HTM 038 LEC 8

PATIENT CARE SKILLS

Patient care skills refer to a set of skills required to be able to properly care for patients with
chronic illnesses, injuries, disabilities, and those who are elderly.

Providing basic and direct care each day takes energy and a lot of dedication. The skills include:

1. Empathy

One key trait that patient care technicians must have is empathy. Empathy helps PCTs
understand and commiserate with the pain their patients are feeling. When you have empathy for
someone else, you can easily think from their perspective. Empathy will allow you to become
more intuitive to know when a patient needs assistance. Empathy will help build strong bonds
and make the work environment more caring.

2. Interpersonal skills

As a patient care technician, you need to communicate with patients, their family members,
physicians, nurses, and other coworkers each day. You need to be able to effectively care for
patients by addressing patients’ or residents’ concerns. Plus, you will need to relay important
information about a patient’s health care plan or status to other healthcare professionals.

3. Strength and physical endurance

Patient care technicians are busy and active caring for patients throughout the day. In this role,
you will be on your feet most of the day, so you’ll have to be have endurance. If there are
emergencies, you need to be alert and ready to help patients. There will be times when you also
need to move, lift, or transport patients who have trouble moving.

4. Patience

As a patient care technician, you need to stay calm when you work with patients. Many of your
charges may be elderly, disabled, or have injuries so they may move at a slower pace or have
trouble understanding your directions. Part of your job is to help them eat and conduct daily
activities. Remain respectful and calm while you help them. They will feel more comfortable
around you, and you can ensure you do your job properly while offering the highest quality of
care.
5. Technical skills

In a patient care technician program, you can learn how to use the technical skills that you need
each day on the job. You can learn how to measure vital signs, handle lab specimens, administer
EKGs, and administer First Aid.

Application of the technical skills

I Assessment of a sick or injured person

Assess the nature of any injury or illness and set priorities for the care required.

If the patient appears collapsed, first check their response to a shouted command and to a firm
squeeze of the shoulders. If the collapsed patient does not respond, then CPR may be required.

If the patient responds to your voice, then it is possible to obtain important information and plan
any emergency treatment required.

Unless the injury or illness appears to be minor, ask a bystander to call 112/ 999 for an
ambulance and then follow these simple steps:

1. Ask the patient and any by standers for the history of the problem, outlining what
happened, the time of onset, and whether there is any known underlying health problem,
such as asthma, diabetes, epilepsy or a heart condition. Quickly check for a Medic Alert
bracelet or necklet, which may record any major health problem.
2. Ask the patient to describe any symptoms, including pain, soreness or discomfort, and
any other unusual sensations such as numbness or tingling in the fingertips.
3. Check the patient carefully, looking for any signs of injury or illness, basing your
observations on the history and any symptoms described. After an injury, look for any of
the following:

 bleeding
 bruising
 wounds
 swelling
 deformity (when one side is compared with the other)
 loss of power or function
The observations should be as follows:

    Conscious state: If help is going to be delayed, check the conscious state every few minutes
and note any changes. Use the ‘AVPU’ code:

A   Alert

 Is the patient alert and responding to you?

V   Voice

 Does the patient respond to your voice?

P   Painful

 Does the patient respond to a painful stimulus?

U   Unresponsive

 Is the patient unresponsive?

2.    Airway: ensure that it is clear and open and that the patient does not have any secretions that
might obstruct breathing.

3.    Breathing: Check for normal breathing – note the rate and rhythm for any changes. Check
whether the breathing is deep or shallow, quiet or noisy, and whether there are any abnormal
sounds such as wheezing on breathing out. This is especially important with the unconscious
patient because any change may be a warning of deterioration.

4.    Skin: Look at the skin and note the colour (whether tinged with blue), and feel whether it is
hot (with fever) or cold and clammy (as in shock).

II Mechanism of injury

Encompasses both what happened to the casualty, and how the injury has affected the casualty.

It identifies the cause of the injury.

Mechanisms of injury that require an ambulance right away:

• A fall from 6.5 meters (20 feet) or more

• A vehicle collision with signs of a severe impact

• Severe damage to the inside of the vehicle, a bent steering wheel, or a broken windshield
• Casualty was thrown from a vehicle

• The vehicle has rolled over

• Casualty was struck by a vehicle

• Crush injuries

When any of these mechanisms are apparent, call an ambulance as soon as you can. When we
understand the cause of the injury, we are able to predict what injuries may be present and what
injuries are not likely, even in situations in which there are no visible signs of injury and/or the
casualty is unable to describe their symptoms.

Examples of Signs and symptoms

Blood, deformity, bruising, unequal pupils, painful

Signs you can see
Signs you can hear
Signs you can feel
Signs you can smell
Symptoms the casualty
may tell you about
expression and/ or flinching, sweating, wounds,
unusual chest movement, skin colour, swelling, foreign
bodies, vomit, incontinence
Noisy or distressed breathing, groans, sucking wounds
(chest injury), bones scraping together, quality of speech
Dampness, skin temperature, swelling, deformity
Casualty’s breath (fruity breath, acetone/nail polish breath,
or alcohol), vomit, incontinence, gas fumes, burning,
solvents or glue
Pain, fear, heat, cold, loss of normal movement, loss of
sensation, numbness, tingling sensation, thirst,
nausea, faintness, stiffness, feeling faint, weakness,
memory loss, dizziness, sensation of a broken bone

III Primary survey

Assess each casualty for life-threatening injuries and illnesses, call or send someone to call 9-9-

9, and give life-saving first aid.

Check for life-threatening conditions, the ABCs:

A = Airway

B = Breathing

C = Circulation

The sequential steps of the primary survey should be performed with the casualty in the position

found unless it is impossible to do so.

The primary survey should begin immediately after the scene survey.

Check the airway

If the casualty is conscious, ask “what happened?” How well the casualty responds will help you

determine if the airway is clear. Use a head-tilt-chin-lift to open the airway of an unresponsive

casualty. If you suspect a head or spinal injury, and have been trained, use a jaw-thrust without

head-tilt.

Check for breathing

• If the casualty is conscious, check by asking how their breathing is.

• If the casualty is unconscious, check for breathing for at least five seconds, and no more than

10 seconds. If breathing is effective, move on to check circulation. If breathing is absent or

ineffective (gasping and irregular, agonal), begin CPR.

Check circulation

• Control obvious, severe bleeding

• Check for shock by checking skin condition and temperature

• Check with a rapid body survey for hidden, severe, external bleeding and signs of internal

bleeding
IV Secondary survey

The secondary survey is a step-by-step way of gathering information to form a complete picture

of the casualty’s overall condition.

A secondary survey follows the primary survey and any life-saving first aid. It is a step-by-step

way of gathering information to form a complete picture of the casualty. In the secondary survey,

the first aider is looking for injuries or illnesses that may not have been revealed in the primary

survey.

You should complete a secondary survey if:

• The casualty has more than one injury

• Medical help will be delayed for 20 minutes or more

• You will transport the casualty to medical help

A SAMPLE history is used to gather a brief medical history of the casualty. This information

may be useful for health care professionals who will continue to assist the casualty. If the

casualty is unable to respond, some of the SAMPLE history could be answered by a close family

member.

S = symptoms – what the casualty is feeling (such as pain, nausea, weakness, etc.)

A = allergies – any allergies, specifically allergies to medications

M = medications – any medications or supplements they normally take, have taken in the past 24

hours, or any doses they may have missed

P = past or present medical history – any medical history, especially if it is related to what they

are experiencing now. Ask if they have medical alert information

L = last meal – last meal they ate and when, anything else taken by mouth
E = events leading to the incident – what was happening before the injury/illness? How did the

injury occur?

V Head-to-toe exam

The head-to-toe exam is a complete and detailed check of the casualty for any injuries that may

have been missed during the rapid body survey. Do not examine for unlikely injuries. You may

need to expose an area to check for injuries, but always respect the casualty’s modesty and

ensure you protect them from the cold. Only expose what you absolutely have to.

• Ask the casualty if they feel any pain before you start. Note any responses.

• Speak to the casualty throughout the process. Explain what you are checking for as you

proceed.

• Always watch the casualty’s face for any facial expressions that may indicate pain.

• Do not stop the exam. If you find an injury, note it and continue.

• Do not step over the casualty. If you need to, walk around them.

• During a detailed exam, you are looking for all bumps, bruises, scrapes, or anything that is not

normal.

• If the casualty is unconscious, look for medic alert devices during your survey, such as a tag,

bracelet, necklace, watch, or other indicator.

• Look, then feel

Start at the head:

• Check the skull for anything abnormal

• Check the ears for fluid

• Check the eyes, are the pupils the same size?

• Check the nose for drainage

• Check the mouth, are the teeth intact? Are the lips blue or pale?

Check the neck:

• Are the neck veins bulging?

• Is there a medical alert necklace?

• Check the collarbones

• Check the shoulders on both sides

Check the arms:

• Check each arm completely

• Check the fingernails for circulation by squeezing and watching the blood return

• Ask the casualty to squeeze two of your fingers in both hands at the same time. Do they have

an adequate strength and is the strength equal?

Check the chest and under:

• Does it hurt the casualty to breathe?

• Does the chest rise and fall with breaths as it should?

• Reach around the back as far as you can

Check the abdomen and under:

• With flat hands, check the abdomen carefully

• Do not push into the abdomen. Gently feel for pain, tenderness, or rigidity

• Place a flat hand on their abdomen and ask the casualty to push against it. Does this cause pain?

• Reach around the back as far as you can

Check the pelvis:

• Place your hands on top of the pelvic bones and very gently squeeze for stability

Check the legs, ankles, and feet:

• Check each leg completely one at a time

• Is one leg shorter than the other?

• Carefully check the stability of the kneecap and under the knee

• Squeeze or pinch a foot. Ask the casualty what you just did to see if they answer correctly.

• Place both hands on both feet. Ask the casualty to push and then pull against you. Feel for

equal strength. Ask the casualty to wiggle their toes and watch for the response.

• Check circulation

VI Monitoring vital signs

Definition:

Monitoring vital signs is defined as the procedure that takes the sign of basic physiology that

includes temperature , pulse, respiration and blood pressure. If any abnormality occurs in the

body, vital signs change immediately.

Purpose:

1. To assess the client’s condition

2. To determine the baseline values for future comparisons

3. To detect changes and abnormalities in the condition of the client

Equipment required:

1. Oral/ axilla / rectal thermometer

2. Stethoscope

3. Sphygmomanometer with appropriate cuff size

4. Watch with a second hand

5. Spirit swab or cotton

6. Sponge towel

7. Paper bag (2): for clean for discard (1)

8. Record form

9. Ball- point pen: blue (1) black (1) red (1)

10. Steel tray (1): to set all materials

a. Taking axillary temperature by glass thermometer

Definition:
Measuring/ monitoring patient’s body temperature using clinical thermometer
Purpose:
1. To determine body temperature
2. To assist in diagnosis
3. To evaluate patient’s recovery from illness
4. To determine if immediate measures should be implemented to reduce dangerously elevated
body temperature or converse body heat when body temperature is dangerous low
5. To evaluate patient’s response once heat conserving or heal reducing measures have been
implemented

Procedure:
Care Action Rationale
1. Wash your hands.  Handwashing prevents the spread of infection
 Organization facilitates accurate skill
2. Prepare all required equipment
performance.
3. Check the client’s identification.  To confirm the necessity
4. Explain the purpose and the procedure to the  Providing information fasters cooperation and
client. understanding
 Maintains client’s privacy and minimize
5. Close doors and/or use a screen.
embarrassment.
 Wipe from the area where few organisms are
6. Take the thermometer and wipe it with cotton
present to the area where more organisms are
swab from bulb towards the tube.
present to limit spread of infection
7.Shake the thermometer with strong wrist  Lower the mercury level within the stem so
movements until the mercury line falls to at least that it is less than the client’s potential body
95 ℉ (35 ℃). temperature
8.Assist the client to a supine or sitting position.  To provide easy access to axilla.
  To expose axilla for correct thermometer bulb
9. Move clothing away from shoulder and arm
placement
10. Be sure the client’s axilla is dry. If it is moist,  Moisture will alter the reading. Under the
pat it dry gently before inserting the condition moistening, temperature is generally
thermometer. measured lower than the real.
11. Place the bulb of thermometer in hollow of
axilla at anterior inferior with 45 degree or  To maintain proper position of bulb against
horizontally. blood vessels in axilla.

 Close contact of the bulb of the thermometer

12. Keep the arm flexed across the chest, close to
with the superficial blood vessels in the axilla
the side of the body
ensures a more accurate temperature registration.
13.Hold the glass thermometer in place for 3
 To ensure an accurate reading
minutes.

14.Remove and read the level of mercury of

thermometer at eye level.
15. Shake mercury down carefully and wipe the
thermometer from the stem to bulb with spirit
swab.
16. Explain the result and instruct him/her if
he/she has fever or hypothermia.
17. Dispose of the equipment properly. Wash
your hands.
18. Replace all equipment in proper place.
19. Record in the client’s chart and give
signature on the chart.
20. Report an abnormal reading to the senior
staff.
 To ensure an accurate reading
 To prevent the spread of infection
 To share his/her data and provide care needed
immediately
 To prevent the spread of infection
 To prepare for the next procedure
 Axillary temperature readings usually are
lower than oral readings.
 Giving signature maintains professional
accountability
 Documentation provides ongoing data
collection

b. Measuring a Radial Pulse

Definition: Checking presence, rate, rhythm and volume of throbbing of artery.

Purpose:
1. To determine number of heart beats occurring per minute( rate)
2. To gather information about heart rhythm and pattern of beats
3. To evaluate strength of pulse
4. To assess heart's ability to deliver blood to distant areas of the blood viz. fingers and lower
extremities
5. To assess response of heart to cardiac medications, activity, blood volume and gas exchange
6. To assess vascular status of limbs
 Procedure:
Care Action
1. Wash hands.
2. Prepare all equipment required on tray.
3. Check the client’s identification
4. Explain the procedure and purpose to the
client.
5. Assist the client in assuming a supine or
sitting position.
6. Count and examine the pulse
- Place the tips of your first, index, and third
finger over the client's radial artery on the inside
of the wrist on the thumb side.
-Apply only enough pressure to radial pulse
- Using watch, count the pulse beats for a full
minute.
-Examine the rhythm and the strength of the
pulse.
-.Record the rate on the client’s chart.
Sign on the chart.
-Wash your hands.
- Report to the senior staff if you find any
abnormalities.
Rationale
 Handwashing prevents the spread of infection
 Organization facilitates accurate skill problems
 To confirm the necessity
 Providing information fosters cooperation and
understanding
 To provide easy access to pulse sites
 Relaxed position of forearm and slight flexion
of wrist promotes exposure of artery to palpation
without restriction.
 The fingertips are sensitive and better able to
feel the pulse. Do not use your thumb because it
has a strong pulse of its own.
 Moderate pressure facilitates palpation of the
pulsations. Too much pressure obliterates the
pulse, whereas the pulse is imperceptible with
too little pressure
 Counting a full minute permits a more accurate
reading and allows assessment of pulse strength
 and rhythm.
 Strength reflects volume of blood ejected
against arterial wall with each heart contraction.
 Documentation provides ongoing data
collection
 To maintain professional accountability
 Handwashing prevents the spread of infection
 To provide nursing care and medication
properly and continuously

c. Counting Respiration
Definition: Monitoring the involuntary process of inspiration and expiration in a patient
Purposes:
1. To determine number of respiration occurring per minute
2. To gather information about rhythm and depth
3. To assess response of patient to any related therapy/ medication

