In the following chapter, we will explore basic concepts related to patient care. You will learn about the use of specific equipment, including feeding tubes, peripheral IVs, mechanical lifts, and sequential compression boots. The chapter concludes with a five question self-assessment drill.

GENERAL PATIENT CARE

Provide Basic Patient Care Under the Direction of Nursing Staff

The certified patient care technician (CPCT) is responsible for performing tasks assigned By the nursing staff. Tasks can include bathing patients, bed making, room preparation and cleaning and assisting patients with activities of daily living (ADLs). The CPCT is also responsible for obtaining vital signs, transferring a patient from a bed to a wheelchair or other assistive device, and reporting changes in the patient's condition to the nursing staff.

Assisting with ADLs

Patients admitted to the hospital often require assistance when performing tasks they would normally do on their own-such as eating, getting dressed, bathing, going to the bathroom, and ambulating. It is important for the CPCT to enable patients to do as much of their own care as possible and to offer assistance when needed. The CPCT must ensure patient safety at all times and work with the patient and family to determine the appropriate level of assistance needed to complete each ADL.  For example, patients sometimes require no assistance brushing their teeth, but need assistance ambulating to

and from the bathroom.

Bathing

Bathing is essential for maintaining personal hygiene and ensuring patient comfort. The CPCT is responsible for gathering the supplies necessary for bathing and for delivering the supplies to the patient's room. Supplies needed for bathing include a water basin, bath blanket, bath towels, washcloths, soap, gown, clean bed linen, bedpan or urinal, and a laundry bag.

While the patient is bathing, it is important for the CPCT to assess the condition of the patient's skin and take note of any rashes, cuts, open sores, and pressure ulcers. The CPCT should also note any range-of-motion difficulty reported by the patient. The CPCT should also evaluate the patient's ability to tolerate the activity. Any changes in skin condition, range of motion, and activity tolerance should be reported to the nursing staff

immediately.

Remember to empower the patient by allowing him or her to complete as much of the bathing and dressing as possible. Offer assistance with any tasks he or she cannot perform. This promotes patient independence and ensures a more enjoyable hospital stay.

Bathing Procedure

When bathing patients, the CPCT must consider the following:

• Water temperature- The bath water should not exceed 105°F (41°C). Water that is too hot or cold can be uncomfortable for the patient and can cause injury.  Always ask the patient to feel the water and to determine if the temperature is appropriate.

• Privacy - The CPCT must ensure patient privacy at all times. Close the door to the patient's room when the patient is bathing. If the patient is sharing a room with another person, ensure that curtains are closed and that no one can see into the patient care area. Use a bath blanket to keep the patient covered.

• Body mechanics - Adjust the bed's height to a comfortable working position. This can prevent back strains.

• Safety devices - Always keep the bed rails up to prevent falls. Ensure bed sheets are stretched tightly over the mattress and eliminate bunching of linens under the patient. Use moisture barriers where appropriate and follow the facility's guidelines for applying lotion or powder after bathing.

• Patient position - Patients should be repositioned after bathing and again every 2 hours (unless specified by a provider). Repositioning has been shown to reduce the risk for developing skin breakdown and pressure sores. If the patient has the ability to reposition himself, encourage him to change positions periodically.

The CPCT should take note of the patient's overall ability to bathe. The CPCT should look for the following signs: shortness of breath, increased pain, reduced range of motion, inability to stand, and the inability to follow instructions. The CPCT should report these to the nursing staff immediately. The CPCT should also report any changes in the patient's skin condition.

Bed Making

The CPCT should gather all of the necessary equipment for bed making prior to entering the patient's room, in order to care for the patient more efficiently. Items include a fitted sheet, a flat sheet, pillowcases, draw sheet, absorbent pad, blankets, and a linen bag. 

The patient's bed should be raised to a comfortable working height for the CPCT. Follow the facility's policies for making the bed, replacing linens, and disposing of soiled items.

As previously mentioned, it is important to ensure that linens are tightly pulled across the mattress. Bunched materials can create pressure points and promote skin breakdown and ulcer formation. Follow manufacturer recommendations when changing linens on specialty mattresses.

The CPCT will often have to replace linens while the patient is in the bed. Prior to changing the linens, be sure to complete any tasks that could soil the sheets. For example, bathe the patient and then change the sheets. The easiest method for changing linens while the patient remains in the bed is to:

1. Roll the patient to one side of the bed

2. Change the sheets on the unoccupied side

3. Roll the patient to the fresh side

4. Complete the linen change

Always ensure the bed rails are up and locked to prevent falls and injury to the patient.