drug may cause it.
Anaphylactic symptoms:
 Skin reactions, including hives along with
itching, and flushed or pale skin (almost
always present with anaphylaxis)
 A feeling of warmth
 The sensation of a lump in your throat
 Constriction of the airways and a swollen
tongue or throat, which can cause
wheezing and trouble breathing
 A weak and rapid pulse
 Nausea, vomiting or diarrhea
 Feeling light headed or faint
Anaphylaxis requires an immediate treatment . Call
emergency agency ( such as Cruz Roja ) If anaphylaxis isn't
treated right away, it can lead to unconsciousness or even
death.
M-3

Measurements Most commonly used measurement system is Metric
Kg= kilogram which is 1000 Grams
Gm = gram which is 1000 mgs or mgms
Mg= milligram
L = liter which is 1000ml
mL= mililiter
1 Gm = 15 grains ( gr)
Metric and household equivalents
5ml = 1 teaspoon ( tsp)
15 ml= 1 tablespoon ( Tbs) = 3 teaspoons
30 ml = I ounce (oz)
240 ml = 8 ounces = 1 cup
500ml = 2 cups = I pint
Times of administration
Standing---. Give medication every 8 hours
Single--- Give medication once only
STAT----- Give medication immediately
PRN------ Give medication as needed, ex. every 6 hours for pain
q = every H or hr = hours
M-4

Administration Procedure
CHECK
The Person…if in nursing home, ask person to say
their name, if unable or unreliable, ask someone else
to verify.
Medication…check the medication label with
agency chart ****If in the home, have a list of
medications with the times to be given.
Check expiration date.
Route…check the way it should be administered
and assess if person is able to take it.
Ex.one cannot swallow. Report if a problem.
Time..double check that you are giving the drug at
the right time, **especially if in morning or evening
Dose…double check you giving right amount
Document …write on agency chart or piece of paper
date, time and what given.
Note response if possible i.e. pain relief
Common errors:
• Failure to give a medication
• at prescribed time or not
at all
• Incorrect dosage, too much,
or not enough.
• If dosed missed, report to
get advice, but never double
the next dose.
M-5

Routes of Administration
Always wash hands before and after administration of medications.
In some instances you should wear gloves.
Oral (swallow) or sublingual, (under the tongue), or chewable
1. Tablets, capsules , lozenges (on the tongue) and liquids
2. Most taken with water, but check some may have to be taken with food.
3. Some have bad interactions with food such as grapefruit, green leafy vegetables .
4. Never crush, break open nor chew a capsule or tablet before checking with
nurse or doctor.( some medications are coated to reduce stomach
irritation, others are time released ).
5. Time released may have tiny spheres or have a coating that dissolve at various
rates.
May open and put in applesauce, but do not crush!! This will cause release of
all medication at once and cause overdose.
Difficulty swallowing contact care provider/ responsible person to get in
different form such as liquid
6. If a liquid in bottle, shake gently first
M-6

Eye drops
1. Check the dropper tip to make sure that it is not chipped, cracked or soiled.
2. Glove if possible
3. Tilt head back, using a tissue pull down lower lid with index finger
4. Hold dropper ( tip down) with other hand as close to eye as possible without touching it,
eye drops and dropper must be kept clean
5. While looking up, gently squeeze the dropper so that so that the correct number of drops
falls into the pocket of the lower eyelid.
6. Have person close eye for 2 to 3 minutes and tip head down as though looking at the floor.
7. Instruct not to blink or squeeze eyelids.
8. Place a finger on the tear duct and apply gentle pressure
9. Wipe any excess liquid from the face with a tissue.
10. If you are to use more than one drop in the same eye, wait at least 5 minutes
before instilling the next drop.
11. Replace and tighten the cap on the dropper bottle. Do not wipe or rinse the
dropper tip.
Eye ointment
• Close eyelid and cleanse lid and lashes with mild soap and water
• Distribute small amount of ointment ( ½ inch) along lower lid
• Have person close eye and instruct to move eye to distribute the ointment.
• Clean any excess
.
Instillation optic (eye), otic ( ear), rectal, vaginal
M-7

Instillation otic ( ear), Ear drops (gtts)
1. Clean outer ear and dry
2. Warm container of drops in hand , until body temperature if needed
3. Shake bottle if cloudy
4. Have person tilt affected ear toward opposite shoulder or lie on
unaffected side
5. Pull ear backwards and up (if child under 3, pull backwards and down)
6. Place correct number of drops in ear
7. Gently press small flap over ear “called tragus” or “trago” ( Spanish),
keep head tilted for few minute, especially if instilling drops
in other ear or insert cotton plug if recommended by doctor
Follow directions from nurse or doctor for rectal or vaginal creams or
suppositories
Parenteral (intravenous, subcutaneous, intramuscular, intradermal) must
be supervised by a nurse
M-8

