Home Health Aide Student Portal

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

Opening Procedure

Wash hands

Knock on the door

Introduce yourself

Explain the procedure clearly, using eye contact and ensuring understanding

Provide privacy (if needed)

Ensure bed is at proper height for procedure, bed is locked, and side rail is down for good body mechanics

Use gloves on any procedure that might provide exposure to blood or body fluids

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Using a Fire Extinguisher

When: In case of a fire.

Why: A small fire can become a larger, more dangerous fire quickly. If a small fire can be extinguished using a fire extinguisher, it can save lives.

What: Supplies needed for this skill include

  • Fire extinguisher—ABC preferably

How:

  1. Pull the pin on the fire extinguisher.
  2. Aim the nozzle at the base of the fire.
  3. Squeeze the handle of the extinguisher.
  4. Sweep the nozzle from side to side at the base of the fire until extinguished or until the canister is empty.

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Responding to a Natural Disaster

When: In case of a natural disaster.

Why: To limit injuries and/or casualties due to a natural disaster.

What: Supplies needed for this skill include

  • Blankets
  • Flashlights
  • Emergency radios

How:

  1. Identify that an emergency exists.
  2. Transport the client to the designated safe area of the home. Typically this is a hallway with no windows.
    • Keep bed-bound clients in their beds; move the entire bed to the designated safe area.
  3. Cover clients with blankets to shield them from debris and to keep them warm.
  4. Complete a census of clients to ensure that everyone is accounted for.
  5. Assemble emergency supplies such as radios and flashlights.
  6. Reassure the clients that they are safe and well cared for.
  7. Stay with the clients and meet client needs throughout the event.
  8. Complete any special directives from the nurse.
  9. Once the threat has passed, return the clients to their desired location or activity.

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Responding to a Bomb Threat

When: In case of a bomb threat.

Why: To limit injuries and/or casualties due to a bomb threat.

What: Supplies needed for this skill include

  • Notepad and pen

How:

  1. Identify that the facility is threatened with a bomb.
    • This is usually in the form of a note found or a telephone call received.
  2. If the bomb threat is called in, keep the caller on the line as long as possible to get as much information as possible. Ask the caller the following questions:
    • When is the bomb going to explode?
    • Where is it right now?
    • What does it look like?
    • What kind of bomb is it?
    • What will cause it to explode?
    • Did you place the bomb?
    • Why?
    • What is your address?
    • What is your name?
  3. While on the telephone with the caller, alert someone to call 911.
  4. While on the telephone with the caller, write down the answers to the questions you have asked. Also write down other information such as:
    • If the caller is male or female
    • If there are any sounds in the background
    • If there are any identifying qualities to the person’s voice, such as an accent or a stutter
  5. If a note was found, immediately take the note to the facility management or your supervising nurse.
  6. Follow the directives of the supervising nurse, management staff, and authorities for evacuation. Follow your facility evacuation policy.

Retrieved August 2, 2010, from https://www.fema.gov/hazard/terrorism/exp/exp_threat.shtm

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Using a Blood Spill Kit

Supplies needed for this skill:

  • Gloves
  • Spill kit, which includes:
    • Biohazard bag
    • Absorbent material such as a powder or towel
    • Germicidal wipe or bleach solution spray bottle
    • Tongs or dust pan

How:

  1. Don gloves.
  2. Grasp any sharp material (such as broken glass) with the tongs and place in the biohazard bag.
  3. Place absorbent material on top of the spill. Allow time for it to soak up the blood or bodily fluid.
  4. Remove the towel and place it in biohazard bag. If using an absorbent powder, sweep the contents into a dust pan. Discard the contents in the biohazard bag.
  5. Spray bleach solution on the affected area and clean with a paper towel, or use the germicidal wipe to clean the affected area.
  6. Discard the soiled towel or wipe in the biohazard bag.
  7. Remove gloves and discard in the biohazard bag. Hand wash or hand sanitize as appropriate.
  8. Touching only the outside of the bag, tie the top and place the bag in the biohazard receptacle located in the designated area.
  9. Hand wash or hand sanitize as appropriate.

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Applying Splints

When: Splints are ordered by the provider or therapist to address a mobility concern. Some splints will remain on throughout the day and be removed at night, while some may be worn at all times only to be taken off during caregiving to check skin integrity and perform range of motion exercises.

