Module 6 basic skills

1. Module 6 basic skills BFI 2018 CNA Prep Course

2. Vital signs measurements that show how well the vital organs of the body are working; consist of body temperature, pulse, respirations, oxygen saturation, blood pressure, and level of pain.

3. Vital signs

4. Vitalsigns

5. Vital signs

6. Vital signs • Notify the nurse in any of these cases: • Resident has a fever • Respiratory or pulse rate is too rapid or slow • Blood pressure changes • Pain is worsening or unrelieved • Patient is cyanotic or pale

7. temperature • Remember these things about monitoring body temperature: • Age, illness, stress, environment, exercise, and the circadian rhythm all affect temperature. • There are four sites for measuring (mouth, rectum, armpit, ear). • Oral temperatures cannot be taken on someone who is unconscious, has recently had facial or oral surgery, is younger than 5 years old, is confused, is heavily sedated, is likely to have a seizure, is coughing, is using oxygen, has facial paralysis, has a nasogastric tube, has sores, redness, swelling, or pain in the mouth, or has an injury to the face or neck

8. Vital signs-pulse • Pulse is the number of heartbeats per minute. • Pulse is commonly taken at the wrist where radial artery runs. • Normal rate is 60-100 beats per minute for adults. • Normal rate is 100-120 beats per minute for small children, as high as 120-140 for newborns. • Pulse may be affected by exercise, fear, anger, anxiety, heat, medications and pain. • Rapid pulse may result from fever, infection, or heart failure. • Slow/weak pulse may indicate dehydration, infection, or shock.

9. Pulse locations

10. Major pulse sites • Carotid – neck (used during emergency situations-CPR) • Apical – left chest below nipple (need stethoscope) • Brachial – inner aspect of elbow • Radial – thumb side of wrist (most frequently used site) • Femoral – groin • Popliteal – behind knee • Posterior tibialis – behind inner ankle • Dorsalis pedis – on top of foot

11. Qualities of pulse • Rate – number of beats/min • Rhythm – regularity of pulse • Strength – force • Weak or thready • Bounding • Strong

12. Vital signs-respirations • A breath includes both inspiration and expiration. • Normal adult rate is 12-20 breaths per minute. • Normal rate for infants is 30-40 breaths per minute. • Do the counting immediately after taking the pulse. • Do not let the resident know you are counting breaths • Normal breathing is quiet, effortless, & regular in rhythm

13. Abnormal respirations • Labored – struggles to breathe • Orthopnea- can breathe only when sitting or standing • Stertorous – snoring sounds when breathing (partial airway obstruction) • Abdominal – uses abdominal muscles • Shallow – uses only upper part of lungs • Dyspnea – painful or difficult breathing • Tachypnea – respiratory rate > 24 per min • Bradypnea – respiratory rate < 10 per min • Apnea – absence of breathing • Cheyne-Stokes – respiratory gradually increase in rate & depth & then become shallow & slow

14. Vital signs-blood pressure • Pressure exerted against walls of blood vessels • The two parts are systolic (top number) and diastolic (bottom number). • Hear thumping sounds as blood flows through arteries • Normal range is: Systolic=100 to 119, Diastolic=60 to 79. • Brachial artery at the elbow is used. • Equipment used is stethoscope and sphygmomanometer (blood pressure cuff) • An electronic sphymomanometer may be available. If so, you will be trained in its use. • The cuff must first be completely deflated before using it

15. Blood pressure • Normal adult reading 120/80 • Normal systolic = 100 – 140 • Normal diastolic = 60 – 90 • Abnormal readings • Hypertension – BP > 140/90 • Hypotension – BP < 90/60

16. Increased bp • Strong emotion • Exercise • Sitting or standing • Excitement • Pain • Decrease of vessel size • Digestion • Improperly placed or sized cuff

17. Low blood pressure • Rest/sleep • Lying down • Depression • Shock • Hemorrhage • Improperly sized cuff

18. Bp measurement procedure • Guidelines • Measure BP at brachial artery • Do not use injured arm, arm with IV, or casted • Resident should be at rest • Position arm level with heart • Apply cuff to bare arm NOT over clothing • Use appropriate size cuff • Position sphygmomanometer at eye level

19. Process of taking Vs • Take temperature first • Pulse second • Respirations, then blood pressure • When taking respirations, keep fingers on pulse so that resident does not know you are counting respirations • Blood Pressure and Oxygen saturation • Document all together

20. Vital signs-pain • Remember the following about pain management: • Pain is as important to monitor as vital signs. • Pain is an experience that is uncomfortable and different for each person. • Take complaints of pain seriously • Observe and report carefully since care plans are based on your reports. • Ask questions to get accurate information • Pain is not a normal part of aging

21. Vital signs- pain • Ask resident if they have pain • Observe facial expression, movement, respiration • Ask level of pain using facility method (Usually number 0 – 10) • Report c/o pain to licensed nurse

22. pain • Signs and symptoms of pain (cont’d.): • Increased restlessness • Agitation or tension • Change in behavior • Crying • Sighing • Groaning • Breathing heavily • Difficulty moving or walking

23. Vital signs

25. weight • Review the following points about weight: • Resident will be weighed repeatedly during his or her stay, and any change in weight should be reported immediately. • Some residents will be weighed on a wheelchair scale. The weight of the wheelchair may need to be subtracted from a resident’s weight. • Residents may need to be weighed on a bed scale. • Ambulatory residents may be weighed on a standing scale.

