Nurse Assisting
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Chapter 25 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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Care of the Client With Tubing (IV, Nasogastric, Gastrostomy)

When: Caregiving for the client can occur during the morning or evening care times, or as needed or requested by the client throughout the day.

Why: It is important for the nursing assistant to be mindful of all tubing during caregiving so as to not injure the client or disrupt the purpose of the tubing.

What: Supplies needed for this skill include

  • None

How:

  1. Complete your starting-up steps.
  2. Identify based on the client’s care plan if tubing is in place and if so, which type.
  3. When caregiving be mindful to maintain slack on the tubing at all times. Always avoid any tugging or pulling.
  4. For IV tubing:
    1. Look at the IV insertion site. If it is red, swollen or painful report this to the nurse immediately.
    2. Dress the client by first removing the IV bag from the IV pole and inserting the IV bag into the sleeve of the shirt followed by the hand and arm. Promptly place the IV bag back on the IV pole. Then assist the client in placing the opposite arm into the second sleeve.
  5. For nasogastric tubing:
    1. Ensure the adhesive tape is in good repair and fully adhered across the client’s nose.
    2. Keep the nasogastric bag of contents on the IV pole when in use.
    3. To dress the client in a pullover top when the nasogastric tube is in use, take the nasogastric bag of contents on the IV pole and feed through the head opening of the top followed by placing the top over the client’s head and down to the shoulders. Replace the nasogastric bag of contents on the IV pole and proceed to assist the client with getting the arms through the top.
    4. If the nasogastric tubing is not in use delivering contents from the bag, ensure the tubing is properly secured to prevent any pulling or tugging.
  6. For gastrostomy tubing:
    1. Ensure the adhesive tape is in good repair and fully adhered on the client’s stomach and the tube is attached to this when not in use.
    2. Keep the gastrostomy bag of contents on the IV pole when in use.
    3. When dressing a client be sure the pants do not rub against the gastrostomy tube insertion site or pinch the tubing in any way.
  7. Complete the caregiving needs.
  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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