Module 29. Assisting with Prescribed Medical Equipment, Supplies… · Medical Equipment, Supplies,...

HOMECARE AIDE WORKFORCE INITIATIVE (HAWI)

Trainer’s Manual—Page 29.1

Home Health Aide Training

Module 29. Assisting with Prescribed Medical Equipment, Supplies,

and Devices Goal The goal of this module is to prepare participants to assist clients with a variety of equipment, supplies, and devices that are prescribed to assist the client with ambulation, elimination, or respiration.

Time 8 hours [2 hours on the first day; 6 hours on the second day]

Module 29. Assisting with Prescribed Medical Equipment, Supplies, and Devices


Trainer’s Manual—9.2

Activities Teaching Methods Time

Day 1

1. Introduction to Prescribed Medical Equipment, Supplies, and Devices

Interactive presentation, small-group discussion, and large-group discussion

30 minutes

2. Your Role in Assisting with the Use of ACE Bandages, Enemas, and Douches

Interactive presentations, demonstration, pairs work and reporting

1 hour and 30 minutes

Day 2

3. Overview of Respiratory Conditions

Large-group exercise, small-group work and large-group discussion, and interactive presentation

45 minutes

4. Introduction to the Nebulizer and CPAP Machines

Interactive presentation with demonstrations

40 minutes

5. Working with Oxygen Small-group work, interactive presentation, and demonstrations

50 minutes

6. The Aide’s Role in Assisting with Respiratory Equipment, Supplies, and Devices

Small-group work, large-group reporting and discussion, and interactive presentation

45 minutes

7. Assisting with Prescribed Medical Equipment, Supplies, and Devices: Practice Lab and Return Demonstrations

Practice triads and return demonstrations

2 hours and 30 minutes

8. Identifying Your Feelings about Assisting with Prescribed Medical Equipment, Supplies, and Devices

Small-group work and large-group discussion

30 minutes

Supplies

Flip chart, markers, and tape

Paper and pencils

Index cards

CPAP machine

Nebulizer




Air compressor

Oxygen tank

Nasal cannula

Oxygen mask

Liquid oxygen reservoir and oxygen concentrator (if available)

Learner’s Book 1. What Are Prescribed Medical Equipment, Supplies, and Devices? 2. Why Are Prescribed Medical Equipment, Supplies, and Devices Important? 3. Basic Information about Skin and the Medical Equipment Prescribed to Prevent Skin

Breakdown 4. Basic Information about Elimination and the Medical Equipment Prescribed for It 5. Basic Information about Asthma 6. Basic Information about COPD 7. Basic Information about Sleep Apnea 8. Medication Nebulizer 9. CPAP Machine Illustration 10. Safety Precautions to Follow When Oxygen Is in Use 11. Parts of an Oxygen Tank 12. Oxygen Concentrator 13. Stories from Home Health Aides

Skills Checklists

Skills Checklist 1. Assisting with an ACE Bandage (DOH Procedure Checklist E-1)

Skills Checklist 2. Assisting with the Use of a Commercially Prepared Enema (DOH Procedure Checklist E-5)

Skills Checklist 3. Assisting with the Use of a Soap Solution Enema (DOH Procedure Checklist E-6)

Skills Checklist 4. Assisting with the Use of a Douche (DOH Procedure Checklist E-7)

Skills Checklist 5. Assisting with the Use of a Commercially Prepared Douche (DOH Procedure Checklist E-8)

Skills Checklist 6. Assisting with the Use of a Medication Nebulizer and Air Compressor (DOH Procedure Checklist E-11)

Skills Checklist 7. Assisting with the Use of a CPAP Machine (DOH Procedure Checklist E-12)




Skills Checklist 8. Assisting with the Use of an Oxygen Tank and Liquid Oxygen Reservoir (DOH Procedure Checklist E-10)

Skills Checklist 9. Assisting with the Use of an Oxygen Concentrator (DOH Procedure Checklist E-9)

Handouts

Handout 1. Key Terms

Handout 2. Summary of Key Information

Advance Preparation

Review all the training instructions and learner’s materials for this module. Note that icons are used to remind the trainer of the following:

When you are presenting or covering Key Content in the discussion. (Key Content is also addressed in many of the handouts.)

When it is important to ask a particular question to get participants’ input.

When it is time to refer to the Learner’s Book.

When it is time to distribute a skills checklist.

When it is time to distribute a worksheet.

When it is time to distribute and discuss a handout. Copy all handouts and worksheets for participants Prepare copies of the skills checklists. You will need one copy for each participant, to be collected and reused for subsequent trainings. Laminating the skills checklists will make them more durable and reusable. Gather all necessary supplies and equipment. Please note that the Key Content is meant to be background information for the trainer. DO NOT READ OUT LOUD TO PARTICIPANTS.




Activity 1. Introduction to Prescribed Medical Equipment, Supplies and Devices

Prepare the flip chart page, “Learning Agenda” (Step 1).

Activity 2. Your Role in Assisting with the Use of ACE Bandages, Enemas, and Douches

Prepare the flip chart page, “Summary Questions for Skills Checklists” (Step 8).

Activities 3 to 6

No advance preparation needed. Activity 7. Assisting with Prescribed Medical Equipment, Supplies, and Devices: Practice Lab and Return Demonstrations

Set up workstations. Organize the equipment for the number of practice triads that you will have. You should have enough equipment so every triad can be practicing a procedure for assisting with medical equipment, supplies, and devices at all times. . Have the extra set of skills checklists ready for trainers to use in assessing return demonstrations. Additional trainers may be needed for this activity, to assist, monitor, and assess return demonstrations. If possible and if needed, be prepared to observe participants who need to do return demonstrations for skills covered prior to this module.

Activity 8. Identifying Your Feelings about Assisting with Prescribed Medical Equipment, Supplies, and Devices

No advance preparation needed.




Activity 1. Introduction to Prescribed Medical Equipment, Supplies, and Devices

30 minutes Learning Outcomes By the end of this activity, participants will be able to:

Name at least three types of prescribed medical equipment, supplies, or devices. Describe at least one way that prescribed medical equipment, supplies, or devices may benefit for the client.

Key Content

Prescribed medical equipment, supplies, and devices play an important role in the well-being

of some clients, both in terms of physical health and in terms of quality of life.

Medical equipment, supplies, and devices may be prescribed to assist a client with:

Mobility

Preventing Skin Breakdown

Respiration

Elimination

Activity Steps Interactive Presentation—10 minutes 1. Introduce the activity. Post the prepared flip chart page with the “Learning Agenda” for this

module and review. Ask if there are any questions.




Flip Chart

LEARNING AGENDA:

Assisting with Prescribed Medical Equipment, Supplies, and Devices

Understand why medical

equipment, supplies, and devices are important and how they are used.

Understand your role in assisting clients with prescribed medical equipment, supplies, and devices.

Explore your own feelings and attitudes about assisting clients with prescribed medical equipment, supplies, and devices.

2. Define prescribed medical equipment, supplies, and devices. Explain that prescribed

medical equipment, supplies, and devices help a client to gain or maintain functions of the body. Explain that this equipment may assist the client with one of four body functions or systems.

3. Refer to 1. What Are Prescribed Medical Equipment, Supplies, and Devices? in the Learner’s Book. Ask if there are any questions.

Small-Group and Large-Group Discussion—20 minutes

4. Form small groups and give directions. Divide participants into groups of three to four people, and then refer to 2. Why Are Prescribed Medical Equipment, Supplies, and Devices Important? in the Learner’s Book. Read the directions in the first paragraph out loud. Let the groups know that they will have ten minutes to read the three stories on 2 and to answer the discussion questions for each of them. Ask the participants if they have any questions.




5. Debrief with participants. After ten minutes, ask the small groups to return to the large group. Then, read the first story out loud and ask one or two small groups how they answered the discussion questions for this story. Next, read the second story out loud and ask one or two different small groups how they answered the discussion questions. Repeat this process with the third story.

6. Summarize this activity. Point out that the clients in these three stories all were able to

improve their bodily functions when medical equipment was prescribed for them. Emphasize that, once these clients had the medical equipment they needed, they all felt better and the quality of their lives improved. Explain that, in the rest of this module, participants will learn about their own role in assisting clients with prescribed medical equipment.




Activity 2. Your Role in Assisting with the Use of ACE Bandages, Enemas, and Douches

1 hour and 30 minutes

Learning Outcomes By the end of this activity, participants will be able to:

Describe their role in assisting with ACE bandages, enemas, and douches. Describe what to observe, record, and report when assisting with the ACE bandages, enemas, and douches.

Key Content

The direct-care worker has an important role in assisting with prescribed medical equipment,

supplies, and devices.

When assisting with prescribed medical equipment, supplies, and devices, safety is very important! Always wash your hands before and after each procedure and wear gloves or other protective personal equipment if you may be exposed to body fluids.

