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Special Care Skills
Define the following term:
Subacute care
care given in a hospital or in a long-term care facility for
people who have had an acute injury or illness or problem
resulting from a disease.
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Special Care Skills
1. Understand the types of residents who are in a subacute
setting
The following residents may be found in subacute units:
• Residents who need more treatment, monitoring and services
than other residents
• Residents having recent surgery and chronic illnesses, such as
AIDS
• Residents requiring complex wound care, dialysis or a
mechanical ventilator
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Special Care Skills
Define the following term:
Anesthesia
the use of medication to block pain during surgery and other
medical procedures.
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Special Care Skills
2. Discuss reasons for and types of surgery
Note the following reasons for surgery:
• Relieve symptoms of a disease
• Repair or remove problem tissues or structures
• Improve appearance or correct function of damaged tissues
• Diagnose disease
• Cure disease
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Special Care Skills
2. Discuss reasons for and types of surgery
The following are three categories of surgery and examples of
each:
• Elective surgery (e.g. facelift)
• Urgent surgery (e.g. coronary artery bypass surgery)
• Emergency surgery (e.g. repairing damage from a gunshot
wound)
There are three levels of anesthesia: local, regional, and general.
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Special Care Skills
Define the following term:
Preoperative
before surgery.
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Special Care Skills
3. Discuss preoperative care
Remember the following information about preoperative care:
• Includes both physical and psychological preparation
• Doctor will explain the procedure.
• Patient can ask questions, give opinions, and must give
consent for surgery.
• Patient often experiences anxiety, fear, worry, sadness and
other emotions.
• NA can listen to residents’ concerns, report
concerns/questions to nurse.
22 Special Care Skills
Transparency 22-1: Guidelines for Preoperative Care
• Follow NPO (nothing by mouth) order by removing water
pitcher, glass, and any food or fluids from the immediate
area. Explain to the resident why you are doing this.
• Assist resident to urinate before surgery.
• Enema or suppository may be ordered to clear the bowels.
Assist as trained, ordered, and allowed. Provide privacy.
• Assist with bathing as needed.
• Make sure call light is within reach every time you leave the
room.
22 Special Care Skills
Transparency 22-1: Guidelines for Preoperative Care (cont’d.)
• Measure and record vital signs as ordered.
• Remove and store dentures, glasses, contact lenses,
hearing aids, jewelry, hairpieces, hairpins and any other
personal items. (For local or regional anesthetic, hearing
aids and dentures may be needed for better
communication.)
• Assist resident to change into gown if required.
• Transfer to gurney/stretcher if necessary.
• Make sure identification bracelet is accurate prior to
transport.
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Special Care Skills
Define the following term:
Postoperative
after surgery.
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Special Care Skills
4. Describe postoperative care
Remember the following about postoperative care:
• Goal is to prevent infections, promote healing, return person
to state of health.
• Immediate concerns:
• Problems with breathing
• Mental status
• Pain
• Wound healing
• Complications can include urinary retention or infections,
constipation, BP variances, and blood clots.
• Careful monitoring is critical.
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Special Care Skills
4. Describe postoperative care
The following equipment may be needed for postoperative care:
• Bed protector
• Towels and washcloths
• Vital signs equipment
• Emesis basin
• Pillow and other positioning devices
• Warming blankets
• IV pole
• Oxygen and suction equipment
22 Special Care Skills
Transparency 22-2: Guidelines for Postoperative Care
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Move furniture as needed to allow room for the stretcher.
Assist with transferring resident back into bed (see Chapter 10).
Return personal items to resident.
Measure and record vital signs as directed.
Reposition resident every hour to two hours, or as ordered.
Elevate extremities as ordered.
Assist with deep breathing and coughing exercises.
Apply anti-embolic hose if ordered. Assist with leg exercises.
Apply binders as ordered.
Encourage proper nutrition and fluid intake.
Assist with elimination.
Help with bathing and grooming.
Assist with ambulation as needed/ordered. Be encouraging and
positive.
