NAC Skills

Locked

Wash Hands

Intro- clinets name and your name

turn on water

wets hands and wrists

lathers all surfaces of hands wrists and finger for 30 seconds,

hands lower than elbow, fingertips down,

clean fingernails with palm rubbing

rinse with hands lower than elbow fingertips down, wrists hands and finger

dry starting at fingertips and working down

use dry paper towel to turn off faucet

gait belt

need: gait belt

explain procedure and introduce self if not done before

pull curtain

help up to edge and say scoot to edge

bed is locked bed is at safe level, shoes are on, feet are flat on floor

ask to point to belly button

put gait belt on over belly button and make sure you pull the gown over them as much as possible

help them get up

check and tighten belt

walk behind and to side with hand pointed up

turn so you go backwards

help them sit back feeling back of bed with legs

remove belt

signal device

wash hands

gait belt wheelchair

need gait belt and wheel chair

explain

pull curtain

position wc alongside bed with locked and footrest removed or folded

assisted to edge with feet flat on floor, bed is locked and safe level, shoes on

ask to see belly button

puts gait belt over belly button

cover gown in back

push with hands and help up,

move to wheel chair and back of legs are touching it

remove gait belt

hips touch back of wheel chair

place feet on footrests

signaling device

wash hands

skill complete

denture cleaning

need: gloves paper towel and denture kit thing

put on gloves

place paper towel on bottom of sink and counter

rinse cup inside and out, and cup lid

fill cup with water that has both hat and cold watter

rinse denture on all sides

clean denture with toothpaste

rinse all sides

places denture in cup and lid back in cup, rinse toothbrush, place back in basin

remove paper towels in sink and counter

remove gloves

wash hands

skill complete

pulse

need: pen paper and watch

explain procedure

keep device within reach

find pulse

start 60s

stop

wash hands

write down

skill complete

respirations

need: pen paper and watch

for testing purposes count respirations

signal device within reach

say start, count respirations

wash hands

write down

skill complete

PPE

need ppe and gloves

put arms on

tie neck opening

tie back, making sure as much is covered as possible

put on gloves which overlap sleeves

remove gloves and dispose

hands inside of cuff and cross arms pinch and 1 roll

place away

and wash hands skill complete

shirt

need 2 shirts

explain procedure

pull curtain

adjust height of bed

ask for which shirt

removes gown from left then right

gown into soiled container

places shirt on right arm first, and then places it over the covers before doing left

pull sheet while they hold onto shirt

signal wash hands skill complete

blood pressure

need wipes stethoscope bp cuff, pen paper,

explain procedure

clean stethoscope ends

test and place on neck

show arm with palm up

feel for artery

place cuff on arm and put on stethoscope

measure bp and and remove cuff

place signal device

wash hands

write down

skill complete

urinary output

need gloves, pen paper, and graduate

put on gloves

pour bedpan into graduate

rinse bedpan and pours rinse into toilet

measure urine

empty graduate into commode

rinse graduate into commode

remove gloves

wash hands

record contents

skill complete

weight

need pen paper

explain procedure, help client up

put on shoes

set scale to zero

clinet steps on and get weight

ask clinet to step off

wash hands

record weight

prom leg

explain thing

pull curtain

adjust height

lmk if you have pain

support leg under knee and ankle

bend knee 3 times

support foot and ankle

pushes and pulls foot 3 times

place signal device and lower bed

wash hands

prom shoulder

explain

pull curtain

adjust height and head of bed

lmk if you have pain

support wrist and elbow and raise arm to ear level 3x

and then move arm to shoulder level 3x

signal device

wash hands

side

need 4 pillows total

explain

curtain

adjust height and lower head if needed

uncover

roll on side w one hand

adjust head pillow

fold pillow in half and behind back

lift leg and place pillow underneath

place pillow under arm

move client so not on shoulder

lower bed

signal

wash hands

foot care

need basin gloves soap lotion 2 wash cloths 1 hand towel 1 bath towel

explain procedure

pull curtain

adjust height of bed

fill basin and check temp

place basin over towel and put on gloves

foot in water and put soap on wet cloth and wash (toes) , then dispose,

rinse with new cloth (toes) and then dispose

put basin on table

new cloth dry (toes) then dispose

applies lotion and wipe off excess no lotion in toes

support foot and ankle

empty rinse and dry basin

remove gloves

wash hands

signal device

wash hands skill complete

mouth care

need gloves, emesis basin, tooth paste, tooth brush cup of water paper towel 1 towel