You will need to carefully record the procedures you assist with. Recording must be done

accurately, carefully, and promptly.




Activity Steps Interactive Presentation—5 minutes 1. Introduce the activity. Explain that this activity will focus on their role in assisting with

certain kinds of prescribed medical equipment, supplies, and devices. Note that participants already learned about their role in assisting with prescribed medical equipment and devices related to mobility in the module on Assisting with Ambulation and Transfers; Making a Bed. In this module, they will learn about their role in assisting with an ACE bandage and with equipment, supplies, and devices related to elimination and respiration.

2. Refer to 3. Basic Information about Skin and Medical Equipment Prescribed to Prevent Skin Breakdown in the Learner’s Book. Ask if there are any questions.

Teaching Tip Note to participants that they will learn more about special skin care and assisting with a dressing change in other modules.

Demonstration—10 minutes 3. Demonstrate the procedure. Show participants an ACE bandage. Then ask for a volunteer

to help you demonstrate how to put an ACE bandage on a client. Apply the ACE bandage, following the steps described in Skills Checklist 1. Assisting with an ACE Bandage. Explain that assisting with an ACE bandage is done only under special circumstances, which means that the nurse would teach them how to follow the procedure described on the skills checklist in the client’s home.

4. Distribute and review Skills Checklist 1. Assisting with an ACE Bandage.

5. Describe what to observe, record, and report. Explain that it is important for participants to observe the client’s skin for any signs of discoloration, irritation, or swelling. If these are observed, they should be reported to the nurse. Ask participants if they have any questions.




Interactive Presentation—10 minutes

6. Discuss and display equipment, supplies, and devices prescribed for elimination. Refer to 4. Basic Information about Elimination and Medical Equipment Prescribed for It in the Learner’s Book. Show a sample of each item as you are discussing its purpose. Explain that participants will learn about assisting with catheters, catheter tubing, and drainage bags in the module on Assisting with Ostomy Care.

Pairs Work—20 minutes 7. Form pairs and give instructions. Divide the participants into pairs. Explain that each pair

will be given a skills checklist that describes their role in assisting with a procedure related to elimination. Explain that they will read this procedure with their partner. They will then answer some questions about this procedure. These questions will help them remember important safety information about the procedure, and also help them remember what they need to observe, record, and report.

8. Distribute skills checklists and give remaining instructions. Distribute Skills Checklist 2. Assisting with the Use of a Commercially Prepared Enema to one pair. Each of the remaining pairs should get one of the following skills checklists:

Skills Checklist 3. Assisting with the Use of a Soap Solution Enema

Skills Checklist 4. Assisting with the Use of a Douche

Skills Checklist 5. Assisting with the Use of a Commercially Prepared Douche

9. Post and review the flip chart page with summary questions. Make sure participants understand that they should read their skills checklist with their partner and then work together to answer the questions on the flip chart. Note that they will have 15 minutes for this activity. After 15 minutes, they will come back to the large group to share their answers to these questions with everybody.




Flip Chart

SUMMARY QUESTIONS FOR

SKILLS CHECKLISTS:

1. What steps will help you prevent the spread of infection?

2. What do you need to observe (look for) during this procedure?

3. What might you need to report to the supervising nurse?

4. What do you need to record after this procedure?

Teaching Tips Do not distribute all four skills checklists to all of the participants yet because this might be confusing or overwhelming. Instead, give one copy of each skills checklist to the pair that is assigned to read it and discuss it. After the pairs work, participants will get copies of all skills checklists. You may not have enough participants to distribute one skills checklist to each pair. If this is the case, you can assign more than one skills checklist to each pair.

10. Monitor the pairs work. Be sure to observe the pairs carefully while they are working to

make sure they have understood your directions, and to offer help as needed. Ask them to wrap up after 15 minutes.

Demonstration with Pairs Reporting—45 minutes

11. Demonstrate how to assist with using a commercially prepared enema. After the pairs have finished their work, distribute Skills Checklist 2. Assisting with the Use of a Commercially Prepared Enema to all the participants (except for the pair that has it already) and read it out loud. Demonstrate how to use the equipment or supplies, as appropriate. Note that they will practice these procedures later in this module. Ask the pair(s) that was assigned to this skills checklist to share their answers to the four discussion questions on the flip chart page. Briefly discuss their answers, clarifying or adding any information as needed.




Teaching Tip The pairs should stay seated together. This is because they will discuss another skills checklist with the same partner in the next activity.

12. Discuss Skills Checklists 3 through 5. Repeat Step 11 for each of the remaining skills

checklists that were distributed to the pairs.

13. Summarize. Briefly review the importance of safety, including infection control, in the procedures discussed in this activity.




Activity 3. Overview of Respiratory Conditions 45 minutes


Identify equipment, supplies, and devices that may be prescribed to clients to assist enhance respiratory function.

Key Content There are many diseases and conditions that can have an impact on respiratory functioning.

Some of the most common are:

Asthma

COPD

Sleep apnea The respiratory equipment that the home health aide may assist with includes:

The medication nebulizer and air compressor

The CPAP machine

The oxygen tank

The liquid oxygen reservoir

The oxygen concentrator

There are some tasks that the home health aide is permitted to do, and some tasks that the home health aide is not permitted to do when assisting with respiratory equipment, supplies, and devices. There are also some tasks that the home health aide may assist with under special circumstances only. There are certain things that the aide will observe, record, and report.




Activity Steps Large-Group Exercise—10 minutes 1. Introduce respiration and conduct an experiment. Begin by explaining that “respiration”

is the term used to describe how the body uses oxygen to sustain its vital functions. We bring oxygen into the body when we breathe. Explain that it is extremely important for the body to get enough oxygen. Demonstrate how important oxygen is for the body by conducting an experiment with participants: tell them that when you say “go,” you want them all to exhale all of the air in their lungs and see how long they can go without inhaling. Explain that you will count out loud for one minute (counting each second) so that participants can time themselves to see how long they can go without inhaling. Say go, and then count each second out loud for one minute. After one minute, ask participants how many seconds they were able to hold their breath. Then, point out that their experience with this experiment demonstrates that the body needs a constant supply of oxygen. Share the following facts about breathing and respiration:

A person can only go without oxygen for only three to four minutes before brain cells start to die. The average person breathes 10 times per minute, 600 times per hour, over 14 thousand times per month and over five million times per year!

Small-Group Work and Large-Group Discussion—15 minutes

2. Introduce small-group work. Next, explain that many diseases and conditions make it

difficult for the body to get the oxygen it needs in order to function properly. Then explain that you would like participants to share their own experiences with these diseases and conditions. Divide participants into small groups of three to four people. Then explain that they will have ten minutes to discuss the following questions:

Do you know anyone who has a respiratory condition or disease?

What is the condition or disease?

What are their symptoms?




3. Facilitate discussion. After ten minutes, ask the small groups to share with the large group the diseases and conditions that they discussed. Point out that, fortunately, there are many different types of equipment, supplies, and devices that can help clients who have these diseases and conditions. Explain that, later in the activity, they will be introduced to the equipment, supplies, and devices that may be prescribed to clients, and will also learn about their role in using them.


4. Review Learner’s Book sections about asthma, COPD, and sleep apnea. Explain that participants will now learn about some of the most common respiratory diseases and conditions. Refer to 5. Basic Information about Asthma, 6. Basic Information about COPD, and 7. Basic Information about Sleep Apnea in the Learner’s Book. Review sections with participants. When reviewing section 6, explain that oxygen equipment may be prescribed to clients who have a range of diseases or conditions, but that COPD is the most common condition for which oxygen is prescribed. Ask participants if they have any questions.

5. Review the home health aide’s role. Explain that the home health aide plays a very important role in assisting the client with respiratory equipment, supplies, and devices. As always, knowing what to observe, record, and report is vital. However, what they are allowed to do beyond that is different with each piece of equipment or device. Therefore, it is very important to know what they are allowed to do, are not allowed to do, and are allowed to do only under special circumstances (that is, with training from the supervising nurse). The remainder of this module will focus on their specific roles in the use of each type of respiratory equipment or device.




Activity 4. Introduction to the Nebulizer and CPAP Machines


Describe their role in assisting with nebulizers and CPAP machines.

Key Content

A nebulizer changes liquid medication into a mist that is inhaled through a mouthpiece. The

parts of the nebulizer include the cup, mouthpiece, tubing, and an air compressor.

The home health aide can assist the client in using the nebulizer by setting up the equipment, adding saline to the nebulizer cup, cleaning the equipment after use, and putting it away.

The home health aide is allowed to add medication to the nebulizer cup under SPECIAL CIRCUMSTANCES ONLY.