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Special Care Skills
4. Describe postoperative care
Observe and report these signs and symptoms of complications
when providing postoperative care:
• Changes in vital signs
• Difficulty breathing
• Mental changes (e.g. confusion, disorientation)
• Changes in consciousness
• Pale or bluish skin
• Cold or clammy skin
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Special Care Skills
4. Describe postoperative care
Signs and symptoms of postoperative complications (cont’d.):
• Increased drainage
• Swelling at IV site
• IV not dripping
• Nausea or vomiting
• Numbness or tingling
• Resident complaints of pain
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Special Care Skills
Define the following term:
Pulse oximeter
a device that measures a person’s blood oxygen level and
pulse rate.
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Special Care Skills
5. List care guidelines for pulse oximetry
Remember these points about the pulse oximeter:
• Warns if blood oxygen level is less than optimal
• Normal blood oxygen is between 95% and 100%, but it can
differ.
• Report any increase/decrease in oxygen levels to nurse.
22 Special Care Skills
Transparency 22-3: Guidelines for Pulse Oximeter
• Report to the nurse immediately if alarm sounds.
• Tell the nurse if pulse oximeter falls off or resident requests
you remove it.
• Check the skin around device often. Report any of the
following:
• Swelling
• Bluish, or cyanotic, skin
• Shiny, tight skin
• Skin that is cold to the touch
• Sores, redness or irritation
• Numbness or tingling
• Pain or discomfort
• Check vital signs as ordered and report changes to the
nurse.
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Special Care Skills
Define the following term:
Telemetry
the application of a cardiac monitoring device that sends
information about the heart’s rhythm and rate to a
monitoring station.
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Special Care Skills
6. Describe telemetry and list care guidelines
REMEMBER:
Telemetry data is monitored and assessed at all times by
specially trained staff.
22 Special Care Skills
Transparency 22-4: Guidelines for Telemetry
• Report to nurse if the pads become wet or soiled, or if they
are loose or fall off.
• Report if alarm sounds.
• Check the skin around the pads often and report the
following:
• Swelling
• Sores, redness, irritation
• Fluid or blood draining from skin
• Broken skin
• Report resident complaints of chest pain or discomfort,
difficulty breathing
• Check vital signs as ordered, reporting changes to nurse.
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Special Care Skills
Define the following terms:
Artificial airway
any plastic, metal, or rubber device inserted into the
respiratory tract to maintain or promote breathing.
Intubation
the passage of a plastic tube through the mouth, nose, or
opening in the neck and into the trachea.
Tracheostomy
a surgically-created opening through the neck into the
trachea.
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Special Care Skills
7. Explain artificial airways and list care guidelines
REMEMBER:
Artificial airways are necessary when the natural airway is
obstructed to to illness, injury, secretions, or aspiration.
22 Special Care Skills
Transparency 22-5: Guidelines for Artificial Airways
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Observe resident closely. Tell nurse if tubing falls out.
Check vital signs as ordered. Report changes to the nurse.
Perform oral care often, as directed.
Watch for biting and tugging on tube. Tell the nurse if
resident is doing this.
• Use other methods of communication if person cannot
speak.
• Be supportive and reassuring.
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Special Care Skills
8. Discuss care for a resident with a tracheostomy
Tracheostomies may be necessary due to
• Tumors/cancer
• Infection
• Severe neck or mouth injuries
• Facial surgery and facial burns
• Long-term unconsciousness or coma
• Airway obstruction
• Paralysis of muscles relating to breathing
• Aspiration related to muscle or sensory problems in throat
• Severe allergic reaction
• Gunshot wound
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Special Care Skills
8. Discuss care for a resident with a tracheostomy
Review the following points about tracheostomies:
• Be supportive and responsive.
• Resident may be unable to speak. Use other methods of
communication.
• Answer call lights promptly.
• NA responsibilities will mostly include observing and reporting.