Why: Splints offer adaptive support to clients who need it.

What: Supplies needed for this skill include:

  • Appropriate splint for the client
  • Towel
  • Washcloths
  • Gentle soap as needed

How:

  1. Complete your opening procedure steps.
  2. Identify the proper splint the client requires by reviewing the care plan. Ensure it is in good repair. If any defects are noted report that to the nurse and do not use.
  3. Wash the area that will make contact with the splint with water or gentle soap and water. This will be indicated on the care plan. If soap is used completely rinse the area.
  4. Completely dry the area that was washed.
  5. Follow the directives found in the care plan on how to properly apply the splint. You may need to complete range of motion exercises on the affected extremity prior to reapplying the splint. Check the care plan for directives.
  6. Look at the client’s skin that will touch the splint. If there are any red or open areas do not reapply the splint. Report this to the nurse for further assessment.
  7. Apply the splint. Ask the client if the fit feels correct. If not, remove the splint and start over.
  8. Complete your closing procedure steps.

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Emptying a Urostomy Bag

When: Empty the urostomy bag when it becomes half full and at the end of each shift.

Why: Urine must be emptied to prevent a back flow of urine into the bladder. The amount must be recorded and documented at the end of each shift.

What: Supplies needed for this skill include:

  • Gloves
  • Graduate or urinal
  • Towel or paper towels
  • Alcohol wipes

How:

  1. Complete your opening procedure steps.
  2. Assist the client to a sitting or high-Fowler’s position.
  3. Don gloves.
  4. Expose the urostomy. Place paper towels or a towel under the urostomy bag and on top of the client’s clothes or bed linens to prevent soiling.
  5. Wipe the drainage port of the urostomy with an alcohol wipe. Discard the wipe into the wastebasket.
  6. Hold the graduate or urinal underneath the urostomy drainage port.
  7. Open the drainage port and allow the all urine to drain completely from the urostomy into the graduate or urinal, making sure that the tip of the drainage port does not touch the inside of the graduate or urinal.
  8. Wipe the drainage port of the urostomy with an alcohol wipe. Discard the wipe into the wastebasket. Close the drainage port.
  9. Remove the paper towels or towel and place directly into the wastebasket or linen bag, as appropriate.
  10. Adjust the client’s clothing as necessary to cover the appliance. Adjust the bed linens as necessary to cover the client. Position the client as desired.
  11. Measure the urine output in the graduate or urinal if the client is on intake and output, as indicated on the care plan.
  12. Empty the contents of the graduate or urinal into the toilet. Rinse the graduate or urinal and empty the contents into the toilet. Repeat as necessary. Dry the graduate or urinal with paper towels and place in the designated storage area in the client’s room.
  13. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  14. Complete your closing procedure steps.
  15. Record the amount of urine if indicated on the care plan.

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Emptying an Ostomy Bag

When: An ostomy bag should be emptied when it is more than half full, or when the client requests.

Why: An ostomy bag is emptied to remove feces from it. The bowel movement must be recorded and documented at the end of each shift.

What: Supplies needed for this skill include

  • Gloves
  • Adult wipes
  • Towel or paper towels
  • Bedpan

How:

  1. Complete your opening procedure steps.
  2. Don gloves.
  3. The client can be lying in bed or in a sitting position, whichever she prefers.
  4. Expose the ostomy.
  5. Keep the following items nearby throughout the procedure: adult wipes, bedpan, and a wastebasket.
  6. Place paper towels or a towel under the ostomy bag and on top of the client’s clothes or bed linens to prevent soiling.
  7. If the bag has a removable clamp on the bottom, first remove the clamp from the bottom of the ostomy bag, empty the contents into the bedpan, clean the bottom of the bag with an adult wipe, and then discard the wipe immediately into the wastebasket. Replace the clamp on the end of the ostomy bag.
  8. Empty the contents of the bedpan into the toilet and rinse it. Cleanse the bedpan with disinfectant or adult wipes per the facility’s policy. Dry the bedpan with paper towels and discard them into the wastebasket. Place the bedpan in the designated storage area in the client’s room.
  9. If the bag does not have a removable clamp on the bottom and the bag is to be reused:
    • First remove the bag from the ostomy appliance, place the bag in the bedpan, and set aside.
    • Clean the skin around the stoma with the adult wipes. Use as many as needed to clean the area. Discard the wipes immediately into the wastebasket.
    • Cover the stoma with an adult wipe before emptying the contents of the bedpan.
    • Empty the contents of the ostomy bag into the toilet, and then rinse the ostomy bag and empty the rinse water into the toilet.
    • Dry the ostomy bag with paper towels. Discard the paper towels into the wastebasket.
  10. Return to the client to reapply the bag to the ostomy appliance, as needed. Remove the adult wipe covering the stoma and discard it into the wastebasket. Once reapplied, remove the paper towels or the towel from under the bag and place in a wastebasket or linen bag, as appropriate.
  11. Remove gloves and discard into the wastebasket. Hand wash or hand sanitize, as appropriate.
  12. Adjust the client’s clothing as necessary to cover the appliance. Adjust the bed linens as necessary to cover the client.
  13. Complete your closing procedure steps.
  14. Record the bowel movement results, if indicated on the care plan.

