Morning CNA Visit

DRT 

• Call in with Assuricare (only if are in their system) 
• Read Reports and White Board
• Turn on ERICA and move her by the blue chair so Don can see it. 
• Wash hands
• Set Up Supplies for visit on Table at foot of bed
• Water syringe for  trach
• Condom cath and Allkare
• Lotion
• Trach solution
• Tissue
• Set up Supplies for cart by door
• 2 Gauze packages 
• 3 Q-tips
• Water Management and Mouth Suction
• Remove and place in cart by door: 
• Right hand, yellow finger foam 
• Hand Blue Bird Pillows, Hand Towels and Arm purple pillows
• Foam pillow behind head
• Move sheet to the left side of the bed 
• Remove blue roll under knees and place on dining room table
• Drain Condom Catheter hose - but first raise head up first and then feet down
• Disconnect Tube from Bag and remove condom
• Strap on Cart by door
• Grab 2 Blue Washcloths and place on bathroom counter
• Grab 2 more Blue Washcloths for face and belly and place on towel bar
• Drain Cath Bag in Bathroom
• At the same time- fill Orange Bucket with HOT water
• Put both washcloths in tub
• Take out 2nd washcloth and dab with soap
• Place Orange tub on Shower Chair in bedroom
• Cath Bag on cart by door
• Legs up for Butterfly
• Wash stomach, then groin area,  with soapy washcloth
• Rinse with other washcloth
• Then dry with Towel on back of Shower Chair (towel stays on bed foot board)
• Fold sheet

ROM- Both Legs

• Butterfly x3
• Remove foot foam and place in corner at headboard
• Leg straight then heel to butt x3
• Stretch foot back once
• Pull toes
• Remove bandanna - put it in laundry, foam pad (helpful hint:  use bandanna if foam just needs to be wiped clean otherwise wash if gross), and Wet Trach with water in syringe
• Keep 1 tissue for catching mucus under trach
• Lotion on Lower Legs and Foot (not between toes)
• Keep Right leg bent up

ROM- Left Arm 3x

• Thumb out, fingers in, then Thumb in, fingers stretched x3
• Arm up- sideways, bend arm x3

• Remove gauze and clean trach with 3 long wet Q-tips
• Use Colloidal Silver, A&D ointment
• Wad tissue and place under trach
• Put Condom on
• Apply Allkare- fan then apply condom
• Put on TED hose
• Important, put both feet beside the box (in place for lung suction - not on box) 
• Put things on Cart by door
• Return orange tub to bathroom
• Save washcloths to use on upper body
• Wet 2 Q-tips

ROM- Right Arm x3

• Same as LEFT
• Remove feeding tube and take peg out of shirt

Clean PEG tube

• Remove gauze on belly
• Get belly wash cloth from bathroom- dot of soap on one corner
• Clean PEG with soapy corner then rinse- 2 drops Colloidal Silver

• Nose Suction- use Sucky Machine, then 2 wet Q-tips then dry end, tissue (save tissue)
• Clean Sucky machine then grab face cloth
• Wash Face with HOT washcloth- eyes first, forehead, cheeks, chin, nose, mouth
• Turn over washcloth and wash ears
• Dry neck with tissue - save tissue for spit while dressing

• Mouth Suction
• Shave
• Lift chin up to shave Adams apple and neck
• Chin, cheeks and mustache
• Wipe hairs off lips after mustache 

• Last Q-tip- Calmoseptine, put on PEG tube
• Gauze- PEG tube and Trach
•  Important! Always put the balloon little tube over the gauze as shown: 
  
  
  
  When you put it under it hurts and causes a red mark as shown: 
  

• Lung suction- Bullet ALWAYS:
  
• Between first and second - get brace, unhook roll pillow

ROM- Neck Exercises

• Remove roll pillow and place in corner at headboard and put white pillow to the right of head
• Turn Neck- Up and Around- look up, turn right and back, turn left and back, side to side – 90  degrees
• Down and Around- look down
• Head to the side- massage sternoclaidomastoid
• Brace On
• Water Management

Transfer to Shower Chair - left hand on thigh, right hand off bed 

• Have your pa help swing my feet around, put shoes on and put feet on disk. 
• Move disk so legs are vertical 
• Your pa helps lift Don's hips
• Have your pa push the shower chair to Don's legs. 

