Transcript Document 7162649

Unit 11
Resident Care Procedures
Nurse Aide I Course
DHSR Approved Curriculum-Unit 11
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Resident Care Procedures
Introduction
Residents frequently require assistance
to meet their normal elimination needs.
They may also require special
procedures that the nurse aide will
perform.
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Resident Care Procedures
Introduction
(continued)
This unit explores:
• helping the resident to the bathroom;
• assisting with use of the bedside
commode, bedpan and urinal;
• providing catheter care and emptying a
urinary drainage bag;
• collecting a routine urine specimen;
• applying and caring for condom
catheters;
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Resident Care Procedures
Introduction
(continued)
In addition, this unit explores:
• collecting a stool specimen;
• administering cleansing enemas;
• applying warm or cold applications,
elastic bandages, elastic stockings
(TED hose) and non-sterile dressing;
• and assisting with coughing and deep
breathing exercises.
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11.0 Describe what is meant by
elimination needs.
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Elimination of Waste Products
• Natural process
• Healthy individuals
have regular
elimination habits
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Elimination of Waste Products
(continued)
• Equipment needed
–Bedpan
• regular size - used by female for
urination and both men and
women for defecation
• fracture pan - smaller and flatter
and usually used with fracture of
vertebrae, pelvis or leg
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Elimination of Waste Products
(continued)
• Equipment needed
–Urinal
• used by men
• used for urination
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Elimination of Waste Products
(continued)
• Equipment needed
–Bedside commode
• portable chair brought to bedside
• contains opening for a bedpan or
similar type container
• used for residents unable to walk
to bathroom
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11.1 Review the guidelines to follow
when assisting the resident with
elimination needs.
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Guideline To Assist With Elimination
• Assist to as close to a
sitting position as
possible
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Guideline To Assist With Elimination
(continued)
• Provide privacy and warmth
–close doors, curtains, and drapes
–assist with robe and footwear
–cover with cotton blanket or lap
robe when using bedside
commode
–leave area if safe to leave alone
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Guideline To Assist With Elimination
(continued)
• Provide toilet paper and
place call signal within
the resident’s reach
• Offer bedpan
periodically as residents
may be uncomfortable
requesting its use
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Guideline To Assist With Elimination
(continued)
• Do not leave on bedpan
for long periods of time
• Cover and empty
bedpan immediately.
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Guideline To Assist With Elimination
(continued)
• Put on glove and assist
resident to clean genital
area as necessary
• Assist with handwashing
–at the sink
–by providing soap and
basin of warm water
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11.2 Demonstrate the procedure to
follow when assisting the resident
to use the bathroom.
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11.3 Demonstrate the procedure to
follow when helping the resident
to use a bedside commode.
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11.4 Demonstrate the procedure to
follow when assisting the resident
to use a bedpan.
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11.5 Demonstrate the procedure to
follow when assisting a resident
to use a urinal.
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11.6 Discuss indwelling catheters and
catheter care.
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Indwelling Catheters
• Used to continuously drain
urine from bladder
• Inserted by licensed nurse
or NA II after being
ordered by physician
• Attached to tubing that
connects to urinary
drainage bag
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Indwelling Catheters
(continued)
• Use
–Residents with nerve injury:
• following spinal cord injury
• after stroke
–After surgery
–Some incontinent residents
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Indwelling Catheters
(continued)
• Increased Risk of Urinary Tract
Infections
–Urinary meatus and
surrounding area must
be kept clean
–Catheter care given at
least daily and PRN
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11.6.1 Identify guidelines to follow
when caring for residents with
indwelling catheters (Foley).
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Guidelines To Follow When
Caring For Residents With
Indwelling Catheters
• Never pull on catheter and keep
catheter tubing and drainage tubing
free of kinks, so that urine can flow
freely
• Report any leakage, complaints of
pain, burning, or need to urinate
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Guidelines To Follow When
Caring For Residents With
Indwelling Catheters
(continued)
• Observe and report any
swelling, skin irritation, or
discoloration
• Measure and record urinary
output accurately, noting color,
odor and appearance of urine
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Guidelines To Follow When
Caring For Residents With
Indwelling Catheters
(continued)
• Keep collection bag below bladder
• Attach collection bags to bed frame,
never to side rail
• Never leave on floor
• Follow facility policy for securing
catheter to resident’s leg without
tension on catheter
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Guidelines To Follow When
Caring For Residents With
Indwelling Catheters
(continued)
• Never disconnect catheter
from tubing to drainage
bag
• When emptying urinary
drainage bag, never touch
drain with measuring
container or graduate
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11.7 Demonstrate the procedure for
providing catheter care.
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11.8 Demonstrate the procedure for
emptying a urinary drainage bag.
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11.9 Discuss the collection of urine
specimens.
