Vital Signs and Hypotension

Vital Signs Assessment

• Assess vital signs upon admission to any facility
• Adhere to institutional policies when taking vital signs
• Take vital signs when a patient's condition changes
• Assess vital signs when a loss of consciousness occurs
• Assess vital signs before and after invasive procedures
• Assess vital signs before and after activity that may increase risk
• Assess vital signs before and after medications that affect cardiovascular & respiratory function

Hypotension

• Defined as blood pressure <90/60mmHg
• Hypotension may be caused by chronic disease, such as Parkinson's
• Loss of blood volume or a poorly pumping heart can cause hypotension
• Orthostatic hypotension is inadequate response to posture changes
• Orthostatic hypotension is common after surgery or long time on bedrest
• The body's response to hypotension includes dizziness, confusion, blurred vision, fainting, and headache
• Nurses should get patient up slowly, raise head of bed, sit on side of bed (dangling to avoid symptoms of hypotension)
• Advise the patient to sit or lay patient down should signs of hypotension present

Asepsis and Infection

• Asepsis is the absence of pathogens
• Infection is a disease state resulting from a pathogen's presence
• A pathogen is a specific microorganism that causes disease

Infection Cycle

• Infectious agent present in bacteria, viruses, fungi, and parasites refers to a microorganism's ability to cause disease
• Bacteria are classified as aerobic or anaerobic, and Gram-positive or Gram-negative
• Traditional antibiotics don't work on viruses
• Fungi include molds and yeast which can cause athlete's foot and vaginal problems
• A number of organisms can impact if disease can be produced
• Virulence, or the degree to which agents produce illness, and the length of contact with an infected person also contribute to whether or not disease develops

Reducing Infectious Agents

• Practice hand hygiene and sanitization
• Utilizing sterilization techniques
• Prescribing antibiotics/antimicrobials

Reservoir

• Reservoir relates to the natural habitat of the organism, where the infectious agent lives
• The reservoir is often people (colds, TB, HIV)
• Human reservoirs may or may not have symptoms (asymptomatic/colonized)
• Asymptomatic carriers include typhoid (C. diff), HIV, Cholera, TB, and Covid
• Animal reservoirs include birds, insects, and mammals, which can carry diseases, like malaria, histoplasmosis, plague, and Zika
• Environments like inanimate objects (food, water, milk, feces) can also act as reservoirs

Reducing Infectious Agents in the Reservoir

• Apply transmission-based precautions
• Utilize sterilization techniques
• Use disposable supplies

Portal of Exit

• This describes the point of escape for the organism, where the infectious agent leaves the reservoir
• Common portals of exit include the respiratory tract, GI tract, urinary tract, blood, skin, secretions, and excretions
• Anything coming from/out of the patient should be considered a portal of exit

Reducing/Preventing Portal of Exit

• Isolation, sterile technique, and masks when indicated
• Using dry, intact dressings
• Following hand hygiene practices
• Wearing gloves when contact with body fluids is likely
• Covering the nose & mouth when sneezing

Means of Transmission

• This refers to how infectious agents spread from the reservoir to the host
• Direct contact/droplet examples include touching, sneezing, kissing, biting, sex, blood (from people), physical contact
• Droplets typically spread within 3 feet
• Airborne transmission is less common
• Indirect Transmission: Vehicle/fomite borne (doorknob, instrument, needles, utensils, dressings, blood, food, water)
• Vectors (insects, animals, etc.)

Reducing Means of Transmission

• Hand hygiene
• Using pesticides to eliminate vectors
• Adequate refrigeration
• PPE, asepsis technique

Portals of Entry

• This refers to the point at which organisms enter a new host, often the same as the exit point
• Methods include:
  • Breaks in the skin (mucous membrane)
  • Ingestion (Respiratory)

Reducing Portal of Entry for Infectious Agents

• Hand hygiene
• Wear gloves
• PPE: Use masks and appropriate protective gear
• Proper disposal of needles/sharps

Susceptible Host

• Refers to someone at increased risk for infection
• Infectious agent must overcome resistance mounted by host's defense, such as intact skin/mucous membranes, hereditary factors, or being weak, malnourished and/or having chronic disease
• Being immunocompromised or unvaccinated increases risk
• Age is a factor: Infants, elderly (more susceptible than infants)
• Presence of medical devices
• Stress

