Basic Care and Comfort

Communication and Sensory Impairments

• Be aware of communication issues such as hearing and vision problems in patients.

• Assisted Devices:

• Examples include eyeglasses, hearing aids, prosthetics, and mobility aids (e.g. walkers, canes, crutches).

• Sizing Walkers:

  • Stand patient up and size to their wrist.

  • Walkers are not for standing support.

• Cane Usage:

  • Canes should be used on the strong side (non-affected side).

• Crutch Measurement:

  • Fit crutches so that the axilla is 1-2 inches below the top.

  • Hands should bear weight, not under the armpit.

Sensory Impairments and Mobility:

• Address bowel and bladder elimination, including urine output measurement from catheters (which should be documented and checked at shift change).

• Familiarity with urinary devices and procedures (e.g., Foley catheters, PureWick, in-and-out catheters).

• Irrigations:

• Use copious amounts of normal saline for ear and wound irrigations.

• Promote patient mobility to reduce complications such as DVT, renal stones, skin breakdown.

Skin Integrity and Immobility Complications:

• Monitor for changes in consciousness, gas exchange, and appetite.

• Use sequential compression devices (SCDs) to support venous return and reduce blood clot risk.

• Understand the importance of regular repositioning every 2-3 hours to prevent pressure ulcers.

Nutrition and Diet:

• Assess nutritional needs, especially in those with chewing or swallowing difficulties.

• Recognize dietary plans related to patients’ conditions (diabetes, heart diseases, etc.).

• Be aware of foods high in potassium and the importance of protein intake post-surgery.

Patient Education:

• Provide education on ADLs and necessary assistive devices for independence in daily living.

• Post-mortem care: remove equipment only after legal clearance and delegate responsibilities appropriately.

Pain Management:

• Recognize different pain types (acute, chronic, phantom pain) and appropriate interventions.

• Be aware of herbal supplements (like garlic and ginseng) and their effects on clotting and medications.

Vital Signs and Monitoring:

• Understand normal ranges and frequency for vital signs in various patient conditions.

• Calculate BMI and the significance of monitoring vital parameters in all patient scenarios.

• Prepare patients for diagnostic tests (e.g., NPO instructions, inform about necessary precautions).

Laboratory Tests:

• Familiarity with lab values for conditions such as Chronic Kidney Disease, including BUN and creatinine levels.

• Understand fluid management through IV and nutritional assessments pre- and post-operative.

Infection Control and Prevention:

• Monitor for signs of infection, especially through drainage devices (JP drains, chest tubes) to ensure proper output.

• Educate on signs of infection and manage wound care for pressure injuries effectively.

Respiratory Care:

• Emphasize the importance of incentive spirometry to prevent atelectasis.

• Know how to assess changes in lung function for intubated patients (e.g. chest rise, secretions).

Cardiac Monitoring:

• Know how to assess cardiac rhythms, and the implications of bradycardia, tachycardia, and arrhythmias.

• Recognize when to use pacing interventions and how to monitor responses.

Hemodialysis and CRRT:

• Understand normal protocols for dialysis procedures and patient education about risks and symptoms to watch for.

• Monitor for fluid overload during the oliguric phase and hydration needs during the diuretic phase.

Professional Practice and Risk Reduction:

• Always look for ways to reduce risks through patient assessments and interventions, ensuring patient safety is a priority.