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Collecting Routine Urine Specimen
• Collected for laboratory study
–Aids physician in diagnosis
–Evaluates effectiveness of
treatment
• Laboratory requisition slip completed
and sent to laboratory with each
specimen
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General Rules To Follow When
Collecting Urine Specimens
• Wash hands carefully before and
after collection of urine specimens
• Wear gloves
• Collect specimen at appropriate time
• Use proper container and do not
touch inside of lid or container
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General Rules To Follow When
Collecting Urine Specimens
(continued)
• Label container accurately
and transport to laboratory as
soon as possible
• Tell resident not to have
bowel movement or discard
tissue in bedpan when
collecting urine specimen
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11.10 Demonstrate the procedure for
collecting a routine urine
specimen.
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11.11 Discuss the collection of two
more types of urine sample
collections: the clean catch and
the 24-hour specimen.
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Clean Catch Urine Specimen
(mid-stream)
• Cleaning of perineum prior to
collection reduces number of
microbes that may contaminate
specimen
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Clean Catch Urine Specimen
(mid-stream)
(continued)
• Procedure
–resident begins voiding into
appropriate receptacle and
stops midstream; then container
is placed and urine specimen is
collected.
–follow above general rules when
collecting urine specimen
–follow Standard Precautions
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24-Hour Urine Specimen
• All urine voided in 24-hour
period collected
–urine chilled on ice to prevent
growth of microorganisms
–some tests may require
preservative
–sample usually collected in
dark colored gallon jug
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24-Hour Urine Specimen
(continued)
• Procedure
–the resident voids to begin
test with empty bladder
–first voiding is discarded
–all voidings for next 24 hours
collected
–if test interrupted, it must be
restarted with new gallon jug
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24-Hour Urine Specimen
(continued)
• Imperative that
resident and staff
understand procedure
and exact time period
for sample collection
• Follow Standard
Precautions
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11.12 Discuss guidelines to follow
when caring for a resident with a
condom catheter.
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Applying And Caring For
Condom Catheters
• Description and Use
–External catheter used for
incontinent men
–Made of soft rubber sheath that fits
over penis with tubing connected to
urinary drainage bag
–Ambulatory residents may prefer
leg bags during day
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Applying And Caring For
Condom Catheters
(continued)
• Description and Use
–New condom catheter is applied
daily
–Penis observed for reddened or
open areas and reported to
supervisor prior to new being
applied
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11.12.1 Demonstrate the procedure
for applying a condom
catheter.
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11.13 Discuss the collection of stool
specimens.
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Guidelines For Collecting Stool
Specimen
• Ordered by physician
• Studied by laboratory to identify:
–Blood in stool
–Parasites
–Fat
–Microorganisms
–Other abnormalities
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Guidelines For Collecting Stool
Specimen
• Specimen should not be mixed with
urine
• Use tongue blades to handle
specimen
• Prevent contaminating outside of
specimen container
• Properly label and transport
specimen promptly
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11.14 Demonstrate the procedure for
collecting a stool specimen.
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11.15 Define the term enema and
identify some of the most
common solutions.
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Cleansing Enemas
• Definition - the introduction of fluid
into the rectum and colon to remove
feces
• Physician orders:
–Solution to be used
–Amount of fluid to be used
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Cleansing Enemas
(continued)
• Common solutions
–Tap water
–Saline solution
–Soap suds
–Oil retention
–Prepackaged disposable,
hypertonic solution
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11.15.1 Discuss the guidelines for
giving an enema.
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Cleansing Enemas:
Guidelines For Administration
• Check temperature of enema
solution with thermometer
• Temperature no greater than
105 F
• Container should not be higher
than 12 inches above anus.
Solution must run in slowly to
avoid serious side effects
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Cleansing Enemas:
Guidelines For Administration
(continued)
• Resident should be positioned on
left side with knees slightly flexed
• If possible, enemas should be given
before bath and before breakfast;
otherwise, wait at least one hour
after meals before giving
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Cleansing Enemas:
Guidelines For Administration
(continued)
• Be sure bathroom is
available for use
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11.16 Demonstrate the procedure for
administering a cleansing
enema.
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11.17 Discuss the purposes and
effects of warm and cold
therapy.
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Warm And Cold Therapy
• Requires physician’s
order for type of therapy
and length of time for
application
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Warm And Cold Therapy
(continued)
• Purposes and Effects
–WARMTH: dilates blood vessels
• increased blood supply to area
• blood brings oxygen & nutrients
for healing
• fluids are absorbed
• muscles relax
• pain relieved
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Warm And Cold Therapy
(continued)
• Purposes and Effects
–COLD: constricts blood vessels
• decreased blood supply to area
• prevents swelling
• controls bleeding
• numbs skin, reducing pain
• reduces body temperature
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11.17.1 Discuss the three types of
warm and cold applications.
