Need advice for first clinical..

[KimWill19]

Started my first clinical at a geriatric home facility 2 weeks ago (7a-3p shift) Met my patient the first day.. 87 yr old male w/ dementia, npo, with continuous feeding via peg tube. We are only going once a week this month. Last week was our first day actually really taking care of our pt's hands on. At 7am i woke the pt, checked vitals, changed his diaper, and gave him a bed bath and changed his shirt. Also brushed his teeth with his toothbrush and toothpaste I found in his drawer. Was it right fir me to do that? Bc i was afraid he was going to joke. But thats what I found in his drawer. I found a couple tubes of blue ointment in his drawer too but saw the cna rub some around his butt so i didnt wanna use that to put on his lips for the dryness. Throughout the day I changed his diapers every 2 hours. Kept him up in semi fowlers position and i changed his ostomy gauze also. Other than that, what are some things i could do for the pt?

[TheCommuter, BSN, RN]

1. When performing oral care on a patient who is an NPO tube feeder, keep the bed in high Fowlers position during the entire time to minimize any risk of aspiration.

2. When changing diapers, always perform a quick assessment of the sacral / coccyx area to ensure the skin is not breaking down.

3. Check other bony prominences (elbows, heels, etc.) for signs of skin breakdown. It sounds as if your patient has limited or no mobility, so he has a high risk of developing pressure ulcers.

4. When not performing oral care, keep his head of bed elevated at least 45 degrees at all times to reduce aspiration risk.

5. If something doesn't seem right with your patient, do not forget about his blood sugar. Tube-fed patients sometimes have unstable blood sugar levels, even if they are nondiabetic, because various formulas are rich in glucose.

6. If your patient is having loose stools, the high-osmolarity formula might be the culprit.

[ILoveHealthCare]

Don't forget to turn the patient every 2 hours. And usually oral care should be provided multiple times during the shift if they are npo.