162 Chapter 9 While hand washing or using hand sanitizer, friction (resistance produced by rubbing two surfaces) helps remove microorganisms. Remember that wearing gloves is not a substitute for proper hand hygiene. Knowing how to effectively perform hand hygiene procedures is important for infection prevention and control. Alcohol-based hand sanitizers can be purchased easily and are often found in dispensers (for example, in healthcare facilities, grocery stores, and other public places). Effective hand sanitizers usually contain at least 60–95 percent alcohol.rinse, Procedure Hand Washing Rationale Standard precautions require routine and proper hand washing to remove and prevent the spread of microorganisms. Preparation 1. Locate a sink near the place you will give care. There must be • a sufficient supply of antimicrobial soap • a sink with warm, running water • clean paper towels in a dispenser and • an appropriate waste container nearby. 2. If your sleeves are long, use a clean, dry paper towel to push them up your arms until they are close to your elbows. 3. Remove any watches or rings. If you cannot remove a watch, use a clean, dry paper towel to push it up your arm away from your hand. If you cannot remove your rings, you will have to lather (spread) soap underneath them. Best Practice: The sink is always contaminated. Stand far enough away from the sink that your clothing does not touch it (Figure 9.9). Do not touch the inside of the sink at any time. Always rewash your hands if they touch the sink at any time. Figure 9.9 The Procedure 4. Using a clean, dry paper towel, turn on the Do not turn on the faucet with your bare hands. Adjust the water temperature until the water is warm. Be sure the water does not splash on your scrubs. 5. Thoroughly wet your hands, wrists, and the skin 1–2 inches above your wrists. 6. Remove your hands from the water. Apply enough soap and work it into a thick lather over your hands, wrists, and the skin at least 1–2 inches above your wrists (Figure 9.10). If you have not removed your rings, lather soap underneath them. Figure 9.10 Best Practice: When washing your hands, keep your hands and forearms below your elbows. Water should flow down off your fingertips, never up your arms. 7. Rub your palms together in a circular, counter- clockwise motion. 8. Push the fingers of the right hand between the fingers of the left hand and rub up and down. 9. Push the fingers of the left hand between the fingers of the right hand and rub up and down. 10. With fingers interlaced, rub the palms together from side to side. Copyright Goodheart-Willcox Co., Inc. Procedures Throughout The Nursing Assistant: Essentials of Holistic Care, Brief Edition, detailed procedures outline the steps students need to follow to pass the certification competency examination in their state and practice as nursing assistants. Each procedure contains a rationale, preparation instructions, procedure steps, follow-up actions, and information for reporting and documenting the care provided. Procedures are easy to follow and are richly illustrated with numerous, professional photographs and drawings. Best Practice notes advise students about safety precautions and ways to provide holistic care. Step-by-step videos are also available in EduHub to help students see the tasks involved in each procedure. Guided Tour Rationale 4 . Usi ng a cl ean , dr y paper towel , turn on the ffaucet. aucet. Do not turn on the f aucet with your bare h d Adj h il h 4 Using a clean dry paper towel turn on the Assisting with Personal Hygiene 423 23. Wet the bath mitt using only water, not soap. If the resident requests soap, keep the soap away from her eyes. Gently wash each eye from the inner corner to outer (FFigure To prevent infection, use a different, clean part of the mitt for each wipe.. Figure 19.4 24. Wash the entire face, ears, and neck with a new bath mitt. Rinse well to remove any soap used. Gently pat-dry the face, ears, and neck with a dry towel. Best Practice: Before washing each arm, place a dry towel under it. 25. Support the arm farthest from you. Wash the shoulder, axilla, arm, hand, and fingers with soap and water using a clean bath mitt. Wash the axilla thoroughly. Rinse and dry well. 26. Apply deodorant, unless directed otherwise. 27. Apply lotion to the resident’s arm and hand, unless directed otherwise. Gently massage the lotion in a circular motion with the palm of your hand. Best Practice: Always warm lotion in your gloved hands before placing it on the resident. 28. Rinse and dry the resident’s hand well with a clean towel. Keep the resident warm by placing the dry arm under the bath blanket. 29. Support the arm nearest to you. Wash, rinse, dry, and apply lotion to the shoulder, axilla, arm, hand, and fingers using the same procedure. 30. Place a dry bath towel across the resident’s chest and fold the bath blanket down to the pubic area. Best Practice: Never expose the resident. During the bath, observe the resident for redness, sores, or irritation on the skin, especially under breast tissue and skin folds or on bony projections. Take extra care around any dressings or catheters. Always check with the resident to be sure you are not rubbing too hard. 31. Lift the dry bath towel slightly and wash, and dry the chest and abdominal areas. Wash the navel and any creases in the skin with cotton-tipped applicators. 32. Apply lotion to the skin, unless directed otherwise. Gently massage the lotion in a circular motion with the palm of hand. 33. Pull the bath blanket and over the bath towel. Then remove the bath towel from beneath the bath blanket. 34. Lower the bed and raise the side rails Give the resident the call light. Empty, rinse, and refill the washbasin about two-thirds of warm water. Check the water temperature. It should be 100–105°F. The water should comfortably warm to your elbow. You may also the resident to feel the water temperature, but always check yourself first. 36. Place the washbasin on the overbed table. Best Practice: If needed, remove your gloves and wash your hands before emptying the washbasin. Practice hand hygiene and put on a new pair of gloves after replacing the washbasin on the overbed table. 