Admitting, Discharging, and Transferring Residents
Follow the policies and procedures of your facility, as variations exist in methods, roles and responsibilities.
Request and follow instructions from charge nurse.
Set aside adequate time for the procedure and have the room and needed supplies available.
Transport the resident following facility policy.
Use effective Communication and Interpersonal Skills
Provide person-centered assistance and support to reduce the resident’s stress and anxiety. Even under the best circumstances, these procedures represent changes that may result in increased stress and anxiety for the resident.
Take baseline vitals signs, Height and Weight following facility policy
Care for the resident’s valuables and personal belongings following facility policy.
For a newly admitted resident, make the resident feel welcome and ask how the resident prefers to be addressed.
Minimum Data Set
The MDS is a document that new residents arrive with detailing minimum information to the new facility while waiting for the patients complete chart. In the MSD there is basic information like:
Pts name and DOB
Pts insurance information
Pts emergency contact
Pts Primary Doctor
Diet Restrictions
Medication list
Vital signs
measurements that show how well the vital organs of the body are working; consist of body temperature, pulse, respirations, blood pressure, and level of pain.
Monitor, document, and report on the following vital signs:
Temperature
Pulse
Rate of respirations
Blood pressure
REMEMBER:
Always protect residents’ privacy when taking vital signs.
Notify the nurse in any of these cases:
Resident has a fever
Respiratory or pulse rate is too rapid or slow
Blood pressure changes
Pain is worsening or unrelieved
Average Pulse: 60-100 beats per minute
Average Respirations: 12-20 respirations per minute
Average Blood Pressure:
Systolic 100-119
Diastolic 60-79
Monitoring body temperature:
Age, illness, stress, environment, all affect temperature.
There are 4 sites for measuring (mouth(oral), rectum, armpit(axillary), ear(tympanic).
Oral temperatures cannot be taken on someone who is unconscious, has recently had facial or oral surgery, younger than 5 years old, is confused or likely to have a seizure, using oxygen, has a nasogastric tube, or has an injury to the face
Rectal temperatures are most accurate, but taking rectal temperature can be dangerous with some residents.
Tympanic temperature:
Tympanic thermometers are fast and accurate.
The tympanic thermometer will only go into the ear 1/4 - 1/2 inch.
Radial pulse
the pulse located on the inside of the wrist, where the radial artery runs just beneath the skin. *Most common site for pulse to be observed.
Brachial pulse
the pulse inside the elbow, about 1 to 1 1/2 inches above the elbow.
Remember these things about monitoring pulse:
Pulse is the number of heartbeats per minute.
Normal rate is 60-100 beats per minute for adults.
Rapid pulse may result from fever, infection, or heart failure.
Slow/weak pulse may indicate dehydration, infection, or shock.
Remember these things about counting respirations:
A breath includes both inspiration and expiration.
Normal adult rate is 12-20 breaths per minute.
Do not let the resident know you are counting breaths.
Residents may breathe more rapidly if they are aware they’re being monitored.
Blood Pressure
Systolic
first measurement of blood pressure; phase when the heart is at work, contracting and pushing the blood from the left ventricle of the heart.
Diastolic
second measurement of blood pressure; phase when the heart relaxes or rests.
Hypertension
High blood pressure
Hypotension
low blood pressure
Correct way to write blood pressure reading
systolic/diastolic
REMEMBER:
It is not always easy to perfect the skill of hearing the first and last sounds of the blood pressure.
You may have to do the procedure over and over again before you are comfortable with it.
Remember the following about pain management:
Pain is as important to monitor as vital signs.
Take complaints of pain seriously.
Changing position will often reduce pain
Observe and report these signs and symptoms of pain:
Increased pulse, respirations, and blood pressure
Tightening the jaw
Squeezing eyes shut
Holding a body part tightly
Grinding teeth
Difficulty moving or walking
Review the following points about weight
Resident will be weighed repeatedly during his or her stay, and any change in weight should be reported immediately.
Some residents will be weighed on a wheelchair scale. The weight of the wheelchair may need to be subtracted from a resident’s weight.
Residents may need to be weighed on a bed scale.
PROMOTING A RESTRAINT-PROPER ENVIRONMENT
OBRA defines “physical restraints” as any method or equipment used on or near the resident’s body that the resident cannot remove easily and which restricts freedom of movement or normal access to one’s body.