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Abdominal Thrusts

When: Abdominal thrusts may be used when caring for a client who has a complete airway obstruction.

Why: To assist in removing the object blocking the airway.

How:

  1. Identify that an emergency exists. Call for help.
  2. Ask the client, “Are you choking?” and “Can I help you?”
  3. If the client accepts help, position yourself behind her. Place one foot in between the client’s feet.
  4. Wrap your arms around the client. Locate the umbilicus. If the client is pregnant or obese, position your hands on her sternum.
  5. Form a fist with your dominant hand. Place this hand two finger widths above the umbilicus. Cover your dominant hand with your nondominant hand.
  6. In an inward and upward motion, thrust your fisted hands into the client’s abdomen. If your hands are placed on the sternum, thrust inwardly only.
  7. Continue with abdominal or chest thrusts until the object is removed or the client becomes unconscious.
  8. If the object is removed, update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  9. If the object is not removed and the client becomes unconscious, continue with directives from your supervisor or EMS.
  10. Complete your closing procedure steps.

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Assisting an Unconscious Adult With an Obstructed Airway

When: Assistance may be required when a client has lost consciousness due to a blocked airway.

Why: To assist in removing the object blocking the airway.

How:

  1. Identify that an emergency exists. Call 911.
  2. Assist the client to the floor, and position her on her back.
  3. Kneeling at the side of the client, place one hand in the middle of her sternum. Place your second hand over the first.
  4. With your shoulders directly over your hands, begin chest compressions, pushing straight down approximately 2 inches into the chest.
  5. Continue with chest compressions until the object is removed or until EMS has arrived and proceeds with emergency care of the client.
  6. Complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  7. Complete your closing procedure steps.

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Assisting a Fainting Client

When: Assistance may be needed when a client becomes dizzy or is at risk of fainting.

Why: To limit the risk of injury to the client.

How:

  1. Identify that an emergency exists. Call for help.
  2. If the client is able, assist her to a sitting position, bend forward, and hang her head between her knees.
  3. Alternatively, assist the client to a lying position. Elevate her feet. Loosen any tight clothing.
  4. If she is conscious, assist the client to breathe slowly and deeply.
  5. Note the amount of time that lapses during any unconscious period.
  6. Update the nurse of the event and follow any directives, such as monitoring vital signs or delegated comfort interventions.
  7. Complete your closing procedure steps.

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Assisting a Client During and After a Seizure

When: A client who is experiencing a seizure requires care during and after the seizure.

Why: To limit the risk of injury to the client.

How:

  1. Identify that an emergency exists. Call for help.
  2. Assist the client to a safe place. If the client is sitting or standing when the seizure starts, assist her to the floor. Move furniture and other objects out of the way. If the client is in bed, stay next to her to prevent a fall.
  3. Monitor for an obstructed airway.
  4. Note the start time and end time of the seizure.
  5. After the seizure is over, or if the client vomits during the seizure, place the client in the recovery side-lying position.
  6. After the client regains consciousness, provide supportive measures, which may include
    • providing incontinence care;
    • changing clothing, if soiled;
    • lessening environmental stressors, such as light and sound;
    • assisting to a comfortable position; and
    • promoting comfort and rest.
  7. Update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  8. Complete your closing procedure steps.

