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Fundamental Nursing Skills and Concepts


Entering health care agency for nursing care, medical or surgical treatment. ... (2) enteral feedings or IV fluid administration. (3) bowel or bladder retraining. ... – PowerPoint PPT presentation

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Title: Fundamental Nursing Skills and Concepts

Fundamental Nursing Skills and Concepts
  • Chapter 10
  • PAGE 117

  • Entering health care agency for nursing care,
    medical or surgical treatment. The process
  • 1. obtaining medical authorization
  • 2. collecting billing info. by the admitting
  • 3. completion of admitting procedure by nursing
  • 4. documenting patients medical history and
    findings of the physical
  • Initial medical orders for treatment

Admission to the Health Care Agency
  • Authorization from a physician- admission must be
    determined by a physician either for the clients
    condition, testing that may be needed, special
    care or treatment that can only be carried out in
    that particular health care setting.
  • The admitting dept.- initiates a medical record.
    Gathering of information from or about the client
    for record keeping and billing purposes.

Admission to the Health Care Agency
  • Collection of billing information, done be
    admitting dept.. The ID bracelet may be put in
    place here or later in the pts. room by the
    admitting nurse. Completion of the admission
    procedure- the bracelet is very important and
    contains the name of the pt. , Id , pts. doctor,
    and the pts. room . It will stay in place
    throughout the hospital stay. Other than, asking
    the patients name, the bracelet is the single
    most important method of identifing the patient.

Admission to the Health Care Agency
  • Addressograph card- identifies all pages of the
    pts. chart. So it is important that it is
    correct. Room change- card must be changed.
  • In the hospital setting now sticky labels with
    clients info printed on them are now furnished
    to Id. clients paperwork as well as belongings.

Nursing admission activities
  • Nurse checks to see that the room is clean, well
    stocked with basic equipment. Oxygen equipment
    available. IV standard in place.
  • Nurse welcomes patient, smile, greets the client,
    gives a handshake.
  • Nurse wears name badge so it can be easily read
    and introduce self.
  • Double occupancy room, please do not overlook
    introducing room mate.

Orienting the Client to the Room
  • The location of the nursing station
  • Where to store clothing and personal items
  • How to call for nursing assistance
  • How to adjust the bed, equipment in environment
  • How to regulate the room lights

Orienting the Client to the Room
  • How to use the phone
  • How to operate the television
  • The daily routine, schedule such as meal times,
  • When the physician visits
  • When surgery or diagnostic testing is performed
  • Answer any questions, this will make him more

Valuables and clothing
  • Clothing usually remains in pts. room, but
    valuables should be encouraged to make a return
    trip home with the family or loved ones. Always
    document what was sent home with the name of the
    person taking it home on the inventory check
    list. If sending valuables home is a problem,
    observe the agencys policy on safeguarding
    valuables. Hospital safe is used be descriptive
    of object- 1 yellow metal ring with a clear stone
    or red stone. You are not a gemologist so do not
    assume it is a diamond or ruby. Just put down
    what you see. A second nurse, supervisor, or
    security personnel should be in attendance when
    the nurse and patient co-sign an inventory list.
    A copy to the patient, another attached to the

Valuables and clothing
  • Inventory list of patients belongings on page
  • Patients name should be labeled on all personal
    equipment, such as walkers, c-pap machines,
    wheelchairs. Special cups for dentures should be
    labeled. Please take care of eyeglasses and
    hearing aids also. If negligence is proven in
    loss, the agency replaces.

Helping patient to undress
  • Provide for privacy
  • Bed in low position
  • Remove shoes
  • Remove the most comfortable way in the least
    disturbing fashion. Remove unaffected side last,
    but, dresses it first.
  • Apply hospital gown if possible. Page 120 lays
    steps used.

Admission to the Health Care Agency
  • Documentation of clients medical history- some
    of these skills may be delegated out. Such as
    v/s, weight, and admission questions may be done
    by the receiving nurse who is the LVN.
  • The patients condition and the agencys policy
    may deviate the procedure.
  • Documentation of clients physical examination

Admission to the Health Care Agency
  • Development of an initial nursing care plan-
    completed within 24 hours following admission.
    Initial plan generally identifies the clients
    priority problems and may include the projected
    needs for teaching prior to discharge. Revise as
  • Initial medical orders for treatment, lab and dx.
    tests, activities and diet are done -medical hx.
    obtained and a physical exam within 24 hours is
    done and documented. An associate may be
    delegated to do so but it must be done with in 24
    hours. Medical hx. and physical exam generally
    include, identifing data, chief complaint,
    history of present illness, personal history,
    past health history, family history, review of
    body systems and conclusions.

  • Page 121 identifies the 8 components of a medical
  • Conclusions are reached, if not, physician may
    document rule out, ( R/O ) , this is for
    suspected diagnosis and more testing is required
    to determine the diagnosis.

Initial Nursing Plan For Care
  • Admission data is collected
  • Nurses develops an initial plan of care within 24
  • Skill 10-1 describes basic steps in admitting a
    client page 132.
  • Identifies the clients priority problems
  • Identifies the projected needs for teaching prior
    to discharge
  • The nurse revises the care plan as the clients
    condition changes.

Specific Responses to Admission
  • Anxiety
  • Fear
  • Decisional conflict
  • Situational Low Self-esteem
  • Powerlessness
  • Social Isolation
  • Risk for Ineffective Therapeutic Regimen

Admission Responses
  • Anxiety-uncomfortable feeling caused by
    insecurity. Always explain, instruct or teach, to
    inform the patient what is going to happen. They
    have a fear of the unknown, so keep them informed
    for more cooperation. Also you will find it takes
    less pain medication to combat there pain if they
    are well informed. Nursing care plan on page 122.
  • Loneliness-occurs when a client cannot interact
    with family and friends. Admission limits
    interaction with family and friends. Make
    frequent contact with the client. Many
    facilities recognize that their clients need more
    liberal times for their loved ones to visit.
    Contact with those that are young is very
    important. Check with your facility to see if age
    limits are enforced.