While the client is using the nebulizer, the home health aide should observe and record:

Client’s pulse and respiration (before, during, and after using the nebulizer)

Signs that the client is not getting enough oxygen (stop the machine IMMEDIATELY if these signs are observed and CALL THE SUPERVISOR)

When the nebulizer was used and for how long

The home health aide should report to the supervisor any signs of the client not getting enough oxygen while using the nebulizer, and if the client does not use the nebulizer as directed in the care plan.

CPAP stands for “Continuous Positive Airway Pressure.” A CPAP machine blows air into the client’s nose and throat. The air pressure is high enough to keep the client’s airway open while he or she is asleep.




When assisting your client with a CPAP machine, make sure that:

The mask is not too tight, because this can irritate the face.

The mask is not too loose, because air will blow into their eyes.

The air filter on the machine has air flowing around it. Make sure the machine is not against a wall or too close to the bed.

The HHA can assist the client in using the CPAP machine by setting up the equipment,

cleaning it, and then putting it away. They can also help the client to adjust the mask and head straps and to remove them after sleep, and help them to get comfortable for sleep.

While the client is using the CPAP machine, the home health aide should observe the client for snoring or sleep interruptions. In general, they should observe and report if there are any problems with the equipment or if the client has:

Runny nose

Dry throat

Headache

Ear pain

Daytime sleepiness

Loud snoring

Complaints of not sleeping well, or needing to sit up to breathe

Activity Steps

Interactive Presentation with Demonstrations—40 minutes

1. Display and describe the medications and equipment used for asthma treatment. Show

participants samples of asthma medications and an oxygen mask. Describe their role in assisting the client with these treatments.

2. Display a medication nebulizer and describe the procedure. Explain that a nebulizer turns medication into a mist that can be inhaled. The medication helps to loosen mucus in the lungs so that the client can cough this up. Explain that the medication is mixed with saline and put into the nebulizer with an eye dropper or syringe. Show participants a nebulizer, and where the medication is placed in the nebulizer. Also, show how the client inhales the medication through the mouthpiece. Refer to 8. Medication Nebulizer in the Learner’s Book. Ask participants if they have any questions so far.




3. Demonstate the HHA’s role in assisting with a medication nebulizer. Distribute Skills Checklist 6. Assisting with the Use of a Medication Nebulizer and Air Compressor. Review the skills checklist with participants and answer any questions. Be sure to emphasize that the home health aide is permitted to add saline to the nebulizer, and that it is very important to use saline instead of tap water. This is because saline is sterile, and is specially mixed with salt. Also emphasize that the home health aide is only permitted to add the medication to the nebulizer under special circumstances. Ask the participants to recall what is meant by “special circumstances.”

Teaching Tip If needed, clarify that “special circumstances” means a situation when they will be allowed to do a task after they have been taught how to do it by a nurse at the client’s home.

4. Display a CPAP machine and describe the procedure. Show participants a CPAP machine and describe the various parts of the machine and how they function. Refer to 9. CPAP Machine Illustration in the Learner’s Book and ask participants if they have any questions.

5. Demonstrate the HHA’s role in assisting with a CPAP Machine. Distribute Skills Checklist 7. Assisting with the Use of a CPAP Machine and briefly demonstrate the steps. Explain that participants will have a chance to practice this procedure in the practice lab later in the module.




Activity 5. Working with Oxygen 50 minutes


Describe their role in assisting with oxygen equipment. List the safety precautions that must be followed when working with oxygen.

Key Content

Oxygen is “flammable,” which means it can easily start a fire and burn quickly. Therefore, it

is very important to follow certain safety precautions when oxygen is in use. These safety precautions are:

Remove from the area any materials that can burn.

Post “no smoking” or “oxygen in use” signs.

Learn how to turn off the oxygen tank in case of fire.

Equipment that may be used by the home health aide include:

Oxygen tank

Air tube and nasal cannula

Liquid oxygen reservoir

Oxygen concentrator

The home health aide can assist the client in using oxygen equipment by setting up the

equipment, adding distilled (sterile) water to the humidifying bottle, checking if there is enough oxygen in the tank, turning the oxygen tank on and off, checking the level of the flow meter, turning the flow meter on and off, checking that air is coming through the mask or nasal cannula, assisting the client to put on the mask or nasal cannula, and putting the equipment away.




The home health aide is allowed to adjust the flow meter under SPECIAL CIRCUMSTANCES ONLY.

While the client is using the oxygen equipment, the home health aide should observe and record:

Client’s pulse and respiration (before, during, and after using the equipment)

Signs that the client is not getting enough oxygen (stop the machine IMMEDIATELY if these signs are observed and CALL THE SUPERVISOR)

When the oxygen equipment was used and for how long

Activity Steps

Small-Group Work—10 minutes 1. Introduce the importance of safety when assisting with oxygen. Explain that you are

about to review procedures for assisting with oxygen equipment, but that before you review these procedures, you want to review important safety information. Ask participants:

Why do you think safety is especially important when assisting with oxygen equipment?

Listen to participants’ responses. Then emphasize that one reason safety is especially important when assisting with oxygen equipment is that oxygen is flammable. This means that there is a danger that the oxygen could explode if certain safety precautions are not followed.

2. Set up small-group activity. Explain that you would like participants to return to the same small groups that they were in earlier in the module (for “Overview of Respiratory Conditions”). Explain that you would like the small groups to spend five minutes brainstorming what safety precautions need to be in place in the client’s home in order to prevent a fire or explosion when oxygen is present.

3. Debrief small-group activity. After five minutes, ask the participants to share their brainstorming ideas with the large group.




Interactive Presentation and Demonstrations—40 minutes

4. Explain safety precautions. Refer to 10. Safety Precautions to Follow When Oxygen Is in Use in the Learner’s Book. Ask participants if they have any questions.

5. Describe the oxygen tank. Show participants an oxygen tank and point out the flow meter, the flow meter valve, the regulator gauge, the tank valve, the air tube, and the humidifying bottle. Explain the function of each part of the oxygen tank. Then explain that oxygen tanks come in many different sizes; some tanks are portable so that the client can get oxygen treatment when they are not at home. Refer to 11. Parts of an Oxygen Tank. Ask participants if they have any questions.

6. Demonstrate how to assist with the use of an oxygen tank and liquid oxygen reservoir. Describe the procedure for assisting with the use of an oxygen tank, and then distribute Skills Checklist 8. Assisting with the Use of an Oxygen Tank and Liquid Oxygen Reservoir. Explain that participants will have a chance to practice this procedure at a later time. Be sure to emphasize that:

The only thing they are permitted to adjust on an oxygen tank is the tank valve. They

are permitted to turn this valve on at the beginning of a client’s treatment, and off at the end of the treatment.

They should check the flow meter to make sure that the valve is set for the dosage indicated in the care plan. If it is set for a different dosage, they should call their supervisor, because they are only permitted to adjust the flow valve UNDER SPECIAL CIRCUMSTANCES.

They should check the regulator gauge to make sure there is enough oxygen left in the tank for the treatment. If there is not enough oxygen, they should call the supervisor.

If the oxygen tank has a humidifying bottle, it should be filled with sterile water. The

home health aide is permitted to add the sterile water to the bottle. Note that using tap water is not permitted.




The home health aide can help prevent the skin behind the client’s ears from becoming irritated by padding the tubing.

7. Describe an oxygen concentrator and demonstrate the procedure for using it. Review 12. Oxygen Concentrator in the Learner’s Book..

Next, distribute Skills Checklist 9. Assisting with the Use of an Oxygen Concentrator and demonstrate the procedure. Explain that participants will have a chance to practice this procedure during the practice lab.




Activity 6. The Aide’s Role in Assisting with Respiratory Equipment, Supplies, and Devices


Describe what they are permitted to do when assisting with respiratory equipment, supplies, and devices, as well as what they are not permitted to do or are permitted to do under special circumstances only.

Key Content

It is very important for the home health aide to be aware of what they are and are not

permitted to do to assist their client. Participants can become more familiar with what they are and are not permitted to do by carefully reviewing the procedures in this module. If they ever have a question about what they are permitted to do, they can always call their supervisor for clarification.

Activity Steps

Small-Group Work—20 minutes

1. Set up small-group work. Explain that you will now review some of the key information about assisting with equipment, supplies, and devices related to respiration. Ask participants to work in the same small groups. Distribute Worksheet 1. Review of the Dos and Don’ts. Explain that this worksheet lists some of the tasks related to the procedures that were reviewed. Their task will be to work with their small group to decide which of these tasks they are permitted to assist with, which tasks they are not permitted to assist with, and which ones they can only do under special circumstances. Explain that they can refer back to the skills checklists that describe these procedures (Skills Checklists 6 through 9). Ask if participants have any questions about the task. Explain that they will have 15 minutes to complete this activity.