Reducing Susceptibility to Infectious Agents

• Maintaining intact skin
• Getting immunizations
• Screening healthcare staff
• Diet and exercise
• Stress reduction

Signs of Systemic Infection

• Fever
• Increased pulse and respiratory rate
• Malaise and loss of energy
• Severe hyperglycemia (high glucose) in some patients
• Anorexia, nausea and vomiting
• Enlargement and tenderness of lymph nodes that drain the area of infection

Stages of Infection

• Incubation Period: Organisms growing & multiplying, period variable (cold, 1-2 days; Hepatitis A, 5-50 days)
• Prodromal stage: Worst stage, Most infectious, vague signs of disease, everything is transmitted, you don't know you're sick so you are more likely to transmit disease
• Full stage of illness: Specific signs and symptoms, type of infection determines symptoms and length
• Convalescent period: Recovery

Aseptic Technique

• Activities to prevent or break the chain of infection
• Medical Asepsis is a clean technique, involving
  • handwashing with soap and water or sanitizer
  • before a clean or aseptic procedure
  • after a body fluid exposure risk
  • after touching a patient or patients surroundings
  • avoid sanitizer with Clostridium Difficile (C. diff)
  • carrying soiled linen and other soiled articles away from your body; keeping items off the floor; cleaning least soiled areas first

Surgical Asepsis

• Sterile technique in a sterile field, maintaining sterility, using sterile solutions
• When utilized:
  • Operating room (labor and delivery)
  • Diagnostic testing areas
  • Certain Bedside procedures: wound care (sterile), urinary catheters, IV sites, suctioning pulmonary system.
  • Preparing and injecting medications
  • Nursing
    • Sterile field creation and awareness of breaks in sterile area
    • Adding items to sterile field
    • Putting on and removing sterile gloves

Personal Grooming

• Hair: clean, short or pinned up and back
• Hands: nails short; no broken edges; no rings with groves/stones; NO ARTIFICIAL Nails
• Keep soiled articles away from your clothes
• Offer patients tissues
• Don't come to work sick
• Keep nothing on the floor (linens etc)

CDC Guidelines

Standard Precautions

• Used in the care of all hospitalized patients (also outpatient; other facilities, etc.)
• Apply to blood, body fluids (not sweat), secretions, excretions, non-intact skin, mucous membranes
• Wash hands (most important)
• Wear gloves, change gloves after contact
• Remove before leaving room
• Wash hands immediately after removing gloves
• Wear: gown, mask or eye protection only if splash is possible

Transmission-Based Precautions

• Used in addition to standard precautions for patients with suspected infection
• Include airborne, droplet, or contact precautions

Contact Precautions

• Transmitted by direct patient contact, or items in patient's environment
• Respiratory ailments
• Skin-HSV (herpes simplex)
• Gastrointestinal infections (C diff)
• Wound infections- includes MSRA, VRE, Multidrug-resistant bacteria including pneumonia
• Private room or with a client infected with the same organism
• Gloves, gown, not mask except splash
• Disposable stethoscope and disposible thermometer in room

Droplet Precautions

• For droplet nuclei > 5 microns
• Private room or place with client infected with same microorganism
• Mask (still within 3 feet of client)
• Mask client when out of the room

Airborne Precautions

• For droplet nuclei < 5 microns
• Conditions such as: measles, varicella, tuberculosis (spread person to person via respiratory)
• Private room with special ventilation (neg. air pressure)
• Place mask on patient during transport
• Mask-change if wet or soiled
• N95 respirators: Fit tested

Skin/Wounds

• Functions of the skin:
  • Protection
  • Body temperature regulation
  • Psychosocial
  • Sensation
  • Vitamin D production
  • Immunological
  • Absorption
  • Elimination (through sweat)
  • Salt and water primarily (excessive salt in cystic fibrosis)

Types of Wounds

• Intentional: Planned, ex: surgical cut
• Unintentional: Accident, ex: falling, scraping knee
• Open: Break in the skin or other tissues that exposes the underlying layers; cut or abrasion
• Closed: Skin remains intact, but underlying tissues may be damaged; bruise/contusion (ecchymosis)
• Acute: A fresh injury that occurs and progresses through stages of healing; heals quickly, PVD Chronic: A wound that does not heal within the expected timeframe; pressure ulcers

Wound Descriptors by Color

• Red: Beefy appearance, indicating a healthy wound with good circulation
• Yellow: Needs to be cleaned
• Black: Needs debridement to remove dead necrotic skin, tissue from the area

