Chapter 22: Special Care Skills

5. Sep 2015

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Chapter 22: Special Care Skills

  1. Chapter 22
  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