Case Study Investigation
LEARNING OBJECTIVES
KEY TERMS
ADMITTING, TRANSFERRING, AND DISCHARGING PATIENTS
ADMITTING THE PATIENT
PATIENT PREFERS TO BE ADDRESSED AS:
Complete a personal inventory list of the patient’s
FIGURE 3–2 If the patient’s condition permits, use a wheelchair to transfer the patient to the new room or unit.
TRANSFERRING THE PATIENT TO ANOTHER FACILITY
the manufacturer’s instructions regarding the operation
DISCHARGING A PATIENT
Check to make sure that the patient has received final instructions
List three things that a health care team member should measure and record when a patient is admitted to a facility.
What are mechanical lifts used for?
3:2 POSITIONING, TURNING, AND MOVING PATIENTS
ALIGNMENT
Preventing fatigue:
A pillow or rolled blanket may be placed under
Turn the head to one side. It may be supported with a small pillow.
PRESSURE ULCERS
Stage III: a deep open crater forms when all layers
film dressing. The suction tubing is attached to the suction
TURNING A PATIENT
MOVING A PATIENT UP IN BED
TURNING A PATIENT AWAY TO CHANGE POSITION
Ask the patient to place their arms across the chest and move
TURNING THE PATIENT INWARD TO CHANGE POSITION
Get close to the patient by bending your knees and keeping your
Place your hands under the patient’s legs and draw them toward the center of the bed.
DANGLING
FIGURE 3–15A Place one arm around the patient’s shoulders and the other arm under their knees.
FIGURE 3–15B Slowly rotate the patient toward the side of the bed.
Check the patient’s radial pulse. Note any signs of distress, such
TRANSFERRING A PATIENT TO A CHAIR OR WHEELCHAIR
Position your feet to provide a broad base of support.
FIGURE 3–16A Lock the wheels and raise the footrests before transferring a patient to a wheelchair.
TRANSFERRING A PATIENT TO A STRETCHER
• Position the patient comfortably on the stretcher. Lock the safety belt(s). Raise both siderails of the stretcher.
USING A MECHANICAL LIFT TO TRANSFER A PATIENT
Turn or move the patient to position the sling under the patient.
1� What stage of tissue breakdown is a pressure ulcer that has abrasions, bruises, or open sores?
How frequently should a patient confined to bed be turned or repositioned?
FIGURE 3–19 (A) Position the sling under the patient’s shoulders, buttocks, and thighs.
3:3 BEDMAKING
FIGURE 3–21 Making an occupied bed
FIGURE 3–22 A bed cradle supports the top linen and prevents the linen from coming into contact with the patient’s legs and feet.
Some facilities do not allow linen hampers or carts in a patient’s room.
1� Bed cradles are used for patients with what conditions?
2� What is another term for a draw sheet?
3:4 ADMINISTERING PERSONAL HYGIENE
TYPES OF BATHS
ORAL HYGIENE
FIGURE 3–24 Hold the dentures securely while brushing all surfaces.
FIGURE 3–25 Use a prepared swab to cleanse all parts of the patient’s mouth while providing special oral hygiene.
HAIR CARE
It is also important to observe the condition
NAIL CARE
FIGURE 3–26 Special devices are available for use when shampooing the hair of a patient confined to bed.
FIGURE 3–27 After soaking the nails, use the slanted or blunt edge of an orange stick to clean dirt out of the nail beds under the nails.
BACK RUB
CHANGING A GOWN OR CLOTHING
OBSERVATIONS
1� How frequently should oral hygiene be administered?
2� How do you get tangles or knots out of hair?
FIGURE 3–30 A nasogastric tube is inserted through the nose, down the esophagus, and into the stomach.
3:5 MEASURING AND RECORDING INTAKE AND OUTPUT
INTAKE
Oral intake is by way of the mouth. Liquids taken
OUTPUT
RECORDING INTAKE AND OUTPUT
INTAKE AND OUTPUT RECORD
Various agencies have different policies for recording intake and output.
1� What are two routes that are considered for liquid intake?
2� What units are liquids measured in?
3:6 FEEDING A PATIENT
Before feeding any patient, test the temperature of all hot foods.
1� What do you compare a plate to for a visually impaired or blind patient?
2� How full should you fill a spoon or fork with food?
3:7 ASSISTING WITH A BEDPAN/URINAL
Before emptying a bedpan or urinal, it is the health
1� What is the function of the bladder?
2� What should the health care provider do before emptying a urinal?
3:8 PROVIDING CATHETER AND URINARY DRAINAGE UNIT CARE
FIGURE 3–41A The urinary-drainage bag is connected to the catheter and attached to the bed frame below the level of the bladder to collect the drained urine.
The drainage bag is always below the level
1� What is a catheter?
2� How is a Foley, or indwelling, catheter held in place?
3:9 PROVIDING OSTOMY CARE
ascending colostomy tend to be liquid, while feces expelled through
FIGURE 3–44 Most patients with ostomies wear a bag or pouch over the stoma to collect the drainage.
1� What are two reasons for creating a stoma?
2� What are two characteristics of a normal stoma?
3:10 COLLECTING SPECIMENS OF FECES/URINE
ROUTINE URINE SPECIMEN
FIGURE 3–46 Urine specimen containers should have a secure lid to prevent spillage.
FIGURE 3–47 Place the sterile lid on the container immediately after collecting the urine specimen.
CLEAN-CATCH, OR MIDSTREAM, SPECIMEN
CATHETERIZATION FOR STERILE URINE SPECIMEN
24-HOUR URINE SPECIMEN
FECES SPECIMEN
LABELING
FIGURE 3–48 A 24-hour urine specimen collector.
FIGURE 3–49 All urine or feces specimens must be placed in protective biohazard bags before being transported to the laboratory.
mask or face shield, and a gown must be worn if splashing or spraying
1� When collecting a routine urine specimen, if a specimen cup is not available, what can be used?
2� If a urine specimen cannot be sent to the laboratory right away, how should it be stored?
3:11 ADMINISTERING PREOPERATIVE AND POSTOPERATIVE CARE
PREOPERATIVE CARE
Operative permit:
Remove cosmetics:
ANESTHESIA
Spinal anesthesia: Medication is injected into the spinal canal and
POSTOPERATIVE CARE
Level of pain: An assessment must be made of the amount of pain
using Velcro tabs. Binders are applied from bottom
1� What are the three phases of surgical care?
2� How frequently are vital signs taken after surgery?
3:12 ADMINISTERING OXYGEN
METHODS OF OXYGEN ADMINISTRATION
Ȥ The rate of flow by mask is usually 6–10 liters per minute (lpm).
OXYGEN DELIVERY SYSTEMS
FIGURE 3–57A When oxygen is piped through a wall, the flow meter is plugged into a wall adaptor. A humidifier is used to moisturize the oxygen.
Pure oxygen is very drying and can damage or irritate mucous
SAFETY PRECAUTIONS
FIGURE 3–58 A pulse oximeter may be used to measure the level of oxygen in arterial blood.
PULSE OXIMETERS
PRECAUTIONS
In many facilities, oxygen administration is the responsibility
1� List two methods used to administer oxygen.
2� What is used to moisturize oxygen?
Today’s Research Tomorrow’s Health Care
Case Study Investigation Conclusion