Wound Thickness

• Partial: All or portion of the dermis is intact
• Full: Entire dermis, sweat glands, and hair follicles are severed, might see exposed bone, tendon, or muscle
• Unstageable: Full-thickness loss where true depth cannot be determined
• Complex Wound Healing Principles
• Intact skin is first line of defense
• Careful hand hygiene is mandatory
• An adequate blood supply is crucial
• Normal healing needs a wound free from foreign materials

Wound Principles

• The body's healing ability is affected by the extent of the wound as well as the person's health, as well as wound factors themselves
• Wound factors themselves are:
  • Pressure
  • Desiccation (dryness)
  • Maceration (excess moisture, repeated trauma and edema (swelling)
• A moist healing environment is needed

Primary Intention Healing

• Superficial wounds: epidermis or intentional wounds
• Minimal scarring occurs
• Stitches are used
• Edges of the wound can be/are well approximated (brought together well)
• Stitches from surgery, paper cuts

Secondary Intention Healing

• Partial thickness not through dermis wounds or full thickness wounds: through dermis (maybe muscle, tissue or bone)
• Scarring
• The wound is intentionally left open to heal through granulation, contraction, and epithelialization: healing inside out
• Wound cannot be approximated
• Higher risk of infection, longer healing times
• Ex: Pressure injury

Phases of Wound Healing

• Hemostasis: Immediately after injury (24 hours) Goal: Stop the bleeding & activate white blood cells Process of vasoconstriction using clotting cascade, activates platelets to actively stop the bleeding; clot forms and body dissolves the clot and stimulates other substances for the next phases
• Inflammatory phase: Lasts 2-3 days White blood cells (leukocytes) ingest bacteria and debris) Macrophages (ingest debris and release growth factors) Swelling, edema, pain with inflammation Exudate forms: mass of fluid and cells that seeped out of blood vessel or organ
• Proliferation/repair phase: lasts several weeks Generating new skin cells to fill and cover wound to help regenerate tissue that was lost New tissue forms as collagen and growth factors are produced Capillaries grow; fibrin and epithelial cells. Develop Granulation tissue (basis of scar tissue)
• Maturation/remodeling phase Remodelling scar tissue to rebuild collagen that begins 3 weeks after injury; Collagen remodels (is the scar tissue) no sweat, hair, or tan) thin line for primary intention; large for secondary intention

Wound Drainage

• Serous: Composed primarily of the clear, serous portion of the blood and from serous membranes with clear and watery consistency
• Sanguineous: Consists of large numbers of red blood cells and looks like blood; bright-red drainage indicates fresh bleeding whereas darker indicates older bleed
• Serosanguineous: A mixture of serum and red blood cells with a light pink or blood-tinged consistency
• Purulent: Made of white blood cells, liquefied dead tissue debris, and both dead and live bacteria; thick texture, often has a musty or foul odor, and varies in color (such as dark yellow or green)

Wound Complications

Infection Hemorrhage: Excessive bleeding, damaged blood vessel Dehiscence and evisceration where you want to cover either with sterile towels moistened with saline Dehiscence: partial or total separation of wound layers; previously closed wound opens back up Evisceration: separation and protrusion of a body part through an incision where dehiscence with organs protruding, actively exposed Fistula formation Injury, surgery, infection

Nutrition for Wound Healing

• Protein: meat, beans, eggs, dairy, soy, nuts; protein powder for supplementation
• Vitamin C: Citrus, strawberries, tomatoes, peppers, spinach, broccoli, cabbage, Brussel sprouts
• Vitamin A: Dark green leafy vegetables, orange or yellow vegetables, cantaloupe, fortified cereal
• Zinc: Fortified cereals, red meats, seafood, supplementation
• Chronic wound supplements: Protein powder, multi-vitamin, and zinc supplements

Pressure Ulcers

• Repositioning: Keep the older adult or patient active, turn and reposition dependent patients, change positions every 2 hours
• Ensure adequate nutrition
• Maintain hydration
• Keep skin (and linens) clean and dry
• Provide toileting schedule
• Apply pressure reduction surface but does not substitute for turning
• Pressure reduction surfaces: Foam comforter must be at least 4 inches of dense foam for effectiveness Braden scale is utilized to predict pressure sore risk
• Staging involves: Size of wound, depth of wound, presence of undermining, tunneling, or sinus tract Assess color and type of tissue Determine if there is drainage, tunneling, or epithelization/granulation Understand peri-wound condition