26. restraints Restraints are used for the following reasons: • If person is a danger to self or others • Keep person from pulling out tubing • Prevent falls Important: • Restraints can only be used with a doctor’s order. • It is against the law for staff to apply restraints for convenience or discipline REMEMBER: • There are also pads, belts, special chairs and alarms that can be used instead of restraints.

28. Specimen collecting • NAs must wear gloves for these procedures. • Tagging and storing specimens correctly is important. • Be sensitive to the fact that residents may find it embarrassing or uncomfortable to have others handling their body wastes. • If you feel the task is unpleasant, do not make it known. • Remain professional. • Label specimen with patient’s name, date of birth, date collected, time collected and your initials (per facility policy) • Remember, after discarding gloves after collecting specimens, WASH YOUR HANDS!

29. Catheter care • Keep drainage bag lower than the resident’s hips or bladder to prevent infection • Keep the drainage bag off the floor (hang on non-movable part of the side of bed) • Prevent kinks and twists in tubing (prevents the flow of urine) • Keep genital area clean (provide catheter care once per shift or as needed for soiling)

30. Catheter care • Observe and report when providing catheter care: • Bloody urine • Catheter bag does not fill after several hours • Catheter bag fills suddenly • Catheter is not in place • Urine leaks from catheter • Resident reports pain or pressure • Odor

31. Intravenous lines • In caring for residents with IVs, DO NOT • Take blood pressure on an arm with an IV • Get the site wet • Pull or catch the tubing in anything • Leave the tubing kinked • Lower the IV bag below the IV site • Touch the clamp • Disconnect IV from pump or turn off alarm

32. Indirect Care Skill • 1 Greet resident, address by name, and introduce self • 2 Provide explanations to resident about care before beginning and during care • 3 Ask resident about preferences during care • 4 Use Standard Precautions and infection control measures when providing care • 5 Ask resident about comfort or needs during care or before care completed • 6 Promote resident’s rights during care • 7 Promote resident’s safety during care

33. Skill #1handwashing • Handwashing is the single most important method of preventing the spread of infection • Always wash your hands: • Before entering a patient’s room, and upon leaving • Before handling a patient’s or resident’s meal tray • After using the bathroom • After sneezing, coughing or blowing your nose • After touching anything considered dirty • After removing disposable gloves # NOTE: It is not a good idea to wear rings or bracelets on the job or while testing as these can harbor microbes!

34. Skill #2ambulate patient with gait belt • Transfer belts give you a safe place to grasp and support the patient when assisting with standing, transferring or walking • Always use correct body mechanics • Use a transfer belt on the person according to your facility policy • Watch the person for fatigue or discomfort • Check the person’s clothing and shoes. Shoes should have good support and nonskid soles • Check ambulation devices to ensure that they are in good condition • Request help as necessary when you patient is weak or unsteady • Allow patient to dangle before standing

35. Skill #3assist with bedpan • Bedpan- Used for elimination when a person is unable to get out of bed at all • Use with extreme care so that patient’s skin is not bruised or easily torn • There are 3 types of bedpans: fracture pan and regular pan and bariatric • Fracture pans are used when patient is unable to use regular pan due to fracture, pain, or arthritis (smaller and less bulky) • Placement: Fracture Pan- thin edge goes towards the head of bed. Regular pan- buttocks are placed on wide part like a regular toilet seat • After placement, raise head of bed to allow for normal elimination • Provide privacy (close curtain, shut door) • Remember Safety- lower bed to lowest position, keep side rail up and place call light within reach

36. Skill #4Change linen with patient • Bed linen: top and bottom (fitted) sheets, draw sheet, lift sheet, bed protector (chux pad or incontinence pad), blanket, pillow and pillowcase, bed spread • Collect linen in order that you will use them and only collect linen that is needed • While handling linen always hold them away from your body and uniform • Always use gloves to remove linen from bed (soiling) • Always wash hands before collecting clean linen • Never place clean linen on the floor or other dirty surfaces • Place dirty linen in linen bag or linen hamper and take to designated area (soiled utility room)

37. Bedmaking continued • Linen must remain clean, dry and wrinkle free to protect your patient from skin breakdown • Bedmaking is best done while patient is out of bed (taking a shower or in a chair) • Know your facility policy as to how often the linen is to bed changed • Some linen needs to be changed more often such as with a patient with excessive perspiration or incontinence • Remember to use mitered corners for bedmaking • Types of bedmaking: closed bed, open bed, surgical bed, occupied bed • If bedmaking with person in bed, explain procedure, reassure, provide privacy and safety • Always finish bedmaking by making sure wheels are locked and bed is in the lowest position and patient has their call light within reach

