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Website nurse assistant text

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text book for nurse assistants

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Website nurse assistant text

  1. 1. Mary Anne Molinari GCNS-BC Contributor and editor Jackie Kellum, RN Copyright ©2013
  2. 2. 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)
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 1,000,000,000 trillion bacteria in one tsp of “ poop”
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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:
  16. 16. 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.
  17. 17. 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.
  18. 18. . 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. Magnification Small spectacles to hand held magnifiers to large video and computer magnifiers C-12
  26. 26. 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
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. 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.
  34. 34. 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
  35. 35. To prevent this D-2
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. Fungus Bruising
  41. 41. Skin Changes Shingles Burns Skin , not for book
  42. 42. 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
  43. 43. 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
  44. 44. 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
  45. 45. 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
  46. 46. Pressure ulcer not in book
  47. 47. 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
  48. 48. 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
  49. 49. 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
  50. 50. 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
  51. 51. 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
  52. 52. 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.
  53. 53. 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.
  54. 54. 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.
  55. 55. 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
  56. 56. 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.
  57. 57. 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
  58. 58. 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.
  59. 59. 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
  60. 60. 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. .
  61. 61. 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
  62. 62. • 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
  63. 63. H-3
  64. 64. 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
  65. 65. H-5
  66. 66. 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
  67. 67. 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
  68. 68. 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
  69. 69. 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.
  70. 70. 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
  71. 71. 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
  72. 72. 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
  73. 73. 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
  74. 74. 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
  75. 75. 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
  76. 76. 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
  77. 77. 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
  78. 78. 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.
  79. 79. 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
  80. 80. 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
  81. 81. • 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
  82. 82. 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
  83. 83. 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
  84. 84. 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
  85. 85. 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
  86. 86. 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
  87. 87. 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
  88. 88. 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
  89. 89. 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
  90. 90. 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.
  91. 91. 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
  92. 92. 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
  93. 93. 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
  94. 94. 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
  95. 95. 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
  96. 96. 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
  97. 97. 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
  98. 98. 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
  99. 99. 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
  100. 100. 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
  101. 101. 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
  102. 102. 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
  103. 103. Treatment and Prevention Increase: Fluids Grains ( fiber foods) Activity, if possible Medication..maybe Nurse or Doctor must remove fecal impaction Enema suppository K-3
  104. 104. 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
  105. 105. 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
  106. 106. 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
  107. 107. 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
  108. 108. • 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
  109. 109. 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
  110. 110. 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
  111. 111. 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
  112. 112. 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
  113. 113. 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
  114. 114. 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
  115. 115. 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
  116. 116. 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
  117. 117. 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
  118. 118. 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)
  119. 119. 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
  120. 120. 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
  121. 121. 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.
  122. 122. 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
  123. 123. 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
  124. 124. 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
  125. 125. 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.
  126. 126. 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
  127. 127. 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
  128. 128. 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
  129. 129. 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
  130. 130. 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
  131. 131. 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
  132. 132. 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
  133. 133. 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
  134. 134. 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.
  135. 135. 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
  136. 136. 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
  137. 137. 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
  138. 138. 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
  139. 139. Wound care N-4
  140. 140. 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
  141. 141. 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
  142. 142. 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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