Large-Group Reporting and Discussion—15 minutes

2. Facilitate large-group reporting. After 15 minutes (or sooner, if the groups have completed

their work), have the small groups take turns sharing their responses on Worksheet 1. Review of the Dos and Don'ts. Review the procedures as necessary and answer any questions. Be sure that participants understand that, if they find any equipment that is broken or any supply that needs to be reordered, they are simply to inform the client or the client’s family. It is the responsibility of the client or the client’s family to call the supplier. Explain that if the issue is not addressed, the home health aide should follow up by calling their supervisor.


3. Review what to report. Explain that it is very important to observe the client during the

procedures that they have just reviewed and to report IMMEDIATELY any signs that the client is not getting enough oxygen. Ask participants:

What are some of the signs that might tell you that your client is not getting enough oxygen?

4. Listen to participants’ responses. Make sure the following signs are mentioned:

Difficulty breathing

Rapid pulse and respiration

Cold, clammy skin

Blue or darkened lips, fingernails, or eyelids

Being unable to sit still Not responding when you call his/her name

Having headaches or complaining of no energy




Activity 7. Assisting with Prescribed Medical Equipment, Supplies, and Devices: Practice Lab and Return Demonstrations

2 hours and 30 minutes Learning Outcomes By the end of this activity, participants will be able to:

Demonstrate how to assist with the use of a commercially prepared enema and a soap solution enema. Demonstrate how to assist with the use of a douche. Demonstrate how to assist with the use of a medication nebulizer and air compressor. Demonstrate how to assist with the use of a CPAP machine. Demonstrate how to assist with the use of oxygen equipment.

Key Content By the end of this activity, every participant should have had the opportunity to demonstrate

how to use all of the prescribed medical equipment, supplies, and devices covered in this module. For each return demonstration, a trainer will observe and assess the participant, using the skills checklist.

While some participants are doing their return demonstrations, other participants will continue to practice these skills, working in practice triads as before.

Some participants may need to do return demonstrations for skills covered prior to this module.




Activity Steps Practice Triads and Return Demonstrations—2 hours and 30 minutes 1. Note the workstations for this activity. Point out which skills will be practiced at each

location: assisting with an enema, assisting with a douche, assisting with the use of the medication nebulizer and air compressor, assisting with the CPAP machine, and assisting with the oxygen equipment. (See Advance Preparation for tips for setting these up.)

2. Set up triads and explain your role. Participants will work in triads for skills practice, until they are ready to do their return demonstrations. Explain that you (and other trainers, if available) will be observing their practice and answering questions as needed. Participants will use the skills checklists that were distributed during the activities when the skills were introduced.

Teaching Tips If this is the first time they are practicing a particular skill, each participant should take a turn in each role: practicing the task as a direct-care worker, experiencing what it feels like as a client, and observing (reviewing the steps for each task on the checklist while observing teammates and encouraging them as they perform the steps). For return demonstrations, participants will probably remain in their triads, depending on time, space, and the number of trainers available to observe return demonstrations (see Advance Preparation). Trainers should have enough copies of all the skills checklists to assess return demonstrations for all participants who did not do their return demonstrations earlier.

3. Conduct practice and return demonstrations.




Activity 8. Identifying Your Feelings about Assisting with Prescribed Medical Equipment, Supplies, and Devices


Identify their attitudes and feelings about assisting with the use of prescribed medical equipment, supplies, and devices, as well as how these attitudes and feelings may impact the client.

Key Content

Home health aides feel a range of emotions when they assist with medical equipment,

supplies, and devices. These feelings are normal. It is helpful for the home health aide to pay attention to his or her own feelings and to get support when they need it.

It is important for home health aides to be aware that their feelings can have an impact on

their clients. Home health aides should be encouraging and supportive when they are assisting their clients with medical equipment, supplies, and devices. Home health aides should also encourage clients to be as independent as possible.

Activity Steps Small-Group Work—15 minutes

1. Review the importance of being aware of their feelings and the possible impact on the client. Discuss the two bullets under Key Content.



Trainer’s Manual—.29

2. Set up small-group work. Ask participants to stay in their triads for this discussion. Refer to 13. Stories from Home Health Aides in the Learner’s Book. Read the three stories out loud. Ask participants to spend about 10 minutes discussing the stories in their group and answering the question in section 13.

Large-Group Discussion—15 minutes

3. Encourage sharing with the large group. After 10 minutes, ask the triads to end their discussions. Ask if anyone would like to share with the larger group the feelings that they talked about with their partners. Validate the feelings that participants share by explaining that there is no “wrong way” to feel. Reassure participants that certain difficult feelings (like nervousness) will likely become less strong with time and additional practice. Encourage participants to approach you outside of class to speak further about their feelings if they want to.

Teaching Tip If no one mentions having similar feelings to the home health aides in section 15, you may want to ask the participants to raise their hands if they can identify with each one. Most likely, more than one person will raise their hand. People who are feeling the same way will be reassured that they are not alone.

4. Summarize the module. Distribute and review Handout 1. Key Terms and Handout 2. Summary of Key Information. Answer any questions.


Learner’s Book—Page 29.1

Learner’s Book

Module 29. Assisting with Prescribed Medical

Equipment, Supplies, and Devices Activity 1. Introduction to Prescribed Medical Equipment, Supplies, and Devices 1. What Are Prescribed Medical Equipment, Supplies, and Devices? 2. Why Are Prescribed Medical Equipment, Supplies, and Devices Important? Activity 2. Your Role in Assisting with the Use of ACE Bandages, Enemas, and Douches 3. Basic Information about Skin and Medical Equipment Prescribed to Prevent Skin Breakdown Skills Checklist 1. Assisting with an ACE Bandage 4. Basic Information about Elimination and Medical Equipment Prescribed for It Skills Checklist 2. Assisting with the Use of a Commercially Prepared Enema Skills Checklist 3. Assisting with the Use of a Soap Solution Enema Skills Checklist 4. Assisting with the Use of a Douche Skills Checklist 5. Assisting with the Use of a Commercially Prepared Douche




Activity 4. Overview of Respiratory Conditions 5. Basic Information about Asthma 6. Basic Information about COPD 7. Basic Information about Sleep Apnea Activity 5. Introduction to the Nebulizer and CPAP Machines 8. Medication Nebulizer Skills Checklist 6. Assisting with the Use of a Medication Nebulizer and Air Compressor 9. CPAP Machine Illustration Skills Checklist 7. Assisting with the Use of a CPAP Machine Activity 6. Working with Oxygen 10. Safety Precautions to Follow When Oxygen Is in Use 11. Parts of an Oxygen Tank Skills Checklist 8. Assisting with the Use of an Oxygen Tank and Liquid Oxygen Reservoir 12. Oxygen Concentrator Skills Checklist 9. Assisting with the Use of an Oxygen Concentrator




Activity 9. Identifying Your Feelings about Assisting with Respiratory Equipment, Supplies, and Devices 13. Stories from Home Health Aides




1. What Are Prescribed Medical Equipment, Supplies, and Devices? Prescribed medical equipment, supplies, and devices assist the client with basic bodily functioning. Medical equipment may be prescribed to assist a client in:

Mobility (movement) This equipment helps the client to ambulate (walk) or to change positions. Examples:

o Canes o Walkers o Hoyer Lift

Preventing skin breakdown This equipment helps the client to regain or maintain healthy skin that is free of sores, wounds, or swelling. Examples:

o Bandages o Sheepskin or lamb’s wool o Water mattress or gel padding

Elimination This equipment helps the client to eliminate waste from the body (to void urine and stool). Examples:

o Enemas o Douches o Catheters

Respiration This equipment helps the client to breathe. Examples:

o Oxygen tanks o Nebulizers o CPAP machines




2. Why Are Prescribed Medical Equipment, Supplies, and Devices Important?

Page 1 of 2 Below, three direct-care workers share stories about why prescribed medical equipment, supplies, or devices are important for the clients they assist. After you read each story, work together to answer the discussion questions. Miguel’s story:

“Mr. Ricardo’s ankles were swollen after his surgery. It was uncomfortable for him, and it made it difficult for him to walk. Mr. Ricardo was very frustrated by that. The nurse showed me how to apply ACE bandages around his ankles, and this helped the swelling go down after a few weeks. He’s so happy to be up on his feet again!” Discussion questions: How was Mr. Ricardo feeling at the beginning of the story? What equipment, supply, or device was prescribed to help him? How did Mr. Ricardo feel after using this equipment, supply, or device?

Carla’s story:

“Miss Elena was on a medication for a few months that made her constipated. Once, she went two weeks without a bowel movement! She was so uncomfortable. Then her doctor prescribed an enema for her, and I assisted her with it. About ten minutes later, she was able to have a bowel movement. She felt so much better afterward!”

Discussion questions: How was Miss Elena feeling at the beginning of the story? What equipment, supply, or device was prescribed to help her? How did Miss Elena feel after using this equipment, supply, or device?