Pressure Ulcer Stages

• Stage 1: Just red, 30 min development, takes 4x that time to heal
• Stage 2: Like a blister or popped blister: Keep patient off of it, easy to fix
• Stage 3: Full thickness, down to the muscle, will see the muscle there, observe for slough, will not heal in pressure ulcer as it appears
• Stage 4: Eschar is present inside; pressure ulcers cannot heal with this present inside of it, necrotic, black, dead tissue, blood, yellow, pus, red blood cells, feels like a big scab, hard texture will not come off unless you take it off with: A knife by physicians, pt Cream that can dissolve it, and eschar cannot be healed with this present inside of it

Wound Dressings

• Always offer analgesia (pain relief) before the dressing change
• Purposes:
  • Provide physical, psychological, and aesthetic comfort
  • Remove necrotic tissue
  • Prevent, eliminate, or control infection
  • Absorb drainage
  • Maintain a moist wound environment
  • Protect wound from further injury
  • Protect skin surrounding wound

Types of Wound Dressings

• Sterile dressings vs clean dressings
• Cover
  • Sterile is used for surgical wounds, stitches in acute are
  • Clean is used for pressure ulcers in a hospital, long term care and community
  • Telfa; Gauze dressings
  • Transparent dressings (Op-site, Tegaderm): Used for IVs to maintain sterility or on stage 1 & 2 pressure ulcers
  • Hydrocolloid: moist environment for protection with long-lasting use; used for type 1&2 pressure ulcers; reduces amount time a wound dressing needs to be replaced
• Debride to achieve a Hydrocolloid (DuoDerm)-minor debridemen
• Surgical debridement-major debridement; some non specificity should be considered
• Chemical debriders (Santyl) are known to be Specific but expensive when selected due to their absorbency (Sorbsan, Aquacel

Drainage Systems

• Purpose: Prevent accumulation of fluid & air
• Types of drains:
  • Open systems-drain into dressing, Penrose drain (fat straw of plastic)
  • Closed systems-drain into bottle or bag
    • Jackson-Pratt drain: goes into wound, hangs outside when you squeeze it, it sucks drainage into it, then it can is emptied in the next step when filled
    • Hemovac drain: to suck the drainage out push it down which is known to be Stronger than Jackson-pratt

Factors Affecting Hot & Cold Treatments

• Method and duration of application
• General guideline dictates to apply heat and/or cold for 20 minutes and then remove to avoid a rebound effect
• Longer than 20 minutes, the body will experience adverse effects; the degree varies along the intensity of heat and cold applied plus patient’s age and physical condition
• Amount of body surface covered by the application

Heat

• Effects: make swelling can be resolved
• Heat dilates peripheral blood vessels
• Increases tissue metabolism
• Reduces blood viscosity and increases capillary permeability
• Reduces muscle tension
• Helps relieve pain
• Devices to apply range from Hot water bags and electric heating pads to the utilization of Aquathermia (water flow) pads
• Hot packs can be wet with some Warm and moist compresses; utilized for sitz baths for Warm soaks to Remember to set for 20 minutes on and off!

Cold

• Effects: prevent swelling
• It contracts peripheral blood vessels
• Reduces muscle spasms
• Promotes comfort/relieves pain
• Devices to apply: Utilize ice bags and Cold packs in Hypothermia blankets if able to apply moist cold with Cold compresses which must Remember 20 minutes it is utilized and should be set on and off!

Mobility

• ROM: Range of Motion is the Capability of joints to go through spectrum of movement
• Has a Range of flexion and extension depending on how Active and passive
• Types of Exercise
  • Muscle contractions: Isotonic-muscle shortening with movement for muscle contractions
    • ADL's: ROM: Walking, Running, Swimming
  • Isometric: Muscle contraction without shortening when on No movement: Contractions only with utilizing Ex: wall sit, with planks utilized to
  • Isokinetic: Muscle contraction with resistance is used to Muscle contraction and ROM with weights during
  • Body movement throughout Aerobic-sustained muscle movement that increases O2 need
  • Swimming and walking may result from skiing and dancing during a full ROM bike ride
  • Stretching is needed during a Warm-up and cool down which can result in yoga or during dance during strength and resistance to allow for flexibility, such as Weight training with calisthenics and isometric for flexibility to occur

Hospitalization & Movement

• Function lost quickly with Every day in bed requires 2 times or more therapy to recover as the older one is as a patient, the greater the loss of function.