When Don is sitting down: 

• Raise tubes on vent arm 
• Feet on Foot stool
• Paper Towel between legs

Remove Shirt

• Left arm out first, then Right arm
• Hand under shirt and brace
• Lift head up
• Remove Brace
• Reconnect trach under shirt
• Remove Shirt over head, put in laundry, check if shirt has food spots to be sprayed
• Important, the extra tissue goes under Don's chin 
• Make sure shoulders are straight 

 Important! On Saturday skip washing upper body.  Skip to putting shirt on below.  

• Get Diaper and cut
• Set up Mouth supplies in bathroom

• Toothbrush, tub, cup, pink sponge with mouth rinse

Upper Body Bath- in Shower Chair

• Hot Water in Orange Tub- hot, soapy washcloth
• Wash Chest, Arms, Back (don't hold head)
• Rinse Chest, Arms, and Back
• Dry Back and Lotion entire Back, pain cream on back? Ask Don where? Usually upper  spine or upper right. 
• Dry rest of body
• Need deodorant?

Put New Shirt On- Head, Right arm, Left Arm, Trach 

• Lean Forward, Straighten Shirt down Back
• Diaper on, Shorts on
• Connect Bag to leg
• Wait to connect to condom
• Lotion on Knuckles/Fingers and Psoriasis spot on Left Arm if necessary
• Ring Management
• Return Lotion and Orange Tub to Bathroom
• Grab mouth supplies already set up in bathroom, move to bedroom, get 5 double paper towels and put numbing gel on q-tip

Mouth Care

• Wipe out Mouth with paper towel
• Brush teeth
• Outside- up and down
• Inside
• Outside- up and down
• Inside
• Roof of Mouth and Tongue
• Wipe out Mouth with paper towel
• Lean forward, tub on lap, right hand over left 
• Mouth Rinse 2x
• Wipe teeth with pink sponge
• Wipe out Mouth with paper towel
• Numbing Gel on front teeth top and 

• Belly Rub
• Up on Right, across, down on Left x2
• Lean forward
• Place Batman pillow behind
• Hands on knees
• Butt lift on both sides, fold pillow down
• Fix feet
• Paper towel on hands to catch spit - make sure clips don't stab hands and the yellow tube on bertha is up
• During Wait
• Clean up Mouth supplies
• Set up Nighttime supplies- gauze, water syringe, 3 Q-tips, 2 washcloths, alcohol swab, and 2 tissues
• Make bed and empty suction bucket
• Shower chair back one notch
• Remove batman pillow when finished 
• Brace on
• Connect Condom Cath tube to bag 
• Use alcohol wipe on cath tube
• 2 Tissues on blue tab (if it falls off - this is optional) 
• Pull up diaper and shorts over knees
• Lay on Floor to Wipe Bottom
• Check Duo Derm if on bottom, Prep H
• Mouth Suction

• Move to Living-room

Transfer to Wheelchair

• Use Black Box to Transfer
• Push condom on 
• Sandwich legs
• PA guide hips back as far as possible
• Push knees to get Don as far back as possible

Wheelchair Comfort

• Pull down and Straighten out the back of his shirt
• Feet on pedals
• Put bag in WC holding bag
• Check and straighten condom, cath bag and tissues around blue tab position
• Roll under trach
• Left butt lift
• Seatbelt (make sure shorts are under the strap)
• Cross arms and lean wheelchair all the way back
• Push HARD 2 times with hands just below kneecap & ask if it’s okay
• THE SHOULDER TWIST
• Right arm up, side lateral around – don’t push!
• Shoulder Twist- the lateral should click after this move
• Move wheelchair back into place
• place blue roll pillow by left thigh

• Lung Suction
• After lung suction – Burp tube while still leaning back
•  Head 19, Feet down until foot pedals extend

• Shoes off
• Adjust Neck Brace (Chin lift to tighten) /use the same bib
• Move Wheelchair to big wheel in blue floor tape
• AM- Place black blind behind chair to stop glare on computer screen, feet facing front door
• PM- Spin Don to face TV (hold power cord/ big wheels in line with blue tape)

Set Up ERICA

• ERICA should be horizontal with silver bar, twist Erica sideways if necessary
• Move Erica up/down by grabbing the edges of the screen. Move side to side by using bar. Don will help guide you to the correct positioning.
• Important. When Don says UP it means tilt Erica down so his eye goes up!

FINAL-

• Mouth suction
• Chapstick
• Set up Black Hand Bell