2. Why Are Prescribed Medical Equipment, Supplies, and Devices Important?

Page 2 of 2

Liliana’s story:

“Mrs. Sanchez has a lot of mucus that builds up in her lungs. It used to make her cough a lot, and the coughing made it hard for her to sleep. Her doctor just diagnosed her with chronic obstructive pulmonary disease (COPD), and he prescribed a nebulizer for her. This is a machine that she uses to inhale a medicine that breaks up the mucus. It really seems to help her. She doesn’t cough as much now, and that means she’s able to rest.” Discussion questions: How was Mrs. Sanchez feeling at the beginning of the story? What equipment, supply, or device was prescribed to help her? How did Mrs.Sanchez feel after using this equipment, supply, or device?




3. Basic Information about Skin and Medical Equipment Prescribed To Prevent Skin Breakdown What is skin? Skin is the barrier that covers the outside of our bodies. Why is skin important? Skin protects the inside of the body from germs. It also helps the body maintain the right temperature and the right amount of water. What kinds of conditions can cause skin breakdown?

Wounds

Pressure sores

Edema

Swelling due to injury What medical equipment might be prescribed to prevent skin breakdown?

Dressings (bandages) on wounds or sores Elastic bandages (ACE bandages)

What will your role be in assisting the client with this equipment?

You may: o Apply an elastic bandage UNDER SPECIAL CIRCUMSTANCES

ONLY

You will not: o Apply or change dressings that need to be sterile. o Apply or change dressings on skin that is not stable




4. Basic Information about Elimination and Medical Equipment Prescribed for It

Page 1 of 2 What is elimination? Elimination is how the body gets rid of waste. The body eliminates liquid wastes in urine and solid wastes in stool. Why is elimination important? When a person eats, the cells of the body absorb the nutrients that they need in order to function. The body needs to get rid of anything that is not absorbed.

When the body can’t control the elimination of urine, this is called urinary incontinence. This may cause inconvenience and emotional distress. It can also contribute to skin breakdown.

When the body can’t eliminate solid waste (stool), this is called constipation. This may cause a person pain or discomfort.

What kinds of conditions can lead to problems with elimination?

Aging

Surgery

Medications

Cancer

Lack of exercise




4. Basic Information about Elimination and Medical Equipment Prescribed for It

Page 2 of 2 What medical equipment might be prescribed?

An enema: a procedure that introduces liquids into the rectum and colon through the anus. There are different kinds of enemas. The two you may be asked to assist with are:

o A commercially prepared enema o A soap solution enema

A douche: a procedure that introduces liquid into the vagina in order to help keep it clean. (Also refers to the equipment used)

A catheter: a thin tube inserted into the body that is used to drain urine from the body.

A condom catheter: a catheter that has a covering that is placed over the penis. This kind of catheter is also called an external catheter.

A urinary drainage bag: a bag at the end of catheter tubing that is used to collect urine.

What will your role be in assisting the client with this equipment?

You may: o Assist with the use of an enema o Assist with the use of a douche o Assist with cleaning the skin around a catheter o Assist in cleaning catheter tubing o Assist with emptying a urinary drainage bag o Assist with the use of a condom catheter

You may NOT: o Insert any tube (a catheter tube, for example) into any opening of the

body.




5. Basic Information about Asthma What is asthma? Asthma is a disease that affects the airways that carry air to and from the lungs. In people with asthma, these airways are swollen or inflamed, and become narrow so that less air can pass through them. People with asthma tend to be very sensitive to irritants in the air (like pollen or pollution). Up to 80 percent of people with asthma have allergies to airborne irritants. What are the symptoms of asthma?

Wheezing (a hissing sound when breathing)

Tightness in the chest

Coughing

Difficulty breathing What is an “asthma attack”? This is when the symptoms of asthma are worse than usual. This is often due to exposure to irritants or allergens, or because of stress or exercise. These attacks can come on suddenly, and may be mild, moderate, or severe. Very severe asthma attacks can be life threatening. How is asthma treated? There is no cure for asthma, but people can take medications to manage their symptoms. They can also learn what triggers their asthma attacks, so that they can avoid these triggers. What kinds of equipment, supplies, or devices may be used by a client with asthma?

Inhalers

Nebulizers

Oxygen tanks with a mask or nasal cannula

Sterile (distilled) water




6. Basic Information about COPD What is COPD? COPD stands for Chronic Obstructive Pulmonary Disease, which is a term used to describe two diseases that tend to coexist: bronchitis and emphysema. These diseases cause the airways to become narrow and the lungs to become inflamed. COPD tends to be progressive, which means that the symptoms become worse over time. What are the symptoms of COPD?

Chronic shortness of breath

Acute episodes, when shortness of breath becomes worse than usual What is the cause of COPD? One cause of COPD is smoking, but it can be caused by long-term exposure to other irritants besides cigarette smoke. What kinds of equipment, supplies, or devices may be used by a client with COPD?

Oxygen concentrators


Mechanical ventilators




7. Basic Information about Sleep Apnea What is sleep apnea? Sleep apnea is a condition that causes a person to stop breathing when they are asleep. What is the cause of sleep apnea? Sleep apnea occurs when the muscles in the back of the throat become too relaxed while the body is sleeping. This closes the airway, which leads to a shortage of oxygen in the blood. The brain responds to the oxygen shortage by waking up the body just enough to reopen the airway. People with sleep apnea may wake up hundreds of times a night without knowing it. What are the symptoms of sleep apnea?

Fatigue

Poor concentration Why is sleep apnea dangerous?

It increases the risk of accidents (due to fatigue).

It puts strain on the heart and lungs.

It increases the risk for diabetes, heart disease, high blood pressure, stroke, and weight gain.

What kinds of equipment, supplies, or devices may be used by a client with sleep apnea?

CPAP machine




8. Medication Nebulizer [See page 421 of Providing Home Care1 for a photo of a medication nebulizer.] A medication nebulizer changes liquid medication into a mist that is inhaled through a mouthpiece. The medication is mixed with saline in the nebulizer cup. The cup and mouthpiece are connected by tubing to an air compressor.

1 William Leahy, Jetta Fuzy, and Julie Grafe, Providing Home Care, 4th ed. (Albuquerque, NM: Hartman Publishing, Inc., 2013).




9. CPAP Machine [See page 421 of Providing Home Care2 for a photo of a CPAP machine.] CPAP stands for “Continuous Positive Airway Pressure.” A CPAP machine blows air into the client’s nose and throat. The air goes through the tubing and into the mask. The mask covers the client’s nose and is kept in place with head straps. The air pressure is high enough to keep the client’s airway open while he or she is asleep.

When assisting your client with a CPAP machine, make sure that:

The mask is not too tight, because this can irritate the face.

The mask is not too loose, because air will blow into their eyes.

The air filter on the machine has air flowing around it. Make sure the machine is not against a wall or too close to the bed.





10. Safety Precautions to Follow When Oxygen Is in Use Oxygen is flammable. (Flammable means that it can easily start a fire or burn quickly.) That means that you need to follow safety precautions when oxygen has been prescribed for your client. Remove all flammable materials from the area. Here are some flammable items that you may see in your client’s home:

Cigarettes

Matches

Lighters

Candles

Alcohol

Nail polish or nail polish remover

Electric shavers, hair dryers, or other electrical appliances Post “No Smoking” or “Oxygen in Use” signs. These signs will remind others not to smoke near your client’s oxygen. Never permit smoking in the room or area where oxygen is used or stored. Always turn the oxygen tank off in case of fire. Never adjust the oxygen level.




11. Parts of an Oxygen Tank

An oxygen tank has several parts to it. The regulator gauge shows how much oxygen is left in the tank. The tank valve is the valve that is turned on at the beginning of treatment and off at the end of treatment. When the tank is on, the flow meter shows how much oxygen is flowing (the dosage). The reading on the flow meter should be the same as the dosage that is indicated in the care plan. This dosage is measured in liters (L) per minute. For example, the care plan may say that “…the client should use the oxygen set at the rate of 2L.” Some oxygen tanks have a humidifying bottle attached. This humidifies the oxygen (makes it moist) so that the client’s nostrils and throat do not become too dry when breathing the oxygen. The air tube carries oxygen from the tank to the nasal cannula that is secured in the client’s nostrils with prongs. Some clients may use an oxygen mask instead of the nasal cannula. [See page 283 of Providing Home Care3 for a photo of a person wearing a nasal cannula.]





12. Oxygen Concentrator [See page 282 of Providing Home Care4 for a photo of an oxygen concentrator.] An oxygen concentrator is a machine that increases the amount of oxygen in the air that the client breathes. It affects the air in the whole room. It is turned on and off by a single switch. The oxygen concentrator has several parts. The air filter cleans the air going into the machine. This filter should be brushed off every day to remove dust, and it should be washed once a week in warm soapy water. (The machine can run without the filter for a short time while the filter dries.) The oxygen concentrator dial controls the flow of oxygen. This dial should be set to the position that is indicated on the care plan. Some concentrators have a humidifying bottle that puts moisture into the air going through the air tube. This moisture keeps the client’s nose from getting too dry. When assisting your client with an oxygen concentrator, make sure that:

The air filter on the machine has air flowing around it. The concentrator should not be against a wall or too close to the bed. Make sure that nothing is covering the concentrator.