Negative Functional Consequences

• Mobility changes
  • Increased risk of falls
  • Increased risk of contractures
  • Decreased muscle strength occurs with poor
• Patients will experienced Difficulty performing ADL's along with a Increased risk of fracture
• Contractures: condition of shortening & hardening of muscles, tendons, or other tissue which is known, often leading to deformity & rigidity of joints but Muscles & bone become 100% contracted when this occurs!
• Flexion muscles are the strongest, so if you lay in bed and do nothing, you will lose your flexion muscles
• Hands will ball up, knees will stay closed, arms will bend towards the body -Cause is determined by inactivity & prolonged bed rest that can come from several factors Prevention to avoid passive & active range of motion (ROM)

Proper Body Mechanics

• Widen your stance by flexing your knees hips, and ankles to avoid working against gravity
• Roll or turn objects instead of lifting them to Use to your weight of your body by rocking on your feet or leaning forward/backward
• Alternate rest periods with work periods as you adjust
• Move height of bed (HOB) down to raise patient up in bed
• Raise the height of bed (HOB) when assisting patient out of bed in relation
• Guidelines to assess which to Plan the move or transfer, Make sure environment is free area of obstacles, obtain assistance from others, utilize Use mechanical devices to encourage client to help as much as possible.
• Start any body movement with proper alignment to a point

Assess stand as close as possible as you primarily use leg muscles, never back muscles

• Patient Positioning is most important especially by Pillow and Mattresses usage while adjusting Adjustable beds. As a result provide a Trapeze bar during Protective positioning with utilizing Fowler's position (SUPINE position)

Interventions

• Change positions every 2 hours
• Community Interventions: Individuals Living at Home in Community by making Specifics in a CDC
• Compendium of Effective Falls Interventions where it is vital to Assess the patients:
  • Exercise to maintains their mobility
  • Home modification through applying
    • Scatter Rugs (and other materials)
    • Bathroom Bars in a utilization of a shower for the patient along with providing a toilet through Lighting during utilization of the night. Clinical assessments is vital to include the following recommendations: Vitamin D use (alone or with Calcium), to Withdraw Psychotropic medications after Cataract surgery and/or assessing proper eyewear It is important for:
• Nursing interventions in healthcare facility for you to Complete these following recommendations during your risk assessment: Indicate risk for falling on patient's door and chart while you keep in mind that you should always strive to Keep → bed in low position
• Keep→ wheels on bed and wheelchair locked
• Let patient know too Leave→ call bell within patient's reach
• Instruct→ patient regarding use of call bell
• Answer→ call bells promptly
• Leave a night light on
• Eliminate all physical hazards in the room (a.k.a. eliminate clutter, wet areas on the floor). to Ensure to provide the patient what they need to recover as well as non-skid footwear after that to Provide them other materials to utilize throughout this processes
• Leave the patient in their ability to utilize and be comfortable with drinking water for their thirst, and utilize tissues for their personal nose sanitation, or even using their own bedpan/urinal within patient's reach
• Remove bedside commode out of and the sight itself to discourage attempts at independent transfer (as appropriate).
• Document and report any changes in patient's cognitive status to the health care team at the change of shift.
• Utilizing Use alternative strategies when necessary despite instead of restraints In addition to the listed interventions, also to As a last resort, use the least restrictive restraint according to facility policy as well to Determine if restraint is applied and to assess patient at the required intervasl Decreasing or eliminating through being knowledgeable of Exercise with providing Exercise/strength training such as with
  • Yoga, tai chi, senior center classes, gyms, DVDS, in correlation to ensure patients: Environmental alterations to Clutter and grab bars to the patient hourly during Medication assessment is important to remember and Utilize best during the process: which correlates to medication Start low and go slow during the procedures: to Medications implicated in falls: is common known throughout usage off benzodiazepines, sedatives and and also the proper usage in correlation to their medications from past times to current times
• Restraints can only be used as assistive devices alongside knowing to Refer to PT and OT during the process and that they are also now on the Bed and Chair alarms
• Proper foot wear should always be worn correctly as a reminder to utilize medication along as well by JCAHO