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Special Care Skills
8. Discuss care for a resident with a tracheostomy
Observe and report the following:
• Shortness of breath
• Trouble breathing
• Gurgling sounds
• Signs of skin breakdown
• Type and amount of discharge coughed up through
tracheostomy
• Any increase in discharge
• Thick, yellow, green, or bloody discharge, or discharge with
an odor
• Mouth sores or discomfort
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Special Care Skills
8. Discuss care for a resident with a tracheostomy
REMEMBER:
It is very important to prevent infection when caring for residents
with tracheostomies. Wash hands often, wear gloves when
indicated, and keep equipment clean.
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Special Care Skills
Define the following terms:
Mechanical ventilation
the use of a machine to assist with or replace breathing
(inflate and deflate the lungs) when a person is unable to do
this on his own.
Sedative
an agent or drug that helps calm and soothe a person and
may cause sleep.
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Special Care Skills
9. List care Guidelines for residents requiring mechanical
ventilation
Remember these points about mechanical ventilators:
• May be required due to cardiac or respiratory arrest, lung
injuries or diseases, or head and spinal cord injuries.
• Resident will not be able to speak, which can greatly increase
anxiety.
• Being on a ventilator has been compared to breathing through
a straw.
• Be supportive. Enter the room so the resident can see you
often.
• Use other methods of communication.
• Act and speak as if resident can understand everything even if
he or she is unconscious or heavily sedated.
22 Special Care Skills
Transparency 22-6: Guidelines for Mechanical Ventilation
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Wash hands often.
Tell nurse right away if alarm sounds.
Report disconnected or loose tubing right away.
Answer call lights promptly.
Follow care plan for repositioning instructions. Give careful
skin care, and report any of the following:
• Swelling
• Sores, redness, irritation
• Fluid or blood draining from skin
• Broken skin
• Report if resident is pulling on or biting tube. Report
resident anxiety, fear, distress.
• Be patient during communication.
• Check on resident often so resident can see you. Be
supportive.
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Special Care Skills
10. Describe suctioning and list signs of respiratory distress
Remember these points about suctioning:
• Necessary when a person has collected secretions in upper
respiratory system.
• Suction comes from a pump and bottle or canister collects
suctioned material.
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Special Care Skills
10. Describe suctioning and list signs of respiratory distress
Signs of respiratory distress include the following:
• Gurgling
• Difficulty breathing
• Elevated respiratory rate
• Pale or bluish skin
• Nostrils flaring
• Chest retracting (sinking in below the neck with each breath)
• Sweating
• Wheezing
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Transparency 22-7: Guidelines for Suctioning
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Report signs of respiratory distress immediately.
Monitor vital signs closely, especially respiratory rate.
Follow standard precautions.
Assist nurse as needed. You may be asked to have a towel
or washcloth ready for resident after suctioning. Perform
oral care as ordered.
• Report resident complaints of pain or difficulty breathing.
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Special Care Skills
Define the following term:
Chest tubes
hollow drainage tubes that are inserted into the chest to drain
air, blood, or fluid that has collected inside the pleural cavity
or space.
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Special Care Skills
11. Describe chest tubes and explain related care
Remember these points about chest tubes:
• Can be inserted at bedside or during surgery
• Drain air, blood, or fluid
• Allow a full expansion of the lungs
• Conditions requiring chest tubes include pneumothorax,
hemothorax, empyema, surgery, and injuries.
• Chest tube is connected to bottle of sterile water.
• System must be airtight when attached to suction.
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Transparency 22-8: Guidelines for Chest Tubes
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Be aware of where chest tubes are.
Check vital signs as directed and report changes.
Report signs of respiratory distress and pain.
Keep drainage system below level of chest.
Keep drainage containers upright and level.
Make sure tubing is not kinked.
Report disconnected tubing.
Do not remove equipment in the area.
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Transparency 22-8: Guidelines for Chest Tubes (cont’d.)
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Observe chest drainage for amount and color.
Report if there is increase or decrease in bubbling.
Report clots in tubing.
Be gentle and careful with repositioning.
Report odor.
Provide rest periods.
Measure I&O carefully.
Encourage deep breathing exercises.
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Special Care Skills
11. Describe chest tubes and explain related care
REMEMBER:
Other residents who require more direct care and observation
include those with IVs and those with tube feedings.