Admission Responses
  • Decreased privacy-ensure privacy by closing
    doors. It is common courtesy to knock before
    entering a clients room. You need to demonstrate
    respect and ensure protection of each patients
    rights to privacy. On admission inform the client
    of where they may retreat for solitude, such as
    the chapel, reading room, solarium. Smoking
    areas now are limited to none available.
  • Loss of identity-a healthcare facility may
    temporarily deprive a person of his or her
    identity. Client may feel like they are receiving
    care, but no caring. Learn and call all patients
    by their name. The goal is to keep the admission
    as brief as possible and to discharge patients
    back to their homes as soon as possible.

Discharge a client
  • Skill 10-2 page 135

The Discharge Process page 124
  • Obtain authorization for medical discharge- by
    obtaining a written medical order

The Discharge Process page 124
  • Provide discharge instructions- page 124,
    planning for discharge actually begins when
    patients are admitted. Use the acronym METHOD,
    table 10.2. The nurse reviews the teaching that
    was done, gives the prescriptions to be filled,
    advises to make an office visit appointment,
    gives the client a written summary of discharge
    instructions, patient signs, carbon copy is
    attached to patients chart.
  • Notify the business office of discharge- need to
    make sure all insurance info. is complete,
    authorizations signed for release of medical
    info. for reimbursement or financial arrangements
    have been completed

The Discharge Process page 124
  • Gather the clients belongings
  • Arrange the clients transportation if needed
  • Escort the client at the time of discharge

The Discharge Process page 124
  • Write the discharge summary-of patients condition
    at the time of discharge
  • Request room be terminally cleaned. The room is
    terminally cleaned, stripped of linen cleaned
    with disinfectant, restocked with basic equipment
    and the admissions department notified of a ready

The Discharge Process page 124
  • Authorization, physician writes discharge order,
    prescription and any follow up instructions.

The Discharge Process page 124
  • Leaving against medical advice or AMA, this is
    when a patient leaves before the physician
    authorizes the discharge. The nurse negotiates
    with the patient or family. To no avail, notify
    the nursing supervisor and the physician of the
    patients wishes. Patient still determined the
    nurse asks the patient to sign a special form.
    The AMA form releases the physician and health
    agency from future responsibility for any
    complications that may occur. Patient refuses to
    sign, cannot be detained. Document the AMA form
    was presented, explained and refused to be signed
    and this is all noted in the patients medical

Transferring patients page 125
  • Involves discharging from one unit or agency and
    admitting him to another without going home.
    Maybe to a step down unit or progressive care
    unit or a unit that requires less intensive
    nursing care. Nursing guidelines 10-1 page 126.

Admission to Other Nursing Facilities
  • Extended Care Facilities-Health care agency that
    provides long-term care. Provides care for people
    who are unable to care for themselves but do not
    require hospitalization
  • Skilled Nursing Facilities-Provides 24-hour
    nursing care under the direction of a registered
    nurse. Must be referred by a physician and
    require specific technical nursing skills such as

Admission to Other Nursing Facilities
  • (1) observation during an acute or unstable
    phase of illness.
  • (2) enteral feedings or IV fluid
  • (3) bowel or bladder retraining.
  • (4) administration of injectable meds.
  • (5) sterile dressing changes.
  • This facility must provide rehabilitative
    services, physical therapy, occupational therapy,
    pharmaceutical therapy, dietary services,
    diversional activities, therapeutic activities,
    routine and emergency dental services.

  • Those who have Medicare are entitled to 20 days
    of full coverage and 80 days of partial coverage
    per year for skilled care. Some folks have
    private insurance policies to cover costs that
    medicare doesnt, but for those that go beyond
    100 days they bear the cost personally, until all
    their resources are used and those of their
    spouse. Then when they are considered indigent
    they can apply for medicaid or its equivalent in
    their respective state.

Admission to Other Nursing Facilities
  • Intermediate Care Facilities-Provides health care
    for people who require institutional care due to
    a physical or mental condition, but not 24 hour
    nursing care. They need supervision, assistance
    with meds, bathing and dressing. They tend to
    wander or are confused. Medicare provides no
    reimbursement for ICF. The costs are assumed
    personally or by state welfare programs like
  • Basic Care Facilities- BCF-Agency that provides
    extended custodial care. Provides shelter, food,
    laundry services in group home settings. ADLS
    carried out on own.

Minimum Data Sets (MDS)
  • Assess level of care using a standardized form.
  • Repeated at 3 month intervals.
  • MDS required assessments are listed on page 128.
  • Problems that are identified an MDSs are
    reflected in the nursing plan of care.
  • These defeciencies must be addressed and focused
    on for the care of that client.

Client Referral
  • Selecting a nursing home, page 128
  • A referral- sending someone to another agency or
    special services. Table 10-3 Common Community

Client Referral
  • Continuity of care, care remains uninterrupted
    despite change in caregivers.
  • Home health care- care provided in the home by a
    home health agency employee, either a nurse, LVN
    or RN, aide or therapist. Medicare and insurance
    companys reimbursements are limiting hospital
    stays, so this adds to the need for extended care
    to be carried out in patients homes. There is
    also a greater number of older Americans that can
    use these types of services.
  • This type of nursing service help shorten the
    time spent in the acute care facility.
  • Display 10-3 responsibilities of Home Health