Restraints

• Guidelines:
  • Immediate physical safety of patient or staff
  • Discontinued as soon as feasible
  • Emergency use based on comprehensive assessment
  • Drugs are considered chemical restraints
  • Medical issues as cause of safety concern must be considered first
  • Use of restraints is not a component of falls prevention programs
  • Family requests for restraints can only prompt an assessment
  • Restraints are Number 1 cause of CMS hospital deficiencies

Emergency Restraints

• Used to protect patient from injury to self/others – primarily emotional, drug or behavioral problem
• Nurse may apply restraints but the physician or other licensed independent practitioner must see the client within 1 hour for evaluation
• Order renewed daily
• Written restraint order for an adult, following evaluation, valid for only 4 hours; 2 hours for adolescent: 1 hour for child <9. Orders can be renewed for maximum of 24 hours
• Must be continual visual and audio monitoring if client restrained Acute Medical & Surgical Care Standard:
• Support medical healing during the assistance provided to the patient.
• Full bedrails are a restraint
• Hospital bedrails are enablers
• RN can apply the restraints
• Orders must be renewed daily and PRN order is prohibited
• Order must state the reason and time period
• Restraints used only after every possible means of ensuring safety unsuccessful and documented as part of the process of safety for the patient:
• Need for the restraint made clear to client and family
• Device must be the least restrictive

Alternatives to Restraints

• Give comfort through the usage off soft lights or a back rub.
• Warm beverag and a proper snack through the usage off: Remove offending and uncomfortable lines and tubes if possible.

Reduce Irritants

• Through the usage off medications because the patient is reducing the pain.
• Frequent monitoring of patient status which can result in helping them maintain close to their needs

Hygiene

• Nursing assessment: Check the usual:
  • Assess: the patients:
    • Self care abilities:
    • Skin care practices
      • Usual time for bathing
      • Hygienic products- for the patient
      • Allergies to soaps
    • Cultural preferences- for the patient
    • Assessment of Amount of assistance required
    • Determine: Presence of past or current skin problems
    • Utilize skin safety along the patient
    • Assess: Rashes, lumps, itching, dryness, lesions

Functional Level

• Self care
• Completely independent which is needed for the patient, as that
• Partial assistance is important as to.

Complete Assistance

• The nurse completes the entire procedure
• Supplies equipment
• Positions patient
• Bathes
• Performs oral care
• Dresses
• Provides bedpan

Oral Cavity Assessment

• Assess :
  • Lips
  • Buccal mucosa
  • Color and surface of gums
  • Teeth
  • Tongue must be safely and properly placed with care for: hard and soft palates which must always be placed prior using Oropharynx-

Abnormalities

• Throughout history we must utilize common sense from any oral abnormalities:
  • Common cases throughout the oral route have:
    • THRUSH in mouth from either to much medication utilization or a common side effect from lack of oral sanitation:

Oral issues and risk associated with tooth decay

• Tartar is a common issue with improper teeth cleaning and sanitation:

Periodontitis

• Gum Disease

Patients At Risk for Oral Hygiene Problems & Periodontal Disease:

Utilizing the safest practices for oral hygiene should especially come from a patient who is:

• Confused especially under the need of assistance from others:
• Comatose, depressed, dehydrated, tube fed, clients and patients with nasogastric tubes should receive receiving oxygen and all clients after oral or jaw surgery from chemotherapy and radiation

Periodontitis & Disease:

When you think of and treat Periodontitis this action must occur in relation inflammation and bacteria associated with periodontitis in the teeth:

• Heart is what and where the Disease (increased risk with periodontitis) is:
• Increased risk of endocarditis with normal and new procedures that cause: Oral infection which may cause an infection during periodontits associated stroke risk (due to the severity): Diabetes (Increased incidence of periodontitis) in relation to Increased levels of blood sugar:

Morning Care

• Before breakfast it is important to:
  • Assist patient with toileting.
  • Provide comfort measures to refresh patient to prepare for day.
  • Wash face and hands.
  • Provide mouth care.

After Breakfast

• Toileting
• Oral care
• Bathing
• Back massage
• Special skin measures like lotion and cremes
• Hair care, cosmetics
• Dressing
• Positioning for comfort
• Refreshing or changing bed linens
• Tidying up bedside

Afternoon & Evening Care

• Afternoon Care (PM Care) which means they must Ensure the patient's comfort after lunch by:
  • Offer assistance with washing their mouth and tongue, hand-washing, oral care.
  • Straighten bed linens.
  • Help patient with mobility of the patient the reposition off self.
• Hours of Sleep Care
• Offer assistance with toileting, cleaning the skin, mouth and washing of arms and upper body.

