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