Lab Skills

Question 1

Hand washing

Answer 1

1. Turn water on and regulate temperature and remove ring and watch and put in your pocket.
2. Obtain 3 Paper Towels
3. Inspect hands for open areas
4. Wet hands with water
5. Apply enough soap to cover all hand surfaces.
6. Rub hands Palm to Palm
7. Cleanse backs of fingers (be sure to scrub fingernails) and hands. 30 SECONDS
8. Don’t forget entire Thumb
9. Wash wrists also.
10. Rinse from wrists to fingers, being careful not to touch any sink surfaces.
11. Dry each hand thoroughly, beginning at fingertips with a clean Paper Towel for each hand. Do not go back over dried areas.
12. Use 3rd Paper Towel to turn off faucet.
    Hand Washing

Question 2

Height and Weight

Answer 2

1. Check chart for last height/weight charted
2. Bring scale to the bed & LOCK WHEELS
3. Balance or calibrate at zero (Move large and small weights to zero. Balance beam should be made level and steady by adjusting calibrating knob. Electronic scales are automatically calibrated by use.)
4. Obtain assessment data…
5. Identify self, identify pt. x 2, wash hands, explain procedure
6. Ask usual weight/height
7. Ask about wt. loss or gain
8. Ask if change is desired or undesired
9. Ask about eating patterns, diet plan, appetite, GI abnormalities (nausea, vomiting, diarrhea, constipation, etc.)
10. Medications or herbals used
11. Remove shoes
12. Clean paper towel on platform or floor
13. Stands erect, good posture, back to measuring stick or tape
14. Rod or stick placed on top of head at 90 degree angle to measuring stick
15. Note height in inches or centimeters
16. Assist client to free-standing position in center of scale (on clean paper towel) facing scale
17. Adjust counterbalance to obtain weight
18. Assist client off scale
19. Chart weight according to institutional policy and compare to trend

Question 3

BED BATH

Answer 3

Identify yourself, identify the patient x 2, and explain the procedure.
Hand hygiene.
Assess patient’s ability to assist with bed mobility or ability to cooperate. Get help if needed.
Provide privacy.
Offer bedpan or urinal.
Place a bath blanket over the patient, remove the linen and patient gown.
Fill the basin with water at 110-115 degrees.
Raise bed to working level, lower siderail closest to you, and assist patient to move toward you.

1. Place towel across chest. Make a mitt with the washcloth.
2. Wash the eyes, inner canthus to outer canthus, using plain water.
3. Wash, rinse, and dry face, ears, and neck (soap optional).
4. Place towel lengthwise under distal arm and hand.
5. Wash, rinse, and dry hand, arm and axilla in that order. Apply deodorant.
6. Repeat steps 4 to 5 for proximal arm and hand.
7. Place towel across the chest, pulling blanket down to patient’s waist.
8. Wash, rinse, and dry the chest keeping the chest covered with the towel while rinsing the mitt.
9. Fold the blanket down to the pubic bone, leaving the towel over the chest.
10. Wash, rinse, and dry the abdomen. Cover patient completely with bath blanket.
11. Expose distal leg, keeping perineum well covered. Place the towel lengthwise under the leg.
12. Wash, rinse, and dry the foot, ankle, and leg in that order.
13. Repeat steps 11 and 12 for the proximal leg.
14. Obtain fresh water. Put on gloves.
15. Drape for perineal care. Place towel lengthwise under hips.

Male perineal care:
• Gently grasp the shaft of the penis and retract foreskin.
• Wash tip of penis using circular motion. Wash down shaft of penis.
• Rinse and dry gently. Replace foreskin.
• Wash, rinse, and dry scrotum and upper thighs.