explain

pull curtain

adjust bed and have them sit on edge

put on gloves

towel across chest

moiten toothbrush

applies toothpase

clean all teeth and tounge

hold emesis and give water to client to spit into basin

wipe mouth with towel and remove towel

take all things and dispose of linen at sink

empty rinse and dry basin

take off gloves and wash hands

lower bed and signal

wash hands skill complete

Sock

Needs: sock

explain

pull curtain

raise height

supine

turn inside out at least to heel

places foot over toes foot and heel before pulling up

pulls sock over leg

no twists or wrinkles and open of toe is over or under toe area

signal

lower bed

wash hands

bedpan

Needs: toilet paper, wipes, bed pan, 2 pairs of gloves

explain

pull curtain

adjust height of bed

hed of bed is flat

put on clean gloves and ask to lift hips

places bedpan under clients buttocks (seat part under butt)

remove gloves

wash hands

raise head of bed

lower bed give signal with toilet and hand wipe in reach

clean hands with wipe when finished

ask to signal when done

raise bed

put on clean gloves

lower head of bed

remove bedpan

explty bedpain in toilet

rinse and pour rinse in toilet

place bedpan in dirty supply area

remove gloves

wash hands

give signal device

lower bed

skill complete

feeding

needs : tray wipes napkin from tray

do not ask for name

asks for name

get them upright

places tray

sit in chair facing client

wipes hands before feeding

tells what is on tray

what would you like to eat first

using spoon offer bite of each saying what is on each’s poon

offer drink at least once and you hold water

are you ready for next bite of food/ drink

at end wipe mouth with napkin

cleans hands with wipes

removes tray with wipes

leave sitting up with signal

wash hands skill complete

bed bath

needs: gloves, bath basin, soap, clean gown, hand towel, bath towel, 3 wash cloths

explain procedure

pull curtain

adjust bed

remove gown

checks temperature of water

ask to verify water temp

put on clean gloves

wet washcloth wash eyes inner to outer with different part for each stroke

then wash face and nose

dry face

expose one arm

towlen underneath arm

soap to wet washcloth

wash fingers and finger nails, hand, arm, underarm

rinses fingers and finger nails, hand, arm, underarm

dry fingers and finger nails, hand, arm, underarm

put on clean gown

empty rinse and dry basin

place in dirty supply

remove gloves

signal

lower bed

wash hands

catheter care

needs

gloves, soap, basin, towel, 3 small wash cloths

explain procedure

signal

pull curtain

adjust height of bed

get water and verify temperature

put on clean gloves before washing

linnen protector underneath butt

expose catheter

soap to wet washcloth

honding cather at meatus rest hand on pubic bone

without tugging

moving away from meatus

1 stoke only with new area per stroke if mulitple

rinse in same way

dry in same way

dispose of linen

empty rinse and dry basin

remove gloves

wash hands

signal skill complete

peri care

needs: gloves, basin, soap, 6 wc, towel

explain

privacy

adjust height of bed

check temperature

put on clean gloves

place linen protector under butt

soap on wet washcloth

wash genital from front to back (towards butthole)

1 stoke

rinse with wet washcloth

dry with wet washcloth

turn on side

wash rectal area front to back with soap

rinse with new washcloth

dry with washcloth

empty rinse and dry basin

remove glvoes

dispose of linnel

wash hands

lower bed

signal skill complete