Offer a back massage. And the changing of any of the linens and clothing Position the patient comfortably with what they need.

• Ensure that call light and other objects patient requires are within reach to better reach you as their health facilitator
• Patient must be comfortable and safe under your aid on both fronts for a speedy recover alongside a more confident feeling in place

Medication Administration

• Types of medication orders in place:
  • Written(or)Preprinted (with proper instructions for new staff),Verbal (when either it be to a phone call or from you as an in-person encounter to the patient),Electronic (COPE: Computer Prescriber Order Entry)
• Order- always to have one in place
• MAR (medication administration record): what a team must always
• Routine(or)Standing: the method we as personnel must use at all times and to be able in correlation to
• Single Dose we must set: one time order
• PRN must be available on: as needed as
• Stat should: immediately become available. So you must immediately provide medications to a patient who requires it
• Patient's full Medications: name is vital
• All should be safe and available to use when needed in both safe and sterile conditions

Medication Safety

• You must know to be the Name of what the Drug dosages are and it's safest dosages to ensure it is safe on them
• Date and time written must be recorded and documented within the appropriate sections of the medical chart and/or on the script for the individual

Steps of Medication

• You must check any prescription you deliver or provide medication for to review it to see on whether or not the patient as a prescription:

Medication label checks on all cases

• The first, Second and Third most important steps for medications is you Read label when you reach for the drug!
• Read directly after retrieving off when preparing medications!
• Read during or before returning container to drawer for more OR for or prior to administering medication that patient needs!
• Most recent studies prove and show that. Always remember the 4th Check which correlates to a test for patient status to be given medication at bedside to confirm all or certain rights have been followed
• Medication 'Rights' come first and the most important is you check the patient on these issues to address this
• During safe or in-troubled situations:
  • Know your medical history to avoid any allergies and to better prepare how to handle the issue!
• 10 Rights
  • Right patient - Double check you are giving it to the right patient, you will avoid fatal and life threating errors. You should use methods of two identifiers (Name and DOB, comparing MAR to patient bracelet) Ensure you properly educate the patient (as well as ask them if they know what they are getting.) And you evaluate throughout its process (If a patient takes it, you should later evaluate what the affects or impacts that will correlate)
• Always document your administrations!!!

Preparing/Medication Safely

• Know how to Follow the "rights" to ensure you give or deliver the safest and proper amount that the patent should safely receive!
• As you check, ask: Does this order make sense in the situation? Is It Appropriate or does it have too much power?
• All high-alert meds which should consist of medical-assistance, A-Pinch meds; High risk must use another second check up with a colleague
• Always utilize medical dispensing features (Bar-coding) to again give another 2 more checkups with a colleague; and while you perform these with a colleague or yourself for any errors you may have overseen
• LASA is a step to remember to double check while in SALA, the goal is to make sure that it is easy and accessible to review.
• After giving a medication if an emergency happens quickly Report errors and/or adverse events
• And if the patient as a non documented medication document your actions and the medications being given to the for them as:
  1. Identify the patient and double check the dosage with a colleague
  2. Educate the patient as the main goal
  3. Assess the patient throughout
  4. Administer everything to follow the next
  5. Provide adjunct interventions through the patient
  6. Document interventions and proper assessments including if you need utilize medication
• Patient's medical history is important for everything we can know and avoid to ensure

High Alert Medications (Pinch Meds)

Medications which are high in universal are still at some risk! Based on some hospital incident reporting, we do know: That Anti Infections due to common pathogens can be quite resistant in a lot cases Potassium and Other Electrolytes can also interfere or result in a reaction, while we have a good amount of insulin.

Medication Error

• Every day this has a chance of becoming a regular issue in the environment and to Ensure to review your patient history before you decide to use to them to ensure more safety is on your side every time
• Always: Check patient's condition immediately and Notify proper sources to provide some observations for adverse effects
• Ensure to do proper due to for identification of system issues through documentation and for medical utilization!
• Always make sure there is a plan to Prevent to get those dosages off the ground in more Proper administrations route for all!
• Always review Pharmalocokinetics and absorption with experts