To help position a patient, a variety of items and devices can be used. To prop the patient on their sides or to keep knees and ankles from rubbing together, use blankets and pillows. A washcloth can be rolled to place in the hand of a stroke patient to maintain a natural position. Roll a blanket to make a trochanter roll to support the paralyzed side of a patient's body. A footboard is used to prevent footdrop; the patient's foot is placed against it to maintain flexion, as if the patient were standing.
When assisting a client who is blind or has low vision, allow them to hold your arm so you can guide them. Touch the back of your hand to the back of theirs, so they can move their hand and locate your upper arm. They should hold on above your elbow, and walk half a step behind you. Walk at a pace that is comfortable for both of you.
When a client is not able to take a full shower or bath, and is too weak for a full bed bath, you can still help the client freshen up with a partial bath. With the same procdure as for a full bed bath, wash and dry the client's face, hands, and underarms. When washing the back, observe skin condition. Apply lotion if the client wishes. Finish with perineal care. Help the client put on a clean gown.
Oral hygiene is important for several reasons. The primary purpose is to keep teeth, gums, and mouth healthy, free from decay or infection. Research shows that it also can help prevent heart disease, memory loss, and autoimmune disease.
Bowel movements can be more regular by increasing fluid intake, as well as adding fiber from fruits, vegetables, and grains. Dairy products and sugary foods can cause constipation. Activity stimulates the bowels, too. If the client has fewer than three bowel movements a week or the the stool is hard and difficult to pass, the client may be constipated.
Place a small amount of lotion in one hand, then rub hands together to warm it. Apply the lotion in long, firm strokes in an upward direction from the client's buttocks and lower back to the neck. Use a circular motion, with hands remaining on the back. The strokes should be one continuous motion, lasting 3-5 minutes. During the massage, observe the client's back for any reddened areas.
Residents should be encouraged to be as independent as possible, including when they use the toilet. There are many aids which make transferring, sitting, and standing easier. An elevated seat is more comfortable and requires less leg strength. Grab bars let the resident pull themself up and maintain balance. Bedside commodes are useful for residents who are unable to walk to the bathroom.
Before transporting a client for any reason, always check the client's ID and verify where the client is going. For transfer to another unit, the nurse (or the person responsible for the bed assignment) should provide the room and bed number for the client. To ensure a smooth transfer, do not move the client until the information is confirmed.
If a resident is coughing frequently when eating, report it to the nurse. It could be a sign of a swallowing disorder (dysphagia). Other signs are extra time or effort needed to chew or swallow; food leaking from the mouth or getting stuck in the mouth; and a "gurgly" voice after eating or drinking. Some residents may lose weight because they can't eat enough.
Exposure to feces and urine is one of the most common causes for skin irritation and breakdown. Thorough cleaning after a client has had an incontinent episode is important for several reasons. If perineal skin stays wet, it becomes waterlogged and fragile. Urine contains ammonia, a harsh chemical that damages skin. Many clients have dry skin which can develop tiny cracks, allowing bacteria to enter the body. Clean the client, dry the area, and apply a barrier ointment to minimize any future contact by feces and urine.
Trying to move or transfer a heavy resident alone puts the nurse aide at risk for a back injury. Get assistance from at least one other person. Use a draw sheet to move the resident up or to roll them on their side. This avoids injuring the resident's shoulders and neck, as well as preventing skin damage from friction. Reposition by pulling, not lifting. If the resident is able, ask them to assist by pushing with their heels.
Always start by telling the resident what you are going to do. Raise the bed to a comfortable height. After removing the top blanket and sheet, cover the resident for warmth and privacy. Roll them to their side, with the opposite side rail up. Roll the dirty bottom linens tightly toward the patient, tucking them under the resident's shoulders, back, and feet. If the mattress is soiled, clean and dry. Place the clean linens on the bed, rolling to meet the dirty linens. Tell the resident they will be going over a bump and help them roll to the clean side, with the side rail up. Move to the other side of the bed to remove the dirty linens, clean and dry any soiled areas. and pull the clean linens into place, making sure they are smooth. tuck in all corners and place the clean top sheet and blanket.
Activities of Daily Living (ADLs) are the basic personal tasks that can be done without help. There are six tasks: eating, bathing, dressing, personal hygiene, mobility, and using the toilet. As long as the client can perform these tasks, even with special tools or devices, they are considered independent. A way to remember the ADLs is "DEATH" which stands for D=Dress, E=Eat, A=Ambulate, T=Transfer/Toilet, H=Hygiene.
Research with brain waves, using EEGs, shows that hearing may be the last sense to shut down during the death process. Never assume that the client can't hear, even if are unconcious or not responsive. Continue to speak to the client, as if they can hear. Tell them who else is present and encourage others to tell the client why they are there and to say good-bye.
After a stroke, patients can learn to feed themselves by trying different products. Special silverware with larger handles are easier to grip. Added-weight flatware can stabilize tremors. Angled and open-handled flatwear are two more options. Plates with suction cups and higher edges or guards keep dinnerware in place as the patient pushes food against the side of the plate. Physical and occupational therapists can work with patients to find what is best.
If a resident is competent, they can refuse care or treatment. A resident who has dementia may simply need a different approach to bathing that day. In either case, try to reschedule the shower or offer a bed bath. If the resident continues to refuse, document what was offered. If the resident gave a reason, include their statement. The nurse aide should show that care was offered and refused, not that the care was skipped.
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