Nurse Assisting
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Chapter 20 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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Assisting With Contact Lenses

When: ​Help clients place contacts as desired, most often in the morning after bathing.

Why: ​Most clients can independently insert contacts but may need assistance before, during, and after insertion.

What: ​Supplies needed for this skill include:

  • Gloves
  • Client’s contact lenses
  • Contact solution
  • Tissues

How:

  1. Complete your starting-up steps.
  2. Raise the head of the bed until the client is in a high-Fowler’s position.
  3. Don gloves.
  4. Open the contact container for the first contact you will be inserting.
  5. Pour the contact and the solution into the palm of your hand.
  6. Look at the contact lens; observe if there is any dirt, foreign particles, or tears.
  7. Place the contact lens on the tip of your dominant index finger.
    1. The edges should round upward.
    2. If they flare outward, flip the lens over and turn right side out.
  8. With your nondominant hand, lift the client’s upper eyelid up and pull the lower eyelid down, using your index or middle finger, whichever is more comfortable, and thumb. Spread the eye open.
  9. Ask the client to look up at the ceiling.
  10. Place the lens on the white part of the eye and slowly release the eyelid.
  11. Ask the client to close their eyes and look down, for approximately 5 seconds.
  12. Offer to apply extra solution in the eye if the client complains of dryness.
  13. Offer tissues to the client as necessary for any excess drips of solution.
  14. Repeat Steps 5–13 for the other eye.
  15. Discard used tissues in the wastebasket.
  16. Remove gloves and discard in the wastebasket.
  17. Hand wash or hand sanitize, as appropriate.
  18. Lower the head of the bed.
  19. Complete your finishing-up steps.

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Shaving a Face With a Disposable Razor

When: ​Shave male clients each morning after bathing, or as needed. Female clients may also request to be shaved, usually on an as-needed basis.

Why: ​Preserve client dignity by ensuring the client looks presentable prior to leaving the room.

What: ​Supplies needed for this skill include:

  • Gloves
  • Basin of warm water
  • Washcloth
  • Two towels
  • Shaving cream or soap
  • Disposable razor
  • Aftershave or lotion, as desired by the client
  • Sharps container as needed

How:

  1. Complete your starting-up steps.
  2. Verify with the care plan, ISP, or nurse that shaving with a disposable razor is not contraindicated (i.e., if the client is on blood thinners).
  3. Raise the head of the bed to a high-Fowler’s position. Drape a towel across the client’s chest and shoulders to protect their clothing.
  4. Don gloves.
  5. Wet the washcloth. Offer the client the warm wet washcloth to soften their hair follicles. Assist them if they are unable.
  6. Apply shaving cream or soap to all areas that are to be shaved. Use a towel to wipe excess shaving cream from your hands.
  7. Remove the cover from the disposable razor. If the razor blade is dull, dispose of the razor in the sharps container and replace it with a new one.
  8. Gently, pull the skin taut.
  9. Using short downward motions, shave the cheeks.
  10. Rinse the razor in the water basin between each stroke. Change the water in the basin as necessary.
  11. Ask the client to tuck in their lips to make the skin taut around the upper lip and chin. You may gently pull the skin taut to facilitate this.
  12. In a downward motion, shave the upper lip and chin area.
  13. Ask the client to look up at the ceiling.
  14. Using short upward strokes, shave the neck to the chin and jaw line.
  15. When shaving is complete, wipe off excess shaving cream or soap with the washcloth, dry the client’s face and neck with a towel, and apply aftershave or lotion, as your client desires.
  16. Remove the towel from the client’s chest and shoulders. Place the soiled washcloths and towels in the linen bag.
  17. Empty, rinse, and dry the wash basin.
  18. Remove gloves and discard in the wastebasket. Hand wash or hand sanitize, as appropriate.
  19. Lower the head of the bed.
  20. Complete your finishing-up steps.

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Shaving Legs With a Disposable Razor

When: ​Shave the client’s legs when requested, normally on the bath day.

Why: ​Clean-shaven legs may improve the client’s self-image.

What: ​Supplies needed for this skill include:

  • Gloves
  • Basin of warm water
  • Soaker pad or disposable underpad
  • Washcloth
  • Four towels
  • Shaving cream or soap
  • Disposable razor
  • Lotion, as desired by the client

How:

  1. Complete your starting-up steps.
  2. Raise the head of the bed to a high-Fowler’s position.
  3. If the client is lying under the bed linens, fanfold the top linens to the foot of the bed.
  4. Place the soaker pad on top of the fitted sheet near the foot of the bed.
  5. Don gloves.
  6. Ask the client if the water is a comfortable temperature.
  7. Remove the client’s sock and roll their pant leg up above their knee. Expose only one leg at a time.
  8. Flex the client’s knee to a 45-degree angle so that their foot rests flat on the pad.
  9. Place the basin of warm water on top of the soaker pad.
  10. Ask the client to lift their exposed foot and lower it into the basin of water.
    1. Assist the client if they are unable.
  11. Wet the washcloth, and then wet the client’s leg with it.
  12. Apply a generous amount of shaving cream to the leg or lather soap onto the washcloth and apply this to the leg as far up the leg as the client desires to be shaved.
    1. Using a towel, wipe excess shaving cream from your hands.
  13. Remove the cover from the disposable razor.
    1. If the razor blade is dull, dispose of the razor in the sharps container and replace with a new one.
  14. Starting at the ankle, in long gliding stokes, shave upward against the direction of hair growth.
  15. Rinse the razor in the water basin in between each stroke.
    1. Change the water in the basin as necessary.
  16. When the leg is completely shaved, rinse off remaining shaving cream with the washcloth.
  17. Ask the client to lift their exposed foot.
    1. Assist the client if they are unable.
  18. Remove the basin of water.
  19. Place the client’s foot on the soaker pad.
  20. Dry the leg thoroughly with a clean towel.
  21. Empty the wash basin and refill it with clean water.
  22. Ask the client if the water is a comfortable temperature.
  23. Move to the other side of the bed.
  24. Repeat Steps 14–20 on the opposite leg.
  25. Apply lotion to their legs, as your client desires.
  26. Place soiled washcloths and towels in the linen bag.
  27. Empty, rinse, and dry the wash basin.
  28. Remove gloves and discard in the wastebasket.
  29. Hand wash or hand sanitize, as appropriate.
  30. Lower the head of the bed.
  31. Complete your finishing-up steps.

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Shaving Legs and Underarms With an Electric Razor

When: ​Shave the client’s legs and underarms when requested, normally on the bath day.

Why: ​Clean-shaven legs and underarms may improve the client’s self-image.

What: ​Supplies needed for this skill include:

  • Two pairs of gloves
  • Electric razor
  • Razor brush/cleaning tool

How:

  1. Complete your starting-up steps.
  2. Raise the head up to a high-Fowler’s position.
  3. Don gloves.
  4. Remove the client’s sock and pull their pant leg up to above their knee. Expose only one leg at a time.
  5. If the razor has three rotating heads, move across the area in small, rotating circles.
  6. If the razor has a flat head, start at the ankle, and, in long, gliding strokes, shave up the leg as far as the client desires to be shaved.
  7. Move to the other side of the bed and repeat Steps 4–6 on the opposite leg.
  8. Apply lotion to their legs, as your client desires.
  9. When shaving their underarms, ask the client to raise their arm.
  10. Gently pull the skin taut over the area to be shaved.
  11. Shave the underarm area from top to bottom.
  12. Apply deodorant, as your client desires.
  13. Move to the other side of the bed and repeat Steps 9–12 on the opposite arm.
  14. Remove gloves and discard in the wastebasket.
  15. Hand wash or hand sanitize, as appropriate.
  16. Lower the head of the bed.
  17. Don a clean pair of gloves.
  18. Remove the head of the razor. Using the manufacturer’s cleaning brush, brush out hair and dead skin cells into a wastebasket.
  19. Remove gloves and discard in the wastebasket.
  20. Hand wash or hand sanitize, as appropriate.
  21. Plug the razor in to recharge the battery.
  22. Complete your finishing-up steps.

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Applying and Removing a Behind the Ear Hearing Aid

When: At the beginning or end of the day.

Why: ​Apply the hearing aid(s) at the beginning of the day to ensure the client can hear properly and that the device is clean. Remove the hearing aid(s) at the end of the day so the client can comfortably sleep.

What: ​Supplies needed for this skill include:

  • Client-specific hearing aid
  • Batteries

How:

  1. Complete your starting-up steps.
  2. Ensure the battery is installed in the hearing aid, it is turned on, and it is in good repair and functioning. To make sure it is working cup the hearing aid in your hands. If it whistles the battery is working. If it does not, replace the battery.
  3. Check the skin integrity behind the ear(s) before applying the hearing aid(s).
  4. Assist the client with applying the hearing aid(s) in the correct ears. Check the care plan to determine which ear or if both ears are affected. Ensure the back of the hearing aid(s) are securely placed behind the client’s ear(s).
  5. After the hearing aid(s) are properly placed ask the client if they can hear you speaking and if it is comfortable. If not, readjust, and troubleshoot for problems with the aid(s). If the aid(s) are not working report this to the nurse.
  6. Before going to bed or when the client so desires, assist the client with removing the hearing aid(s).
  7. Place the aid(s) in the respective storage container. Open up the battery compartment and/or turn off the aid(s) so as to not drain the battery while not in use.
  8. Complete your finishing-up steps.

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Combing the Client’s Hair

When: After the client’s hair has been washed or when the client requests.

Why: To meet the grooming needs as well as to preserve the client’s right of dignity by looking presentable prior to leaving the room.

What: Supplies needed for this skill:

  • Comb or brush, hair product as desired by the client

How:

  1. Complete your starting-up steps.
  2. Ask the client how they prefer their hair to be styled.
  3. Using the preferred comb or brush gently comb or brush the client’s hair as desired without pulling or tugging. The client may prefer you wet the comb or brush prior to combing or brushing the hair. Be mindful of glasses or hearing aids that might be bumped during combing or brushing.
  4. Use any styling product that the client desires as per manufacturer’s directives.
  5. Once styled ensure the client is pleased with the way the hair looks, then return the comb or brush.
  6. 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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