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Types Of Warmth And Cold
• Dry cold - water does not touch
skin
–ice bags
–ice caps
–ice collars
–disposable cold pack
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Types Of Warmth And Cold
(continued)
• Moist cold - water touches
skin
–compresses – localized
application
–soaks - body part
immersed in water
–cool sponge bath
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Types Of Warmth And Cold
(continued)
• Dry warmth – pads
with circulating
warm water
• Moist warmth
–compresses
–soaks
–sitz bath
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11.17.2 Discuss the guidelines for
warm and cold applications.
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Guidelines For Warm Applications
• Guidelines for
Applications
–Use bath thermometer to measure
the temperature of moist heat
solutions.
–Do not operate equipment you have
not been trained to use.
–Temperature never over 105° F.
Check skin frequently and report
any signs of complications.
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Guidelines For Cold Applications
• Guidelines for
Applications
–Apply ice caps with metal or
plastic lids away from skin
–Cover ice caps/bags/collars prior
to application
–Check skin frequently and report
any signs of complications
–Never leave in place longer than
directed by supervisor
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11.18 Demonstrate the procedure for
applying warm or cold
applications.
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11.19 Discuss the application of
nonsterile bandages.
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Bandages
• Purposes
–hold dressing in place
–secure splints
–support and protect body parts
• Materials in various types and sizes
–roller gauze
–elastic bandages
–triangular
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11.19.1 Review the guidelines to be
considered with the use of
bandages.
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Guidelines For Use Of Bandages
• Applied snug enough to
control bleeding and prevent
movement of dressings
• Should not be so tight that
they interfere with circulation
• Circulation of extremity
checked below bandage
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Guidelines For Use Of Bandages
(continued)
• Signs/symptoms that indicate poor
circulation should be reported
immediately to supervisor such as:
–swelling
–cyanotic skin
–numbness
–tingling
–skin cold to touch
–pain or discomfort
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Guidelines For Use Of Bandages
(continued)
• Loosen bandages if any signs of
impaired circulation noted and report
to supervisor immediately.
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11.19.2 Demonstrate the procedure
for applying elastic bandages.
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11.20 Discuss reasons for coughing
and deep breathing exercises.
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Coughing And Deep Breathing
• Purposes
–To prevent respiratory
complications in certain at-risk
residents
• persons on bed rest or reduced
activity
• following surgery
• person with respiratory disorders
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Coughing And Deep Breathing
(continued)
• Purposes
–Two major complications prevented
by coughing and deep breathing:
• pneumonia - inflammation of lung
• atelectasis - collapse of portion of
lung
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Coughing And Deep Breathing
(continued)
• Physiology
–Deep Breathing
• increases level of
oxygen in blood
• increases lung
expansion
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Coughing And Deep Breathing
(continued)
• Physiology
–Coughing
• removes mucus from
airways and lungs
• may cause collapse of
lung if congestion not
present
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Coughing And Deep Breathing
(continued)
• Considerations with deep
breathing and coughing
–Doctors order exercises
–Frequency of
performing exercise
varies per doctor’s
order
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Coughing And Deep Breathing
(continued)
• Considerations with deep
breathing and coughing
–Nurse aides receive
instructions from
supervisor
–Coughing may cause pain
and be difficult to perform
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11.20.1 Demonstrate the procedure
for assisting with coughing
and deep breathing exercises.
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11.21 Discuss the purpose of elastic
stockings.
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Elastic Stockings
(Anti-embolitic Hose)
• Purpose
–Provide support
–Provide comfort
–Promote circulation by
providing pressure
–Reduce risk of thrombus
formation
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11.21.1 Discuss indications for use of
elastic stockings.
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Elastic Stockings
(Anti-embolitic Hose)
(continued)
• Indications for use
–Residents with heart disease and
circulatory disorders
–Residents on bed rest
–Residents who recently had
surgery
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11.21.2 Discuss action of elastic
stockings in the prevention of
blood clots.
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Elastic Stockings
(Anti-embolitic Hose)
(continued)
• Prevention of blood clots (thrombi)
–blood clots form (blood flow is
sluggish)
–usually develop in deep leg
veins
–can break loose and travel
though blood stream (then
known as embolus)
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Elastic Stockings
(Anti-embolitic Hose)
(continued)
• Prevention of blood clots (thrombi)
–embolus can travel to the lungs
and possibly cause death
–elastic stockings exert pressure
on veins, promoting venous blood
flow to heart
–also known as anti-embolitic
stockings or TED hose
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Elastic Stockings
(Anti-embolitic Hose)
(continued)
• Fitting of stockings
–Come in thigh
high or knee high
lengths
–Resident must be
measured to
ensure proper fit
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11.21.3 Demonstrate the procedure
for applying and removing
elastic stockings or TED hose.
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11.22 Discuss purpose of applying a
nonsterile dressing.
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Applying Nonsterile Dressing
• Covering applied to wound or
injured body part where slight risk
of infection or re-injury
• Materials come in various types
and sizes:
–Gauze pads
–Band-aids
–Thick compresses
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11.22.1 Demonstrate the procedure
for applying a nonsterile
dressing.
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