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Assisting a Client Who Is Hemorrhaging

When: A client who is bleeding excessively requires assistance.

Why: To limit the amount of blood loss to the client and to prevent shock.

What: Supplies needed for this skill include

  • Bandages or absorbent material
  • Gloves

How:

  1. Identify that an emergency exists. Call 911.
  2. Don gloves.
  3. Assist the client to a lying position.
  4. If they are available, place gauze or bandages on the bleeding wound. If they are not available, use any close-by, clean, absorbent material.
  5. Keep pressure on the bleeding wound. Do not release the pressure.
  6. If the blood soaks through the original bandage or absorbent material, reinforce with additional bandages or materials. Do not remove the original bandage.
  7. While maintaining pressure, using pillows or rolled bed linens, elevate the affected area above the level of the heart, if possible.
  8. If bleeding is excessive and will not slow, place pressure on the involved artery above the wound with one hand, while keeping pressure with the other hand on the covered bleeding wound.
  9. Continue until EMS arrives.
  10. Update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  11. Complete your closing procedure steps.

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Caring for a Client in Shock

When: Care is necessary for a client who is experiencing low blood pressure and a high heart rate due to infection, exposure to an allergen, excessive blood loss, or poor cardiac function.

Why: To reduce the client’s risk of further injury and death.

What: Supplies needed for this skill include

  • Gloves, as necessary
  • Blankets

How:

  1. Identify that an emergency exists. Call 911.
  2. Don gloves if the client is bleeding or vomiting.
  3. Lay the client on her back. If the client is vomiting, place her in the recovery side­lying position.
  4. Using pillows or rolled bed linens, raise the legs at least 1 foot higher than the head. Loosen any restrictive clothing around the waist and neck. Cover the client with blankets to keep her warm.
  5. Monitor vital signs until EMS arrives.
  6. Update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  7. Complete your closing procedure steps.

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Caring for a Client With Second- or Third-Degree Burns

When: Care is necessary for a client who has suffered burns.

Why: To limit the severity of the injuries from the burn.

What: Supplies needed for this skill include

  • Gloves
  • Bandages
  • Sterile water
  • Damp cloths

How:

  1. Identify that an emergency exists. Call 911. Don gloves.
  2. Remove the client from the source of the burn.
  3. If the client’s clothing is on fire, smother the flames with a rug or blanket. Do not remove the client’s clothing.
  4. Cover the burned area with bandages soaked in sterile water or with cool, damp cloths. Elevate the part of the body that was burned, if possible.
  5. Monitor vital signs until EMS arrives.
  6. Update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  7. Complete your closing procedure steps.

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Caring for a Client Who Has Been Poisoned

When: Care is required for a client who has been intentionally or accidentally poisoned.

Why: To reduce the severity of injury after a poisoning has occurred.

What: Supplies for this skill include

  • Safety Data Sheet (SDSs)

How:

  1. Identify that an emergency exists. Call 911.
  2. Don gloves.
  3. Look in the client’s mouth to see if any medication or poison is still present. If so, remove promptly.
  4. Try to determine the poison. If the poison is known, locate the SDS for that chemical.
  5. Contact the poison control center and follow specific directives until EMS arrives.
  6. Monitor vital signs until EMS arrives.
  7. Send the suspected chemical container to the hospital with EMS personnel.
  8. Update the nurse of the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  9. Complete your closing procedure steps.

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Assisting a Falling Client

When: A client may need assistance when falling during ambulating or transferring.

Why: To prevent injury to self and client during a fall.

What: Supplies needed for this skill include

  • A chair or mechanical lift

How:

  1. Recognize that your client is weak or dizzy during ambulation.
  2. Stand behind your client. Place your feet shoulder-width apart, one foot in between the client’s feet. Bend your knees to brace yourself.
  3. If the client has a gait belt around her waist, grasp the gait belt with an underhand grasp with both hands, one hand on each side of the client, just above the hip area. If the client does not have a gait belt on, slide your arms underneath her arms.
  4. Bring the client gently back against your body, sliding her body down your leg to assist her to the floor.
  5. Stepping backward and still bending at the knees, lower the client gently to the floor.
  6. Allow the client to lie in a natural position on the floor. Call for help. Do not reposition the client until the nurse arrives and completes an assessment.
  7. Once the client has been cleared to get off the floor, assist her to use the seat of a chair to help her get to her feet. If the client is unable to assist with getting up off the floor, use a mechanical lift. After assisting the client off the floor, gently place the client into the desired position either in a chair or her bed.
  8. Update the nurse on the event and complete any special directives from the nurse, such as vital signs or delegated comfort interventions.
  9. Complete your closing procedure steps.

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Applying a Warm Compress

When: A warm compress is applied only when you are delegated by the nurse to do so.

Why: Some painful conditions, such as joint stiffness and muscle spasms, can be soothed by warm, moist heat.

What: Supplies needed for this skill:

  • Washcloth
  • Sealable plastic bag, quart or gallon size
  • Towel

How:

  1. Complete your starting-up steps.
  2. Wet the washcloth with warm water.
    • Water is warm to the touch between 95°F and 100°F. Wring excess water out of the washcloth.
  3. Place the wet washcloth in the sealable plastic bag.
  4. Expel excess air out of the bag and seal it. Wrap the bag in a dry towel to protect the client’s skin.
  5. Place the wrapped bag over the affected area. Ask the client to hold it in place. Assist the client if he is unable.
  6. Ask the client if it is comfortable or if the temperature of the compress should be adjusted.
  7. Remove the compress within 10–15 minutes of application. Clients with sensory or cognitive impairments should be checked more frequently.
  8. Complete a skin check every 5 minutes and after removal, and report any observation out of normal limits to the nurse promptly.
  9. Place the washcloth and towel in the soiled linen bag. Discard the plastic bag into the wastebasket.
  10. Complete your closing procedure steps.

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Applying a Cold Pack

When: A cold pack is applied only when you are delegated by the nurse to do so.

Why: Cold packs can reduce swelling and inflammation, which then reduces pain. Cold packs can also help stop bleeding.

Applying Cold Packs #1

What: Supplies needed for this skill:

  • Ice
  • Water
  • Sealable plastic bag, quart or gallon size, or ice bag
  • Towel

How:

  1. Complete your opening procedure steps.
  2. Fill the sealable plastic bag approximately 50% with ice. Pour cool water into the bag up to the line of ice.
  3. Squeeze out the air from the top of the bag and seal it. Wrap the bag in a dry towel to protect the client’s skin.
  4. Place the wrapped bag over the affected area. Ask the client to hold it in place. Assist the client if he is unable.
  5. Ask the client if it is comfortable or if the temperature of the compress should be adjusted with an additional towel wrap.
  6. Remove the compress within 10–15 minutes of application. Clients with sensory or cognitive impairments should be checked more frequently.
  7. Complete a skin check every 5 minutes and after removal, and report any observation out of normal limits to the nurse promptly.
  8. Place the towel in the soiled linen bag. Discard the plastic bag or ice bag into the wastebasket.
  9. Complete your closing procedure steps.

Applying Cold Packs #2

What: Supplies needed for this skill:

  • Water
  • Sealable plastic bag, quart or gallon size
  • Washcloth
  • Towel

How:

  1. Complete your opening procedure steps.
  2. Wet the washcloth with cool water.
    • Wring excess water out of the washcloth.
  3. Fold the washcloth in half, then in half once more to form a square.
    • Place the wet folded washcloth in the sealable plastic bag.
  4. Place the bag in a freezer for 15 minutes.
  5. Remove the bag from the freezer and wrap the bag in a dry towel to protect the skin.
  6. Place the wrapped bag over the affected area. Ask the client to hold it in place. Assist the client if he is unable.
  7. Ask the client if it is comfortable or if the temperature of the compress should be adjusted with an additional towel wrap.
  8. Remove the compress within 10–15 minutes of application. Clients with sensory or cognitive impairments should be checked more frequently.
  9. Complete a skin check every five minutes and after removal, and report any observation out of normal limits to the nurse promptly.
  10. Place the washcloth and towel in the soiled linen bag. Discard the plastic bag into the wastebasket.
  11. Complete your closing procedure steps.

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Closing Procedure

Ensure that the bedside table is within reach

Ask if the client needs anything before you go

Put bed in low position with side rail up, making sure bed is still locked

Remove gloves, if worn

Provide call light within reach

Open privacy curtain

Wash hands

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