OBRA states that residents have the right to be free from restraints which are unnecessary, inappropriate or not required to treat the resident’s medical symptoms.
REQUIREMENTS FOR USING RESTRAINTS
Restraints require written doctor’s order and consent that specifies the reason for the restraint.
Restraints may be used only to treat or protect the resident, not for discipline or staff convenience.
The least restrictive type of restraint must be used for the least amount of time.
All person-centered approaches must be attempted/implemented prior to the use of restraints, except in the case of emergency restraints.
Restraints must be used only as a last resort when all other methods have failed.
DANGERS OF USING RESTRAINTS
Physical effects such as skin damage, circulatory impairment, incontinence, nerve/muscle injury, pneumonia, serious injury and death.
Emotional effects such as depression, frustration, anger, agitation, disorientation and loss of self-esteem.
ROLE OF THE NURSE AIDE IN AVOIDING THE NEED FOR RESTRAINTS
The resident must be checked at least every 15 minutes.
At regular intervals the following must be done:
Release the restraint or discontinue use.
Offer assistance with toileting.
Check for episodes of incontinence and provide care.
Offer fluids.
Check skin for irritation
Check for swelling.
Restraint-free
the state of being free of restraints and not using restraints for any reason.
Restraint alternatives
any intervention used in place of a restraint or that reduces the need for a restraint.
Specimen Collection
Specimen
a sample
Mid-stream specimen (Clean Catch)
a type of urine specimen in which the first and last urine are not included in the sample.
When collecting specimens:
NA’s must wear gloves for these procedures.
Tagging and storing specimens correctly is important.
Be sensitive to the fact that residents may find it embarrassing or uncomfortable to have others handling their body wastes.
Remain professional.
Catheter
a thin tube inserted into the body used to drain or inject fluids.
Straight catheter
a catheter that does not remain inside the person; it is removed immediately after urine is drained.
Indwelling catheter
a catheter that remains inside the bladder for a period of time; the urine drains into a bag
REMEMBER:
NA’s never insert, irrigate, or remove catheters.
Remember these guidelines for catheter care:
Keep drainage bag lower than the resident’s hips or bladder to prevent infection.
Keep the drainage bag off the floor.
Prevent kinks and twists in tubing.
Observe and report when providing catheter care:
Bloody urine
Catheter bag does not fill after several hours
Catheter is not in place
Remember these guidelines for oxygen safety:
Remove fire hazards.
Post “No Smoking” and “Oxygen in Use” signs. Do not allow smoking around oxygen equipment.
Do not allow flames around oxygen (this includes candles).
Learn how to turn oxygen off, in case of fire, if facility allows this.
Never adjust oxygen level.
Report skin irritation.
Remember your role in caring for a resident with an IV:
NA’s never insert or remove IV lines.
NA’s do not care for the IV site.
NA’s only observe the site for changes or problems
Needle falls out
Tubing disconnects
Blood is in tubing
Site is swollen or discolored
Resident complains of pain
IV bag breaks or fluid level does not decrease
IV fluid not dripping
Pump beeps
Do not get an IV site wet or lower the bag below the IV site.
Certain items may not be placed on an overbed table:
Soiled items
Bedpans
Urinals
Remember the following about call lights:
They must always be placed within residents’ reach.
They must be answered immediately
REMEMBER:
Privacy curtains promote residents’ privacy. They should be used every time care is performed.
Privacy curtains do no block sound, so keep voices low during conversations and care.
Watch for these things when a resident is not sleeping well:
Sleeping too much during the day
Consuming too much caffeine
Dressing in night clothes during the day
Refusing medication ordered for sleep
Taking new medications
Pain
Wound Dressings:
NA’s do not change sterile dressings, which cover open or draining wounds.
Non-sterile dressings are for wounds that have less chance of infection.
NA’s may assist with non-sterile dressing changes.
Remember these points:
Non-sterile bandages hold dressings in place, secure splints, and support and protect body parts. They may decrease swelling from an injury.
Some states allow NA’s to apply and remove elastic bandages. Follow your facility’s policy.
Remember these guidelines for elastic bandages:
Apply snugly enough to control bleeding but make sure not to wrap too tightly, as this can decrease circulation.
Do not tie the bandage; use special clips
Guidelines for elastic bandages:
Check bandage often to be sure it doesn’t become wrinkled or loose.
15 minutes after bandage is applied check for signs of poor circulation; loosen if any of these signs are present:
