TEMPERATURE AND PULSE

        A PCWIP will rarely need to take the temperature or pulse of the client. However, these instructions will be helpful if the supervisor or supervisor requests that you obtain these readings on your client.

Temperature Procedure:

1. Wash your hands.
2. Have the client sit or lie down.
3. Gather equipment: thermometer, plastic probe cover, paper towel, soap and water, or alcohol wipe for cleaning.
4. Evaluate the safety of this procedure for this client:

             a)       Can the client hold the thermometer in their mouth? lf they cannot hold the thermometer without close supervision or assistance, do not take the temperature by mouth.

             b)      Report your safety concerns to the person who requested the temperature reading.

1. Evaluate the circumstances for accuracy:

            a)       Did client have something hot or cold to drink, or smoke a cigarette within last 15-20 minutes?

            b)      Is the client using oxygen?

            c)       If any of the above is true, the oral temperature will not be accurate.

1. Clean thermometer: Wipe with soap and water or an alcohol pad, from stem toward the probe end.
2. Apply a disposable probe cover (especially if the thermometer is used by others).
3. Press the on/off button to turn the unit on. (Depending on the model, it can be found either on the end of the thermometer or along the shaft as a raised button).
4. Wait momentarily for the display test to flash on the window. It may read: “8888” or “98.6” or some other brief message.
5. When the window has cleared, have the client place the thermometer probe tip under his tongue, to the left or right of center-tongue. The client should keep lips closed around the thermometer during measurement
6. Keep the thermometer in place for about 60 seconds or until the beeper sounds.
7. Remove the thermometer and discard the probe cover. .
8. Read and record the number in the window of the thermometer. (Oral normal readings are between 97 and 99 degrees Fahrenheit. Anything else should be reported promptly to the supervisor).
9. Push the on/off button. Discard the plastic probe cover.
10. Clean the thermometer from stem to probe, as above.
11. Place the thermometer into its case and put it away.
12. Wash your hands.

Axillary or Rectal Temperature, as above except:

1. Axillary-covered tip of thermometer is held in center of patient’s axilla for at least 9 minutes or until it beeps. Normal temperature is about 96 degrees.
2. Rectal -Use gloves and Standard Precautions. Cover patient to protect privacy.

           a)       Client is side-lying with upper leg pulled toward chest;

           b)      Lubricate covered rectal thermometer or rectal electronic probe. Gently insert to a maximum of I inch into rectum.

           c)       Hold in place at least 3 minutes while supporting the client to prevent any movement that could cause injury.

           d)      Normal reading is about 99 degrees.

Counting the Radial Pulse

• The pulse rate is the number of heartbeats counted in one full minute.
  • It is usually counted at the radial artery on the thumb side of the wrist.
  • Normal adult pulse rates are in the range of 60 – 100 beats per minute. Any number less than 60 or more than 100 beats per minute should be reported promptly to the supervisor.
  • Realize that the pulse rate could be affected by emotion such as anger, excitement, anxiety, exercise, infection, position, pain, and other factors.
  • The pulse should be a regular and strong rhythm.

Procedure for Counting the Radial Pulse:

• Wash your hands and gather equipment: a watch or clock with a second hand.
• Explain what you will be doing.
• Position the client comfortably with his hand and arm supported on the bed, chair, or their lap.
• Ask them to remain silent and still for a full minute.
• Place the first three fingertips of your hand on the thumb side of the client’s wrist and locate the pulse.
• Watch the second hand of the clock and count the number of beats for one full minute.
• Record the number (beats per minute) on your observation record and/or the flow chart in the home folder. Call the office to report any unusual findings, like high or low readings or irregular rhythms.
• Wash your hands.

Feeding the Client

        Clients may need to be fed for a variety of reasons: weakness, paralysis, visual impairment, and memory loss. Other disabilities may make self-feeding impossible.

        Preserving the client’s dignity is important, as are safety factors and techniques:

•  Explain to the client what you are going to do.
•  Wash your hands and assist the client to wash their hands as needed.
•  Seat the client comfortably.
•  Prepare the food to be served and tell the client what kind of food is being served.
•  Put a napkin on the client’s chest.
•  If the client has difficulty swallowing, make sure the food is pureed, soft, or cut in small pieces. (Check care plan).
•  Make sure the food is not too hot.
•  Allow time for the client to chew and swallow.
•  Use a straw for liquids if necessary. Be careful of the temperature of liquids.
•  Converse with the client. B encouraging. Allow the client to be as independent as possible.
•  If the client is confused, it may be helpful to hold one of their hands while feeding.
•  Keep the client’s mouth and face clean.
•  For feeding a blind client, describe the food you are offering and use the numbers on the clock to identify the location of the food on the plate.

EYE CARE

        The care recipient may need your assistance in putting eye drops or ointment in the eyes. Helping with eye care is best when a certain routine has been established for the family caregiver’s assistance. The routine may include things such as the kind of solution, how many drops, and which eye it goes into, etc.

        Instilling Eye Drops or Ointment:

1. Assemble supplies

• Eye care product (drops, ointment);
• Gloves;
• Tissues or cotton balls.

1. Wash your hands.
2. Position the care recipient sitting down with head slightly back. (Can also lay on back with pillow under neck to extend head back.)
3. Put on gloves.
4. Pull down on lower lid and have the care recipient look upward.
5. Hold dropper in dominant hand about ½” – ¾” from eye.
6. Instill prescribed number of drops in lower lid. Do NOT touch lid with dropper.
7. If the care recipient blinks or closes eye, repeat procedure.
8. Have care recipient close eye for a short time.
9. Wipe off any excess medication with tissue or cotton ball. Wipe from inner corner to outer corner of eye.
10. Remove gloves and wash hands.
11. Return supplies to proper place and dispose of garbage.

SELF-ADMINISTERING MEDICATIONS

• A PCW/P is not permitted or licensed to give medications to a client.
• Administering medications is the responsibility of the supervisor, client, or family.

There are two types of medications:

• Prescription drugs which require a doctor’s order
• Over the counter (OTC) drugs that can be bought without a Doctor’s order.

Procedure:

• Check and follow the care plan.
• Remind or ask the client if it is time to take medication – according to the care plan.
• Wash hands.
• Place the container that the client requests within reach.
• Assist with opening top if needed.
• Have spoon for liquid medication and/or water or juice available for client.
• Report to the supervisor and family if the client is confused about the medications

Medication boxes (Pre-poured)

        Some clients have pre-poured medications. These drugs are measured into special containers (medication boxes) by the supervisor or family member. Each compartment is labeled for a certain day and time. For example on Friday morning, the client would take a medication from the compartment labeled Friday 9 a.m.

        Medication set-ups help reduce error and are helpful for clients with poor vision or who have trouble remembering.

        PCW/P’s do not administer prescription or OTC drugs. When a PCW/P reminds or assists a client with medications; this means the client is taking the responsibility.  A PCW/P may take the   container to the client at their request and open it if needed, but may not take the medication out of the container. A personal care worker may assist a client with medication reminding only when medications have been preselected by the client, a family member, a supervisor, or a pharmacist, and are stored in containers other than the prescription bottles, such as medication minders.

        Medications should be properly labeled so you can see the dose and time it should be taken. You can remind the care recipient to take their medication. You can assist with opening and recapping the containers. Since a care recipient with arthritis may have trouble handling the medication bottle, you may put the medication into the cap or make it possible for them to retrieve and swallow the medication on their own. The family caregiver can assist with proper positioning to make sure the client will take the medications safely. The best position is for the care recipient to sit up as much as possible. You can assist the care recipient to drink the fluid needed to swallow the medications.

        Observe your care recipient for any side effects from medications. If noticed, report the observations to the care recipient’s physician. Also, report if the care recipient is not taking the medication or is taking the wrong amount. Make sure that medications are stored properly. Some need to be refrigerated. Keep them out of reach of children. Your care recipient may have a medication planner that has an entire week of medications divided into each day of the week. You can make making sure the right day of the week is opened and taken.

        Common side effects from medication include:

• Nausea and vomiting;
• Diarrhea & Rash or hives;
• Headache;
• Confusion or agitation.

PROSTHESIS/ORTHOTICS

        The care recipient may have a prosthesis or orthotic device that he/she needs assistance with applying or removing. Knowing what they are and some information about their usage will help you in assisting the care recipient. A prosthesis is an artificial body part. Some examples are: arm, leg, breast, or eye. Prosthesis is usually used to promote the independence of the care recipient. An orthotic device is an orthopedic appliance or apparatus used to support, align, prevent, or correct deformities or to improve function of movable parts of the body. A more common word for this device is a brace. The prosthesis and the orthotic device need to be applied correctly to function properly. The care recipient will often have a picture to show the proper application. Follow the recommended use–for example, wearing it for certain time frames, etc. Observe the condition of the skin daily. If the skin has red areas or open sores, the device may not be fitting well or is not being applied properly. The part of the body where the prosthesis or orthotic is applied will often have some type of covering over the skin to protect it. Report any unusual skin conditions to the care recipient’s physician. Check prosthesis or orthotic devices often for:

• Loose or worn parts
• Missing or loose screws
• General condition, especially the straps and/or Velcro
• Cleanliness