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Chapter 22
 Falls between acute care and LTC
 More skilled care needed than LTC
 Greater recovery time needed from surgeries
 Injuries
 Chronic health issues
 Dialysis
 Infusion therapy
 Wound care
 Emergent – life-threatening ( Open heart)
 Urgent – planned (Knee replacement)
 Elective – cosmetic (Nose job)
 Before surgery care
 Involves physical and psychological prep
 May be anxious
 May need physical prep such as
▪ Bowel cleansing – Golytely
▪ Shaving and disinfecting of body –before open heart
surgery
▪ Removal of water pitcher or any snacks due to NPO
status
 Assist with bathing
 Measure and record vital signs
 Remove dentures, jewelry, hearing aids,
other before surgery
 Make sure ID bracelets in place
 Return to room after procedure.
 Will need:
clean bed, emesis basin, pillows and/or positioning
devices, IV pole, warm blankets, other things as
RN states.
 Assist with pt transfer back into bed
 Return glasses, jewelry, hearing aids to pt
 Measure and record vital signs
 May need every 15 minutes for first hour,
 Then every 30 minutes for next two hours, with
 A tapering schedule until every 4 – 6 hours or prn.
 Assist with repositioning, C & DB
 Ted hose
 Elimination needs
 Bathing, as ordered
 Ambulation when needed
 Changes inVS
 SOB
 Confusion
 Swelling at IV site
 IV fluid not dripping
 Any unusual occurrences
 Measures oxygen level in the blood
 Report any alarms or abnormal readings to
nurse
 Normal reading: between 90 and 100, with a
desired reading close to mid –nineties or
above.
 Report bluish skin color
 Any other changes from baseline
 Monitoring of patient’s heart rate and rhythm
 Electrodes placed on chest in various spots.
 As a NA on this unit, you will be trained to place these
electrodes and troubleshoot when the alarm goes off…
 Some NAs receive special training
to read the rhythm strips and
watch monitors
 Called Monitor techs
 Definition:
 Any plastic, metal, or rubber device inserted into
respiratory tract to promote breathing
▪ Tracheostomy – surgically inserted tube into windpipe
▪ Endotracheal tube (for ventilation or emergencies)
 Your role:
▪ Observing and reporting anything abnormal
▪ Patient distress (SOB)
▪ Soiled dressing, suctioning needed
▪ Emotional support
 Trach may need to be suctioned
 Sterile procedure but not always- yankour
▪ Nurse performs but you can inform that needs to be
done
 See pic on pg 393 of portable suction machine
 Report sounds of gurgling when pt trying to
breathe…indicates suctioning is needed
 Nurse performs suctioning but you may be
needed to help
 Inserted into chest wall after trauma to lungs.
 Example:After car accident, lung is collapsed
due to injury…tube is inserted surgically to
help lung expand again.
 Generally attached to collection device
 If you help care for this type of patient, you
will receive special training.
 Report detached tubes
 Watch for any kinks
 Keep drainage unit upright
 Report any changes or complaints of pain and
discomfort to nurse immediately

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Chapter 22: Special Care Skills

  • 2.  Falls between acute care and LTC  More skilled care needed than LTC  Greater recovery time needed from surgeries  Injuries  Chronic health issues  Dialysis  Infusion therapy  Wound care
  • 3.  Emergent – life-threatening ( Open heart)  Urgent – planned (Knee replacement)  Elective – cosmetic (Nose job)
  • 4.  Before surgery care  Involves physical and psychological prep  May be anxious  May need physical prep such as ▪ Bowel cleansing – Golytely ▪ Shaving and disinfecting of body –before open heart surgery ▪ Removal of water pitcher or any snacks due to NPO status
  • 5.  Assist with bathing  Measure and record vital signs  Remove dentures, jewelry, hearing aids, other before surgery  Make sure ID bracelets in place
  • 6.  Return to room after procedure.  Will need: clean bed, emesis basin, pillows and/or positioning devices, IV pole, warm blankets, other things as RN states.
  • 7.  Assist with pt transfer back into bed  Return glasses, jewelry, hearing aids to pt  Measure and record vital signs  May need every 15 minutes for first hour,  Then every 30 minutes for next two hours, with  A tapering schedule until every 4 – 6 hours or prn.  Assist with repositioning, C & DB  Ted hose  Elimination needs  Bathing, as ordered  Ambulation when needed
  • 8.  Changes inVS  SOB  Confusion  Swelling at IV site  IV fluid not dripping  Any unusual occurrences
  • 9.  Measures oxygen level in the blood  Report any alarms or abnormal readings to nurse  Normal reading: between 90 and 100, with a desired reading close to mid –nineties or above.  Report bluish skin color  Any other changes from baseline
  • 10.  Monitoring of patient’s heart rate and rhythm  Electrodes placed on chest in various spots.  As a NA on this unit, you will be trained to place these electrodes and troubleshoot when the alarm goes off…  Some NAs receive special training to read the rhythm strips and watch monitors  Called Monitor techs
  • 11.  Definition:  Any plastic, metal, or rubber device inserted into respiratory tract to promote breathing ▪ Tracheostomy – surgically inserted tube into windpipe ▪ Endotracheal tube (for ventilation or emergencies)  Your role: ▪ Observing and reporting anything abnormal ▪ Patient distress (SOB) ▪ Soiled dressing, suctioning needed ▪ Emotional support
  • 12.  Trach may need to be suctioned  Sterile procedure but not always- yankour ▪ Nurse performs but you can inform that needs to be done  See pic on pg 393 of portable suction machine  Report sounds of gurgling when pt trying to breathe…indicates suctioning is needed  Nurse performs suctioning but you may be needed to help
  • 13.  Inserted into chest wall after trauma to lungs.  Example:After car accident, lung is collapsed due to injury…tube is inserted surgically to help lung expand again.  Generally attached to collection device  If you help care for this type of patient, you will receive special training.  Report detached tubes
  • 14.  Watch for any kinks  Keep drainage unit upright  Report any changes or complaints of pain and discomfort to nurse immediately