38. bedmaking

39. Skill #5change patient to side-lying position • Remember your indirect skills: infection control, safety, communication, and resident preferences, needs, comfort and rights • Changing positions helps you to stay comfortable while preventing complications such as decubitus ulcers • Some patients are not able to change positions without your help • Proper body alignment is very important • Supportive devices may be used: pillows, sheets, blankets, wedge pillows

40. Positioning patient • Supine (Dorsal Recumbent) Position- lying on back, bed flat, head supported with pillow • Fowler’s Position- head of bed elevated between 45-60 degrees • Semi-Fowler’s Position- low fowler’s, HOB 35-40 degrees • High Fowler’s- HOB elevated 60-90 degrees • Side-lying Position (lateral)- laying on either the right or left side • Prone Position- lying on abdomen with head turned to either side • Sims Position- extreme side lying position • You can raise the patient’s knees with pillows or with bed to prevent sliding down in bed • Patient’s unable to reposition themselves are repositioned every 2 hours

41. Positioning patient • When positioning patient make sure to not cause injury to yourself or patient • Shearing- pulling a person across a surface that causes resistance • Friction- when 2 surfaces rub against each other (patient’s skin and the bed linen) • Always ask for assistance from a co-worker when needed

42. patientpositioning

43. Skill 6dress resident with weak arm • In your career you may have residents that have weakness due to illnesses or diseases processes • Help residents to choose clothing that is easy to put on and take off • Dress the person starting with the affected extremity (weak arm) • Take off clothing starting with the unaffected extremity (strong arm)

44. Skill #7empty drainage bag/ I&O • For some residents you may have to record all intake and output • You may measure with cc’s (cubic centimeter) or ml’s (milliliters) • Fluids considered output include urine, vomit, blood, wound drainage and diarrhea • Collection devices for measurement: urinals, graduate, commode hat, emesis basin • Urinals have measurements marked on the side • Urine from catheter must be emptied into a graduate for measurement • Measurements are also located on emesis basin • Always wear gloves while measuring output

45. Skill #8feed resident in chair • Meals should be served as soon as they arrive from kitchen • Always check name card and food allergies prior to delivering tray to patient • Make sure diet on tray matches current Physician ordered diet • Always ask patient if is it ok to use clothing protector before placing it on before meal • Ask patient if it is ok for you to assist with meal. Tell patient what food is on the tray • Help set up meal tray (unwrap utensils, open cartons ect.) • Use a spoon for feeding and fill 1/3 full for each bite • Offer fluids in between each bite

46. Skill #9measure and record radial pulse • Every time the heart beats is sends a wave of blood through your arteries • All arteries have a pulse, you can only feel the pulse of an artery that runs close to the surface of the skin (radial artery-pulse) • Pulse is felt as a throbbing sensation over the artery • You feel it by placing your fingers gently over the artery • Most common pulse site is the radial pulse located on the thumb side of wrist • Pulse rate- number of pulsations felt in one minute • Pulse rhythm- the pattern of pulsations and the pauses between them (smooth and regular with even amount of time between pulsation) but can be (irregular) • Pulse character- not palpable, weak or thread, strong, bounding • Never measure pulse with your thumb (thumb has it own pulse) always use your middle 2 or 3 fingers for measurement • Normal pulse rate for adults is: 60-100 bpm

47. Skill #10measure and record respirations • Respiration= 1 inhalation and 1 exhalation • Inhalation= brings in oxygen and Exhalation= removes harmful carbon dioxide • Look for rate, rhythm and depth of each respiration • Normal adult respirations are 12-20 • Watch for rise and fall of chest for 30 secs. and multiply by 2 or for 1 full minute • Respirations are counted immediately after pulse with your fingers still on person’s wrist • Observe from side or behind person, or by placing your hand on collarbone • Always monitor for breathing abnormalities

48. Skill #11provide catheter care • Indwelling catheters are attached by tubing to a urinary drainage bag • Urine will drain continuously from bladder into the drainage bag • Some drainage bags are attached to patient’s bed or wheelchair, others attached to patient’s leg (leg bag) • Always keep drainage bag lower than person’s bladder • Never attach bag to side rail, always to bed frame! • Make sure that emptying spout is clamped when not in use-prevents urine from leaking • If you must change drainage bag, never let catheter tubing touch any other surface, always wipe exposed tubing with alcohol pad prior to attaching to new bag

49. Types of catheters

50. Catheter care continued… • Catheter care involves cleaning of the perineal area and the catheter tubing in order to prevent infection • You must use soap and water and remember to always wear gloves • Make sure water temperature is comfortable for patient • You may need several washcloths to perform skills • Always wipe front to back and use different side of washcloth per stroke • Catheter care may need to be done per shift as many times an necessary especially if patient is incontinent of stool • Remember the indirect skills while performing care (make sure your non-working bed side rail is raised-safety, close curtains-privacy, ask if it’s ok to enter-respect for patient)