The humidifying bottle on the oxygen concentrator is filled with sterile water. You are not permitted to use tap water.





13. Stories from Home Health Aides Michelle’s Story:

“Mr. Jimenez has asthma. Last month, he had a really bad asthma attack. I assisted him by bringing him his nebulizer, but he still was wheezing a lot. I called the nurse, and Mr. Jimenez went to the hospital. He’s okay now, but I am worried that it will happen again. It was scary to see him that way.”

Peter’s Story:

“Ms. Martin has COPD, so she needs to use an oxygen tank to breathe. Even with the oxygen, it’s hard for her to be able to do many of the things she enjoys. I wish she didn’t need oxygen! It makes me feel sad.”

Janice’s Story

“Mrs. Lowell started taking a new medication a month ago, and it made her constipated. Her doctor prescribed an enema. I felt kind of embarrassed about assisting her with it, but she really felt better afterwards. That made me feel good.”

Question for Discussion:

What are you feeling right now about your role in assisting with the prescribed medical equipment, supplies and devices that were discussed in this module?



Handouts


Page 1 of 3 ACE bandage [3]

An elastic bandage. Asthma [5]

A disease that affects the airways that carry air to and from the lungs. In people with asthma, these airways are swollen or inflamed, and become narrow so that less air can pass through them.

Asthma attack [5]

When the symptoms of asthma are worse than usual. This is often due to exposure to irritants or allergens, or because of stress or exercise. These attacks can come on suddenly, and may be mild, moderate, or severe. Very severe asthma attacks can be life threatening.

Constipation [4]

When the body can’t eliminate solid waste (stool) because the stool is hard and dry.

COPD [6]

COPD stands for Chronic Obstructive Pulmonary Disease. It describes a set of diseases that usually happen together—adult asthma, bronchitis, and emphysema. These diseases cause the airways to become narrow and the lungs to become inflamed. The symptoms of COPD tend to become worse over time.

CPAP machine [7, 9]

CPAP stands for “Continuous Positive Airway Pressure.” A CPAP machine blows air into the client’s nose and throat. The air pressure is high enough to keep the client’s airway open while he or she is asleep.



Handouts


Page 2 of 3 Douche [4]

A procedure that introduces liquid into the vagina in order to help keep it clean. It can also refer to the device that is used to push a stream of water into the vagina.

Dressing [3]

A bandage. Elimination [4]

How the body gets rid of waste. The body eliminates liquid wastes in urine and solid wastes in stool.

Enema [4]

A procedure that introduces liquids into the rectum and colon through the anus. Inhaler [5]

A device that the client squeezes to push medication and air into the throat, which then gets into the lungs.

Liquid Oxygen Reservoir [12]

Another form of oxygen that takes up less space. Liquid oxygen needs to be kept cold, because oxygen turns back into a gas at room temperature. It is stored in a metal container called a reservoir.

Mobility [1]

The ability to move from one place to another, or from one position to another. Nasal cannula [5, 6; illustration in 11]

A plastic tube that goes behind the ears and then connects to two prongs that fit into the nostrils. It brings oxygen from an oxygen tank into the nostrils.



Handouts

Handout 1. Key Terms Page 3 of 3

Nebulizer [5, 8]

A nebulizer changes liquid medication into a mist that is inhaled through a mouthpiece.

Oxygen concentrator [6, 13]

A machine that concentrates the amount of oxygen in the air that the client breathes.

Saline [Activity 4]

Saline is a sterile liquid that is used with a nebulizer. It is very important to use saline instead of regular water because saline has no germs and is specially mixed with salt.

Skin [3]

Skin is the barrier that covers the outside of our bodies. It protects the inside of the body from germs. It also helps the body maintain the right temperature and the right amount of water.

Sleep apnea [7]

A condition that causes a person to stop breathing when they are asleep. The muscles in the back of the throat become too relaxed while the body is sleeping. This closes the airway, which leads to a shortage of oxygen in the blood. The brain responds by waking up the body just enough to reopen the airway. People with sleep apnea may wake up hundreds of times a night without knowing it.

Sterile (distilled) water [5]

This is special water that has no germs. “Distilled” means that the water has been boiled or treated in some way to get rid of any germs.

Urinary Incontinence [4]

When the body can’t control the elimination of urine.



Handouts


Page 1 of 3 Medical equipment, supplies, and devices may be prescribed to a client to assist with:

Mobility [covered in earlier modules]

Preventing skin breakdown

Elimination

Respiration PREVENTING SKIN BREAKDOWN

Skin breakdown can be caused by wounds, pressure sores, and edema. Medical equipment that might be prescribed to prevent skin breakdown include:

Dressings (bandages) on wounds or sores The HHA’s role will be taught in other modules.

Elastic bandages (ACE bandages) Home health aides can assist with elastic bandages UNDER SPECIAL

CIRCUMSTANCES ONLY. ASSISTING WITH ELIMINATION

Urinary incontinence may cause inconvenience and emotional distress. It can also contribute to skin breakdown. A client with urinary incontinence may use a catheter with urinary drainage bag. The HHA’s role in helping with catheters will be taught in another module. Constipation may cause a person pain or discomfort. An enema may be prescribed to relieve constipation. There are different kinds of enemas. You may be asked to assist with:

A commercially prepared enema

A soap solution enema



Handouts

Handout 2. Summary of Key Information Page 2 of 3

ASSISTING WITH RESPIRATION Asthma is a disease that affects airways. It can cause wheezing, a tightness in the chest, coughing, and difficulty breathing. There is no cure for asthma, but people can take medications to manage their symptoms. Medical equipment or supplies that a client with asthma might use include:

Inhalers

Nebulizers


Sterile (distilled) water COPD causes shortness of breath all the time, with acute episodes, when shortness of breath becomes worse than usual. A client with COPD might use:

Oxygen concentrators


Mechanical ventilators Sleep apnea is a condition where the throat closes while a person is sleeping. This limits oxygen to the brain. The brain responds by waking the body up. This can happen hundreds of times every night. This leads to the person being tired a lot and increases risk of other diseases. A client with sleep apnea may use a CPAP machine. Assisting Clients Who Use Oxygen

Oxygen is flammable. It can easily start a fire or burn quickly. Follow these safety precautions when oxygen has been prescribed for your client.

Remove all flammable materials from the area.

Post “No Smoking” or “Oxygen in Use” signs.

Always turn the oxygen tank off in case of fire.



Handouts


Page 3 of 3 THE HOME HEALTH AIDE’S ROLE The home health aide (HHA) plays an important role in assisting the client to use prescribed medical equipment, supplies, and devices.

Always follow the client’s care plan. The HHA is allowed to assist with some of this equipment UNDER SPECIAL CIRCUMSTANCES ONLY—that will also be explained in the care plan.

When assisting with prescribed medical equipment, supplies, and devices, safety is very important! Always wash your hands before and after each procedure. Wear gloves and other personal protective equipment (apron, mask, or glasses) if you think you will be exposed to body fluids.

As always, Observe, Record, and Report is one of the HHA’s main responsibilities. You will need to carefully record the procedures you assist with. Recording must be done accurately, carefully, and promptly. You will be observing the client’s condition AND the condition of equipment and supplies that the client uses.



Worksheets

Worksheet 1. Review of the Dos and Don’ts

Page 1 of 3 When assisting clients with procedures that help them breathe more effectively, it is very important to know what you can do and cannot do. Read each of the tasks on the list below with your small group. Then discuss whether you can or cannot do each task. (If you can’t remember, you can find the answers on Skills Checklists 6, 7, 8, and 9.)

1. When assisting with the use of a medication nebulizer and air compressor (Skills Checklist 6), can you add saline to the nebulizer?