17. Female perineal care:
    • Wash, rinse and dry patient’s upper thighs.
    • Wash, rinse and dry the labia majora, labia minora, urethral meatus, and vaginal orifice from front to back using a separate portion of washcloth for each stroke.
18. Catheter care:
    Wipe in a circular motion along the length of the catheter for 4 inches, beginning at the meatus and working down the catheter. Rinse in same fashion.
19. Place patient on his/her side, facing away from you.
    20 Wash, rinse, and dry anal area from genitalia toward anus.
20. Ask patient to remain on side. Remove and dispose of gloves, dirty towel and washcloth. Obtain fresh water.
21. Place bottle of lotion in fresh water.
22. Place clean towel lengthwise along patient’s back.
23. Wash, rinse, and dry patient’s neck, back, and buttocks in that order.
24. Backrub:
    • Apply lotion to hands. Begin at sacrum, massaging in a circular motion. Stroke upward from buttocks to shoulders. Massage scapulae. Continue in one smooth stroke along lateral sides of back down to iliac crests. Do not allow your hands to leave patient’s skin. Continue massage pattern for 3-5 minutes.
    • End massage with long strokes, growing lighter, and tell patient you are ending.
    • Remove excess lotion from patient’s back with towel.
25. Dress patient in clean gown.
26. Provide hair care and oral care.
27. Shave prn according to preference and policy.
28. Replace bed linens. Place be in low position with siderails up, and call bell within reach.
29. Clean and replace all equipment. Leave clean towel and washcloth at bedside.
30. Wash hands.
    Evaluation:
    Evaluate for fatigue, feelings of comfort and cleanliness. Document per agency criteria.

Question 4

Making an occupied Bed

Answer 4

Determine if patient has been incontinent or has excessive drainage on linens. Determine patient’s ability to cooperate and assist or move in bed, and get assistance if needed.
Planning:
Have all necessary linens available, along with a linen bag or cart.
Implementation:
 Loosen top linens from foot of bed
 Cover patient with a bath blanket
 Remove bedspread, blanket, and top sheet separately; do not allow linens to contact uniform. Do not fan or shake linens. Do not place soiled linens on the floor.
 Position patient in side-lying position, facing away from you on the far side of the bed. Adjust the patient’s pillow and make sure the side rail is up on the patient’s side.
 Loosen the fitted bottom sheet moving from head to foot.
 Fan fold the existing draw sheet and the bottom sheet toward patient. Tuck edges of linen just under the patient’s buttocks, back, and shoulders.
 Wipe off any moisture on the mattress with a towel and appropriate disinfectant before proceeding.
 Apply clean linen to exposed half of the bed; unfolding bottom sheet lengthwise so center crease is situated lengthwise along the center of the bed.
 Open drawsheet so it unfolds in half. Lay center fold along middle of bed lengthwise and position sheet so it will be under patient’s buttocks and torso. Fanfold top layer toward patient with edge alongside patient’s back. Smooth bottom layer out over mattress and tuck excess edge under mattress.
 Have patient roll slowly toward you, over the rolled linens.
 Raise side rail on working side of the bed and go to the other side.
 Lower that side rail. Assist patient in positioning on other side.
 Loosen edges of soiled linens from underneath and remove by folding it into a bundle with soiled linens turned in. Discard in linen bag.
 Spread clean fan folded linens over edge of mattress from head to foot of bed.
 Assist patient in rolling to supine position, and reposition pillow.
 Place top sheet over patient with center fold lengthwise down the middle of the bed. Open sheet from head to foot and unfold over patient.
 Ask client to hold clean top sheet, or tuck around patient’s shoulders.
 Remove bath blanket and discard into linen bag.
 Repeat top sheet process for blanket and spread.
 Make a cuff by turning edge of top sheet down over edge of blanket and spread.
 Tuck in linens at foot of bed and miter corners on working side, or leave linens loose but smooth according to agency policy.
 Allow for movement of patient’s feet by making a toe pleat (for mitered corners) or loosening top linens at the foot of the bed.
 Raise side rail, and process to make other side of the bed.
 Have patient raise their head and remove pillow while supporting the neck.
 Remove soiled pillowcase and discard into linen bag.
 Grasp clean pillowcase at the center of the closed end. Gather case by turning it inside out by holding it.
 Pick up middle of one end of pillow with hand grasping the clean pillowcase. Pull pillowcase down over pillow with other hand. Fit pillow corners evenly into corners of pillowcase.
 Support patient’s head under the neck and place pillow under the head.
 Place call light within reach. Reposition patient into position of comfort. Return bed to low position and raise side rails. Put patient’s table and belongings within reach.
 Hand hygiene.
 Take soiled linen cart to appropriate area.
Evaluation:
Ask if the patient is comfortable, or observe signs of discomfort.