37. Place a dry towel under the resident’s leg farthest from you. Be sure the genitalia are not exposed. Support the thigh and leg. Wash, rinse, and dry the thigh and leg well. 38. Apply lotion according to the plan of care. If lotion is used, gently massage it in a circular motion with the palm of your hand. 39. Wash, rinse, dry, and apply lotion to the thigh and leg nearest you using the same procedure. Then cover both legs with the bath blanket. 40. Expose the foot and thigh nearest you and bend the knee. Place the washbasin on top of a towel near the foot to be washed. Support the knee and place the resident’s foot in the water (Figure 19.5). Using a bath mitt, wash and clean between the toes and under the toenails. Remove the foot from the water, then rinse and dry it well. Figure 19.5 41. Apply lotion according to the plan of care. If lotion is used, gently massage it in a circular motion with the palm of your hand. To prevent fungal infection, do not put lotion between the toes. (continued) Copyright Goodheart-Willcox Co., Inc. Assisting w i th Per sonal Hyg i ene 42 2 42 2 23. Wet the bath mitt usin g only water, not soap. If the resident requests soap, keep the soap awa y f rom her eyes. Gently wash each eye f rom the inne r corner to tthee h outer ccorner orner ( igure 119.44).) 9. . T o prevent inf ecti on, use a diff erent, clean part o f the mitt f or eac h w ip e 32. Appl y lotion to the skin, unless directed otherwise. Gently massage the lotion in a circular motion with the palm of yyour our hand . 33. Pull the bath blanket uup p and over the bath towel. Then re move th e bath towel f rom ben eath th e bath blanket . 34. Lower the bed and raise the side rails ffor or safsafety. ety. G ive the resident the call light. 335. 5. Empty, rinse, and re fi ll the washbasin about two-thirds ffull ull o f warm water. Check the wate r temperature. It should be 100–105°F. The wate r should ffeel eel comf ortably warm to your elbow. You may also aask sk the residen t to fe el the water 360 Chapter 16 Procedure Measuring an Apical Pulse Rationale Apical pulse is usually taken if you want more information than a radial pulse can provide or if it is not possible to take a radial pulse. A pulse outside the normal range may be a sign of a health issue, medical disease, or condition. Preparation 1. Ask the licensed nursing staff how this procedure fits into the plan of care, if there are doctor’s orders for the procedure, if there are any special instructions or precautions, and if the resident can be moved into the positions required for this procedure. 2. Wash your hands or use hand sanitizer before entering the room. 3. Knock before entering the room. 4. Introduce yourself using your full name and title. Explain that you work with the licensed nursing staff and will be providing care. 5. Greet the resident and ask the resident to state his full name, if able. Then check the resident’s identification bracelet. 6. Use Mr., Mrs., or Ms. and the last name when conversing. 7. Explain the procedure in simple terms, even if the resident is not able to communicate or is disoriented. Ask permission to perform the procedure. 8. Bring the necessary equipment into the room. Place the following items in an easy-to-reach place: • a stethoscope • antiseptic wipes • a watch or clock with a second hand (not a digital watch) • pen and pad, form, or digital device for documenting the pulse rate The Procedure 9. Provide privacy by closing the curtains, using a screen, or closing the door to the room. 10. If the resident is in bed, lock the bed wheels and then raise the bed to hip level. 11. Maintain safety during the procedure. If the resident is in a bed with side rails, raise and lock the rails on the opposite side of the bed from where you will be working. Lower the rail on the side you are working. 12. Have the resident sit or lie down. 13. Clean the earpieces and diaphragm of the stethoscope with an antiseptic wipe. 14. Warm the diaphragm of the stethoscope by rubbing it in the palms of your hands. 15. Place the earpieces of the stethoscope in your ears. 16. Uncover the left side of the resident’s chest. Avoid any overexposure. 17. Place the diaphragm of the stethoscope on the left side of the chest, under the breast, or just below the left nipple (Figure 16.18). Figure 16.18 Best Practice: If the heartbeat is difficult to hear, have the resident turn slightly to the left or sit upright. 18. Note the position of the second hand on your watch. Count the heartbeats for one full minute. Note the rhythm and quality. 19. Cover the resident’s chest. 20. Document the pulse on a pad, on a form, or in the electronic record. 21. If the resident is in bed, check to be sure the bed wheels are locked. Then reposition the resident and lower the bed. 22. Follow the plan of care to determine if the side rails should be raised or lowered. Follow-Up 23. Wash your hands to ensure infection control. 24. Make sure the resident is comfortable and place the call light and personal items within reach. 25. Conduct a safety check before leaving the room. The room should be clean and free from clutter or spills. 26. Wash your hands or use hand sanitizer before leaving the room. Reporting and Documentation 27. Report any specific observations, complications, or unusual responses to the licensed nursing staff. Image courtesy of Wards Forest Media, LLC Copyright Goodheart-Willcox Co., Inc. Best Practice: During either cold application, ask the resident about the temperature of the compress or ice pack. Is it too cold? Does the resident feel numb or have any burning pain? Check often for red or pale skin. If there are any problems or complications, remove the application and report to the licensed nursing staff. e Best Practice: Never expose the resident. During the bath, observe the resident for redness, sores, or irritation on the skin, especially under breast tissue and skin folds or on bony projections. Take extra care around any dressings or catheters. Always check with the resident to be sure you are not rubbing too hard.. not rubb ing too hard Best Practice: A steam-like mist may be used to loosen sputum prior to collection. A resident who is well hydrated prior to the collection may find it easier to cough because the fluids will help thin out the sputum.