____ Yes, you can ____ No, you can’t ____ Under special circumstance only

2. When assisting with the use of a medication nebulizer and air compressor (Skills Checklist 6), can you add medication to the nebulizer? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

3. When assisting with the use of a medication nebulizer and air compressor (Skills Checklist 6), can you turn off the machine after the treatment? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

4. When assisting a client with a CPAP machine (Skills Checklist 7), can you help the client adjust the mask and head straps? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only



Worksheets

Worksheet 1. Review of the Dos and Don’ts Page 2 of 3

5. When assisting a client with a CPAP machine (Skills Checklist 7), can you take the tubing, mask, and valve apart to clean them? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

6. When assisting with the use of an oxygen tank or liquid oxygen reservoir (Skills

Checklist 8), can you check oxygen tank or reservoir gauge to see if there is enough oxygen for the treatment? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

7. When assisting with the use of an oxygen tank or liquid oxygen reservoir (Skills Checklist 8), can you adjust the flow meter if it is not set to the level that is noted in the care plan? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

8. When assisting with the use of an oxygen tank or liquid oxygen reservoir (Skills

Checklist 8), can you assist the client in putting on the mask or inserting the nasal cannula? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

9. When assisting with the use of an oxygen tank (Skills Checklist 8), can you turn on the oxygen tank? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only



Worksheets

Worksheet 1. Review of the Dos and Don’ts

Page 3 of 3

10. When assisting with the use of an oxygen tank (Skills Checklist 8), can you turn off the oxygen tank? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

11. When assisting with the use of an oxygen concentrator (Skills Checklist 9), can you clean the air filter? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

12. When assisting with the use of an oxygen concentrator (Skills Checklist 9), can you turn on the switch to the oxygen concentrator? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

13. When assisting with the use of an oxygen concentrator (Skills Checklist 9), can you turn off the switch to the oxygen concentrator? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only

14. When assisting with the use of an oxygen concentrator (Skills Checklist 9), can you adjust the flow meter if it is not set to the level that is noted in the care plan? ____ Yes, you can ____ No, you can’t ____ Under special circumstance only



Skills Checklists

Skills Checklist 1. Assisting with an ACE Bandage

Assisting with an ACE Bandage

1. Explain the procedure to the client. 2. Wash hands. 3. Gather the equipment and supplies you need (ACE bandage; clip, tape, or

safety pin). 4. Make sure the area to be wrapped is clean and dry. 5. Position the client to apply the ACE bandage. 6. Apply the ACE bandage. Make sure that:

a. The bandage is in the place that the care plan indicates. b. The bandage is snug enough to stay in place but not so tight that it will

decrease circulation. c. The bandage is secured with a clip, tape, or safety pin. (Do NOT tie the

bandage.) 7. Observe and feel the part of the extremity that is below the bandage:

a. Note the temperature and any changes in color b. Note any sores c. Note if the skin is swelling, or shiny and tight d. Note any dryness of the skin

8. Wash hands. 9. Observe, record, and report.



Skills Checklists

Skills Checklist 2. Assisting with the Use of a Commercially Prepared Enema

Assisting with the Use of a Commercially Prepared Enema

1. Explain the procedure to the client. 2. Wash hands. 3. Gather the equipment and supplies you need (enema, bedpan or commode if

necessary, toilet paper, waterproof bed protector pad, soap, wash basin if necessary).

4. Put on gloves. 5. Assist client into position directed on the care plan. 6. Place waterproof pad under client’s buttocks. 7. Place blanket on client so only the rectal area is exposed. 8. Remove air from the tip of the enema applicator. 9. Enema is administered slowly. (DONE BY AIDE UNDER SPECIAL

CIRCUMSTANCES ONLY.) 10. Put the used enema applicator back into the box, tip first. 11. If the client has used an oil retention enema, remind client to hold the enema

for the time ordered. 12. Help the client onto bedpan or assist client into bathroom or onto commode.

Remind the client not to flush the toilet. Check on results of enema. 13. Observe the enema results for color, amount, odor, and consistency. 14. Assist client to clean self, if necessary, including wash hands. 15. Remove the waterproof bed protector. 16. Empty and clean the bedpan or commode pail. 17. Dispose of used enema applicator. 18. Remove gloves and throw them away. 19. Wash hands. 20. Help client into a comfortable position. 21. Observe, record, and report the use and results of the enema, including the

amount of stool, whether or not the stool was hard, streaked with red or was very dark, and if client had difficulty administering enema or was unable to tolerate the enema because of cramping.

22. Observe, record, and report any changes in condition or behavior.



Skills Checklists


Page 1 of 2 Assisting with the Use of a Soap Solution Enema

1. Explain procedure to the client. 2. Wash hands. 3. Gather the equipment and supplies you need (enema bag and tubing, clamp,

measuring container, bedpan, lubricant, toilet paper, commode if necessary). 4. Put on gloves. 5. Prepare the enema:

a. Close the clamp on the enema tubing. b. Adjust water flow from the faucet. c Fill the measuring container with water to the quart mark or as ordered. d. Check the temperature of the water on wrist. e. Prepare the enema solution as directed by the care plan. f. Pour the solution into the enema bag. g. Seal the top of the enema bag. h. Hang the bag at the height directed by the care plan.

6. Position the client, as directed by the care plan. 7. Place the waterproof pad under the client’s buttocks. 8. Place blanket on client so only the rectal area is exposed. 9. Position bedpan so it is behind client. 10. Position the enema tubing over the bedpan and open clamp to allow the

solution to flow through the tubing to remove air. 11. Reclamp the tubing. 12. Lubricate the tip of the enema tubing with the lubricant. 13. The enema is administered. (THE AIDE NEVER DOES THIS STEP.) 14. After the enema has been administered and the tubing has been removed,

wrap the tip of the tubing with paper towels and place inside the enema bag. 15. Help the client onto a bedpan or assist client to the bathroom or bedside

commode. Remind the client not to flush the toilet. 16. Assist client in cleaning self, if necessary.



Skills Checklists


Page 2 of 2 17. Help client wash his/her hands. 18. Remove the waterproof bed protector. 19. Discard disposable items. 20. Observe the enema results for amount, color, odor, and consistency. 21. Empty and clean the bedpan or commode pail. 22. Rinse the enema bag and tubing with clear water. Wash the tip of the tubing

with hot, soapy water. Allow to dry; and then store. 23. Remove gloves and throw them away. 24. Wash hands. 25. Observe, record, and report the use and results of the enema, including the

amount of stool, whether or not the stool was hard, streaked with red or was very dark, and if client had difficulty administering enema or was unable to tolerate the enema because of cramping.




Skills Checklists


Page 1 of 2 Assisting with the Use of a Douche

1. Explain procedure to the client. 2. Wash hands. 3. Gather the equipment and supplies you need (douche bag, tubing, clamp,

bedpan, waterproof pad, toilet paper, washcloth, soap, washbasin, thermometer).

4. Put on gloves. 5. Offer the bedpan or suggest the client use the bathroom to urinate. 6. Empty bedpan, if necessary. 7. Wash hands. 8. Prepare the solution. 9. Warm the douching solution to the temperature directed by the care plan. 10. Clamp the tubing and pour solution into the douche bag or container. 11. Position douche bag tubing over the bedpan and open clamp to allow

solution to flow through tubing to remove air. 12. Reclamp tubing. 13. Help client to lie on back. 14. Place waterproof pad under client. 15. Help client to clean the vaginal area. 16. Remove gloves and throw them away. 17. Wash hands. 18. Put on a new pair of gloves. 19. Position client to use the douche (on a bedpan, if necessary). 20. Hold the douche bag or container above the vagina at the height indicated in

the care plan. 21. The douche is administered. (DONE BY AIDE ONLY UNDER SPECIAL

CIRCUMSTANCES.) 22. Observe client for fatigue or pain while douching. 23. Clamp the tubing when the douche bag or container is empty. 24. Place the tubing in the douche bag.



Skills Checklists


Page 2 of 2

25. Help the client to sit up to allow the rest of the solution to drain out. 26. Help the client to lie down again. 27. Remove the bedpan, if necessary, and help the client to dry self with toilet

tissue. 28. Observe returned solution for amount, color, odor, and any material in it,

such as mucus or particles. 29. Empty the bedpan, if necessary, in the toilet. 30. Remove the waterproof pad. 31. Change linen, if necessary. 32. Assist client into a comfortable position. 33. Empty and clean the bedpan, if necessary. 34. Wash hands. 35. Record the amount and type of solution, how client responded (discomfort,

fatigue), the color and odor of the return solution. 36. Report to supervisor if the return solution appeared bloody or smelled foul;

client appeared tired by the procedure; client complained of pain; or client had difficulty in administering the douche.




Skills Checklists


Page 1 of 2 Assisting with the Use of a Commercially Prepared Douche

1. Explain procedure to client. 2. Wash hands. 3. Gather the equipment and supplies you need (douche, bedpan, waterproof

pad, toilet paper, washcloth, soap, washbasin, thermometer). 4. Put on gloves. 5. Offer the bedpan or suggest the client use the bathroom to urinate. 6. Empty bedpan, if necessary. 7. Wash hands. 8. Warm the douching solution to the temperature directed by the care plan. 9. Remove air from tip of the applicator. 10. Help client to lie on back. 11. Place waterproof pad under client. 12. Help client to clean the vaginal area. 13. Remove gloves and throw them away. 14. Wash hands. 15. Put on a new pair of gloves. 16. Position the client to use the douche (on bedpan, if necessary). 17. Douche is administered. (DONE BY AIDE ONLY UNDER SPECIAL

CIRCUMSTANCES). 18. Observe the client for fatigue or pain while douching. 19. Put the used douche back into the box, tip first, and discard. 20. Help the client to sit up to allow the rest of the solution to drain out. 21. Help the client to lie down again. 22. Remove the bedpan, if necessary, and help the client to dry self with toilet

tissue. 23. Observe returned solution for amount, color, odor, and any material in it,

such as mucus or particles.