Inhalation ( respiratory)
A metered-dose inhaler is a device that delivers a specific amount of medication to the
lungs in the form of a short burst of aerosolized ( very small particles) of medicine that
is inhaled by the patient.
Procedure…Direct person or assist
1. Remove cap and hold the inhaler upright, then shake well
2. Hold inhaler 1-2 inches( 2-5 cm) in front of mouth or connect extender ( spacer) to
inhaler and place in mouth
3. Take a deep breath and exhale, then inhale deeply through open mouth
4. Press down causing a short burst on medication canister while continuing to
inhale deeply
5. Hold breath for 5-10 seconds , then breath out
6. If another puff is required wait 1-5 minutes and repeat steps 3-6
7. Thoroughly rinse mouth with water, spit out water and do not swallow ( some
medications can cause fungal infections so rinsing is very important )
Dry powder inhaler (DPI) is a device that delivers medication to the lungs
in the form of a dry powder.
1. Read directions, slide cap open
2. Seal lips around the mouthpiece, do not block opening with tongue or teeth
3. Breath in quickly 2-3 seconds
4. Remove and hold breath 5-10 seconds
5. If another dose needed , wait 5-10 seconds
6. Rinse mouth and spit , never inhale , replace cap
M-9

Inhaler test
Many have people use the float method to determine the fullness
of an inhaler canister. This is not considered reliable and may be
dangerous if an emergency arises and the canister is really empty.
Most canisters have 200 puffs and now have a built in counters,
but if not, date a new canister and count how many puffs per day
to estimate date when it will be empty.
M-10
Topical,through skin
topical medication is a medication that is applied to body surfaces such as the
skin or mucous membranes to treat ailments
Cleanse skin thoroughly before application of lotion or cream or ointment, gel or foam or
patch, paste.

Expose the affected skin area enough to apply medication and not soil clothing
Possible applications :
1. With cotton ball , gauze or cotton tip applicator , either placed directly on skin and
rubbed in or place on applicator and massage into skin.
2. Put on a glove and scoop from the medication container or squeeze a sufficient
amount of topical medication from the tube to cover the affected skin area onto
a finger(s) of the glove.
3. Spread the topical medication on the affected area, massage ,following application
instructions
A transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a
controlled release dose of medication through the skin and into the bloodstream .
1. Remove any previously applied transdermal patch and remove any residual medication
from the skin
2. Open the package and remove the new patch and write date and time on outside of
patch.
3. Without touching the adhesive surface, remove the plastic backing.
4. Apply the patch to dry, hairless area of skin
5. Do not apply a patch over a bone, tumor, irritated area, or an area
6. where there is broken skin .
M-11

Wound care
There are many types of wounds
Incision
Edges aligned
Contusion
Intact skin,
broken blood vessels
Laceration
Tearing skin,
irregular edges
Others
Microbial
Thermal burns
Radiation burns
Abrasion
Skin scrapped off
Chemical
Blistering
Puncture
Hole
Amputation
N-1

N-2
Goal: To promote healing and prevent infection
Some are open to air to heal…when risk is higher if bandage applied.
closed wound and open wound care dressings :
1. Prevent/control infection
2. Absorb any drainage
3. Maintain moist environment ( Moist promotes healing)
4. Protect against further injury
5. protect skin around the wound
A dressing procedure is determined by depth of wound and
complexity of the treatment

Primary healing…healing with edges together
Secondary healing …wound left open, heal from bottom up.
Factors which affect healing
1. Maceration ..urinary/ fecal incontinence…bacterial growth
2. Trauma,
3. Swelling (edema)
4. Infection
5. Circulation
6. Nutrition and hydration
Terms :
Acute wound is usually surgery or sharp instrument cuts, usually heal days to weeks
Chronic wound takes longer . Example wounds with poor circulation ..pressure ulcer
Necrosis = dead tissue ( yellow stringy tissue) Dry black = eschar
N-3

N-5
Clean Wound Procedure
1. Gather supplies. Small plastic bag or waste can and gloves, gauze, tape,
medication
2. Cut amount of tape you will need.
3. Wash hands and put on non-sterile gloves (or use plastic grocery bag)
4. Remove old dressing, peel tape toward wound. Do not drag.
5. Place soiled dressing in trash.
6. If dressing sticks, moisten with some warm water or saline solution.
7. Observe for signs of infection redness, bleeding, any drainage, (color,
clear or cloudy) dried blood, odor, swelling and report
8. Remove gloves, put in trash
9. Wash hands and glove

N-6
Cleaning Linear wounds
• Moisten sterile gauze pad
or swab with prescribed
cleaning agent
• Use new swab/gauze for
each downward stroke
• Work outward from
incision line
Cleaning circular wound
• Moisten sterile gauze pad or swab with
prescribed cleaning agent
• Use new swab/gauze for each circle
• Clean wound in full or half circles
• Begin in center and work toward outside
• Clean at least 2.5 cm beyond the end of
new dressing
Drainage
wound

N-7
10. Gently clean the wound with soap and water,
saline water or wound cleanser.
If you need to use an ointment or wound cream, use small amount and apply
with Q-tip to open area or onto gauze, not on surrounding skin.
***never squeeze from tube directly to wound …may contaminate wound.
11. Cover wound with bandage or gauze large enough to cover wound.
May need to use non-adhering gauze
12. Always handle gauze at ends
13. Tape gauze or wrap dressing
14. Remove gloves and places in trash
15. Wrap all of trash in bag, wash hands again
Irrigation and packing of wounds, need to follow doctors orders

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