Nurse Assisting
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Chapter 21 Expanded Skills

Click on the skills to review expanded skills discussed in this chapter.

Starting-Up Steps

  1. Knock before entering, identify the client, and introduce yourself.
  2. Complete hand hygiene.
  3. Provide for privacy.
  4. Explain to the client what you will be doing before you start doing it.
  5. Assemble your supplies.
  6. Ensure that the bed is at a good working height and is locked; or, if the bed is not in use, you are in an ergonomically correct position to assist the client.

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Measuring Oral Intake

When: When a client is placed on intake and output.

Why: To help assess the client’s fluid balance.

What: Supplies needed for this skill include

  • Note pad and pen

How:

  1. Complete your starting-up steps.
  2. Assist the client as needed with fluid intake.
  3. Calculate how many milliliters (mLs) of fluid the client takes in by mouth through your shift. Keep a running total of how many mLs have been consumed based on the fluid container size.
  4. Include items that are fluid at room temperature such as ice cream and popsicles. Include all fluids from meals, snacks and bedside fluids.
  5. At the completion of the shift add up the total of all fluid intake and document the results per facility policy.
  6. Complete your finishing-up steps.

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Assisting the Client Who Can Feed Self and Verifying Diet Tray

When: A client who can feed herself will still need to be served the meal and assisted with any special needs that may arise.

Why: ​Verifying the correct diet tray is imperative to proper nutrition and following the client’s care plan.

What: ​Supplies needed for this skill include:

  • Any adaptive equipment as indicated on the care plan
  • Washcloth or disposable wipes

How:

  1. Complete your starting-up steps.
  2. Ensure the client has washed their hands. If not, offer a washcloth or disposable wipe for them to do so.
  3. Verify the client has been given the right tray and verify the client’s diet and that the meal complies with the specified diet as indicated on the care plan.
  4. Ensure any assistive feeding devices are available to the client as indicated on the care plan.
  5. Ask the client if they would like a clothing protector and if so provide that.
  6. Offer assistance as needed to open fluid containers, season or cut up any food items as requested by the client. Be available to the client throughout the meal should any needs arise.
  7. Calculate the food and fluid intake as per the facility policy once the client has completed the meal.
  8. Complete your finishing-up steps.

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Finishing-Up Steps

  1. Ensure that all of the client’s needs have been met and that the client is positioned as desired.
  2. See to safety. Replace any alarms or positioning devices, as indicated on the care plan or individual service plan. The bed is in the low position and is locked.
  3. Place the call light within easy reach.
  4. Clean and replace equipment, and return supplies to the designated place in the client’s room or facility storage area.
  5. Leave the room clean and in order. Ensure that the bed is made. Remove trash and dirty linens from the room.
  6. Complete hand hygiene.
  7. Report and document, as required by your facility.

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