Skills Checklists


Page 2 of 2 24. Empty the bedpan, if necessary, in the toilet. 25. Remove the waterproof pad. 26. Change linen, if necessary. 27. Assist client into a comfortable position. 28. Empty and clean the bedpan, if necessary. 29. Wash hands. 30. Record the amount and type of solution, how client responded (discomfort,

fatigue), the color and odor of the return solution. 31. Report to supervisor if the return solution appeared bloody or smelled foul;

client appeared tired by the procedure; client complained of pain; or client had difficulty in administering the douche.




Skills Checklists

Skills Checklist 6. Assisting with the Use of a Medication Nebulizer and Air Compressor

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Assisting with the Use of a Medication Nebulizer and Air Compressor 1. Explain to client what you plan to do. 2. Wash hands. 3. Gather the equipment and supplies you will need (nebulizer, saline, clock or

watch with a second hand; medication, if allowed under special circumstances).

4. Put on gloves. 5. Attach the tubing to the compressor. 6. Add saline to the nebulizer. 7. Ensure that the medication is placed in the nebulizer. (THIS STEP IS DONE

BY THE AIDE UNDER SPECIAL CIRCUMSTANCES ONLY.) 8. Put the top back on the nebulizer, and attach the mouthpiece. 9. Attach the tubing to the nebulizer and mouthpiece. 10. Assist client to a sitting or semi-reclining position if necessary. 11. Take and record the client’s pulse and respiratory rate. 12. Turn on the compressor and check for visible mist from the nebulizer. 13. Remind the client to breathe in slowly through the mouth so that the

medication is carried deep into the lungs. The client should hold his or her breath for a short time, and then breathe out.

14. Turn off the machine if the client coughs. Provide tissue to the client. Turn on the compressor when the client is ready.

15. Take the client’s pulse and respirations during the use of the medication nebulizer, and observe for a big increase in pulse rate.



Skills Checklists

Skills Checklist 6. Assisting with the Use of a Medication Nebulizer and Air Compressor

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16. Observe for signs that the client is not getting enough oxygen:

a. Rapid pulse and respiration b. Difficulty breathing c. Cold, clammy skin d. Blue or darkened lips, fingernails, or eyelids e. Being unresponsive (not responding when you call his or her name)

IF YOU OBSERVE ANY OF THESE SIGNS, STOP THE PROCEDURE IMMEDIATELY AND CALL YOUR SUPERVISOR.

17. Time the treatment. 18. Turn off the compressor. 19. Take the client’s pulse and respirations and record them. 20. Wash the nebulizer and mouthpiece according to the directions in the care

plan. 21. Remove gloves and throw them away. 22. Wash hands. 23. Replace the medication nebulizer and mouthpiece as needed. 24. Record the use of the medication nebulizer and any of the signs of too little

oxygen. 25. Report to the supervisor any sign of the client not getting enough oxygen, if

the client has an increase in pulse rate, of if the client does not use the nebulizer as directed on the care plan.



Skills Checklists

Skills Checklist 7. Assisting with the Use of a CPAP Machine Assisting with the Use of a CPAP Machine1. Explain the procedure to the client. 2. Wash hands. 3. Gather all of the parts of the CPAP machine. 4. Put on gloves. 5. Attach the tubing to the flow generator. 6. Assemble the valve according to the directions of the supplier and attach the

mask. 7. Attach valve and mask to the tubing. 8. Assist the client in adjusting mask and head straps. 9. Position the client comfortably in bed. 10. Remove gloves and throw them away. 11. Observe the client for snoring or sleep interruptions, or the need to sit up and

breathe. 12. Assist the client in removing the mask after sleep. 13. Take the tubing, mask, and valve apart to clean according to the directions of

the supplier. 14. Allow the pieces to air dry. 15. Wash hands. 16. Observe the client for problems, such as runny nose, dry throat, headache, or

ear pain. Observe for daytime sleepiness. 17. Record the use of the CPAP machine and your observations of the client, as

well as any problems with the CPAP machine. 18. Report any problems with the CPAP machine or any problems with the

client, such as: o Runny nose o Dry throat o Headache o Ear pain o Daytime sleepiness o Loud snoring o Complaints of not sleeping well, or of needing to sit up to breathe.



Skills Checklists

Skills Checklist 8. Assisting with the Use of an Oxygen Tank and Liquid Oxygen Reservoir

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Assisting with the Use of the Oxygen Tank and Liquid Oxygen Reservoir

1. Explain to client what you plan to do. 2. Wash hands. 3. Gather equipment and supplies you will need (oxygen tank or liquid oxygen

reservoir, mask or nasal cannula, humidifying bottle if used, distilled water, clock or watch with second hand)

4. Put on gloves, if necessary. 5. Check oxygen tank or reservoir gauge to see if there is enough oxygen. Call

supervisor if not 6. Wash humidifying bottle. 7. Check the humidifying bottle to make sure it has an adequate amount of

distilled water in it, and the bottle is screwed on tightly. 8. Take and record the client’s pulse and respiration rate. 9. Turn on the oxygen tank. 10. Ensure that flow meter is set to appropriate level as noted in the care plan.

(REGULATION OF FLOW METER DONE BY AIDE ONLY UNDER SPECIAL CIRCUMSTANCES.)

11. Check that water in humidifying bottle is bubbling. 12. Check that air is flowing from the mask or nasal cannula. 13. Assist the client in putting on and adjusting the mask or nasal cannula. 14. Cannula: prongs go into the nose. 15. Mask: should sit close to face, but not pinch it. 16. Take and record the client’s pulse and respirations. 17. Turn oxygen tank off. 18. Turn the flow meter off. 19. Assist the client in removing the oxygen mask or nasal cannula. 20. Wash hands.



Skills Checklists

Skills Checklist 8. Assisting with the Use of an Oxygen Tank and Liquid Oxygen Reservoir

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21. Observe for difficulty breathing; rapid pulse and respiration; cold, clammy

skin; blue or darkened lips, fingernails, or eyelids; client unable to sit still; client not responding when you call his/her name; client has headaches or complains of no energy.

22. Record the use of the oxygen tank or liquid oxygen reservoir and observations of the client.

23. Report to the supervisor IMMEDIATELY if the client has difficulty breathing; has rapid pulse and respiration; has cold, clammy skin; has blue or darkened lips, fingernails, or eyelids; is unable to sit still; does not respond when you call his/her name; has headaches or complains of no energy.



Skills Checklists

Skills Checklist 9. Assisting with the Use of an Oxygen Concentrator

Page 1 of 2 Assisting with the Use of an Oxygen Concentrator

1. Explain to client what you plan to do. 2. Wash hands. 3. Gather equipment and supplies you will need (oxygen concentrator,

humidifying bottle if used, distilled water, nasal cannula, clock or watch with second hand)

4. Clean air filter. 5. Wash humidifying bottle, if used. 6. Check the humidifying bottle to make sure it has an adequate amount of

distilled water in it, and that the bottle is screwed on tightly, if used. 7. Attach the air tube to the oxygen concentrator or humidifying bottle. 8. Take and record the client’s pulse and respiratory rate. 9. Turn on the switch to the oxygen concentrator. 10. Check that air is bubbling through the humidifying bottle. 11. Check that air is flowing through the nasal cannula. 12. Ensure that flow meter is set to appropriate level as noted in the care plan.

(REGULATION OF FLOW METER DONE BY THE AIDE UNDER SPECIAL CIRCUMSTANCES ONLY.)

13. Assist the client in putting on the nasal cannula. 14. Take and record the client’s pulse and respiratory rate. 15. Turn off the oxygen concentrator. 16. Assist the client in removing the nasal cannula. 17. Wash hands. 18. Observe for difficulty breathing; rapid pulse and respiration; cold, clammy

skin; blue or darkened lips, fingernails, or eyelids; client unable to sit still; client not responding when you call his/her name; client has headaches or complains of no energy.



Skills Checklists

Skills Checklist 9. Assisting with the Use of an Oxygen Concentrator

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19. Record the use of the oxygen concentrator and observations of the client, and

any problems with the oxygen concentrator. 20. Report to the supervisor IMMEDIATELY if the client has difficulty

breathing; has rapid pulse and respiration; has cold, clammy skin; has blue or darkened lips, fingernails, or eyelids; is unable to sit still; does not respond when you call his/her name; has headaches or complains of no energy.

Module 29. Assisting with Prescribed Medical Equipment, Supplies… · Medical Equipment, Supplies,...

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