Procedure:
 Care Action
1. Close the door and/or use screen.
2. Make the client's position comfortable,
preferably sitting or lying with the head of the
elevated 45 to 60 degrees.
3. Prepare count respirations by keeping your
fingertips on the client’s pulse.
4. Counting respiration:
-Observe the rise and fall of the client’s (one
inspiration and one expiration).
- Count respirations for one full minute.
- Examine the depth, rhythm, facial expression,
cyanosis, cough and movement accessory.
5. Replace bed linens if necessary. Record the
rate on the client’s chart. Sign the chart
6. Perform hand hygiene
7. Report any irregular findings to the senior
staff.
Rationale
 To maintain privacy
 To ensure clear view of chest wall and
abdominal movements. If necessary, move the
bed linen.
 A client who knows are counting respirations
may
not breathe naturally.
 One full cycle consists of an inspiration and an
expiration.
 Allow sufficient time to assess respirations,
especially when the rate is with an irregular
 Children normally have an irregular, more
rapid
rate. Adults with an irregular rate require more
careful assessment including depth and rhythm
of respirations.
 Documentation provides ongoing data
collection.
 Giving signature maintains professional
accountability
 To prevent the spread of infection
 To provide continuity of care

d. Measuring Blood Pressure

Definition: Monitoring blood pressure using palpation and/or sphygmomanometer
Purpose:
1. To obtain baseline data for diagnosis and treatment
2. To compare with subsequent changes that may occur during care of patient
3. To assist in evaluating status of patient’s blood volume, cardiac output and vascular system
4. To evaluate patient’s response to changes in physical condition as a result of treatment with
fluids or medications

Procedure: by palpation and aneroid manometer

Care Action Rationale
 1. Wash your hands.
2. Gather all equipment. Cleanse the stethoscope
's ear pieces and diaphragm with a spirit swab
wipe.
3. Check the client’s identification. Explain the
purpose and procedure to the client.
4. Have the client rest at least 5 minutes before
measurement.
5. Determine the previous baseline blood
pressure , if available, from the client’s record.
6. Identify factors likely to interfere which
accuracy of blood pressure measurement :
exercise, coffee and smoking
7. Setting the position:
-Assist the client to a comfortable position. Be
sure room is warm, quiet and relaxing.
- Support the selected arm. Turn the palm
upward.
3) Remove any constrictive clothing.
 Handwashing prevents the spread of infection
 Organization facilitates performance of the
skill.
 Cleansing the stethoscope prevents spread of
infection.
 Providing information fosters the client’s
cooperation and understanding.
 Allow the client to relax and helps to avoid
falsely elevate readings.
 To avoid misreading of the client’s blood
pressure and find any changes his/her blood
pressure from the usual
 Exercise and smoking can cause false
elevations in blood pressure.
 The client's perceptions that the physical or
interpersonal environment is stressful affect the
blood pressure measurement.
 Ideally, the arm is at heart level for accurate
measurement. Rotate the arm so the brachial
pulse is easily accessible.
 Not constricted by clothing is allowed to access
the brachial pulse easily and measure accurately.
Do not use an arm where circulation is
compromised in any way

General Instructions for all Nursing Procedures

1. Wash your hands before and after any procedure.

2. Explain procedure to patient before you start.

3. Close doors and windows before you start some procedures

like bed bath and back care.

4. Do not expose the patient unnecessarily.

5. Whenever possible give privacy to all patients according to

the procedure.

6. Assemble necessary equipment before starting the

procedure.

7. After completion of a procedure, observe the patient reaction

to the procedure, take care of all used equipment and return

to their proper place.

8. Record the procedure at the end

Assignment to be submitted before 24/ 03/2020

Outline the procedure for checking axillary temperature by glass thermometer (10 marks)