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Nurse Assisting Skills

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Admit, transfer, or discharge a patient, demonstrating proper care ... the unit, including any drawers, closets, and storage areas carefully to find all items ... – PowerPoint PPT presentation

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Title: Nurse Assisting Skills


1
Nurse Assisting Skills
  • Diversified Health Occupations
  • Chapter 20
  • pg. 617-737

2
Nurse Assisting OBJECTIVES
  • Upon completion of this unit, the student should
    be able to
  • Admit, transfer, or discharge a patient,
    demonstrating proper care of pts belongings.
  • Administer personal hygiene
  • Measure and record intake and output
  • Assist a patient with eating, feed a patient
  • Collect stool specimens
  • Ostomy care
  • Catheter care

3
ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT
  • This may be one of your responsibilities.
  • Alleviating anxiety and fear
  • Admission can cause anxiety and fear for many pts
    and their families
  • Even a transfer from one room to another can
    cause anxiety because the individual will have to
    adjust to another environment
  • Essential for health care provider to create a
    positive first impression
  • Assistant can do much to alleviate fear by being
    courteous, supportive, and kind.

4
ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT
  • Alleviating anxiety and fear
  • Help patient become familiar with the unit
  • Provide clear instructions on how to operate
    equipment
  • Explain the type of routine to expect, such as
    times for meals
  • Do not hurry or rush
  • Allow the pt to ask questions and to express
    concerns
  • If you do not know the answers to specific
    questions, refer to your immediate supervisor

5
ADMISSION FORMS
  • Forms list the procedures that must be performed
  • Will vary slightly from facility to facility
  • Important for health care worker to become
    familiar with required information on the form
  • Much of the information on the admission form is
    used as a basis for the nursing care plan
  • Must be complete and accurate!
  • It the pt is unable to answer the questions, a
    relative or the person responsible for the pt is
    usually able to provide the information

6
PROCEDURES PERFORMED UPON ADMISSION
  • Vital signs
  • Height and weight measurements
  • Collection of a routine urine specimen
  • Protect patients possessions
  • Make a list of clothing, valuables, and personal
    items
  • In a hospital a family member will frequently
    take clothing home
  • Any personal items left in a room should be noted
    on a list, and the list should be signed by the
    pt and the assistant
  • At the time of transfer or discharge, the list of
    items is checked to make sure all of the
    belongings are returned
  • If the family member does not take items home,
    the items should be placed in a safe
  • FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE
    PROCEDURES!!

7
PROCEDURES PERFORMED UPON ADMISSION
  • Orient patient to facility
  • Provide instructions on how to operate the bed,
    call light, remote control for TV, etc.
  • Explain visiting hours, location of lounges,
    smoking regulations, availability of services,
    times for meals, and other rules and regulations
  • Many facilities have a pamphlet or paper listing
    this information, which is given to the patient
    and family members.
  • FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE
    PROCEDURES!!

8
TRANSFERS
  • Done for a variety of reasons
  • Change in the patients condition
  • Per patient request
  • Agency policy must be followed during any
    transfer
  • Reason for transfer should be explained to
    patient and family by the appropriate personnel
  • New room or unit must be ready to receive the
    patient
  • All personal items must be moved with patient
  • Organized and efficient transfer will help
    prevent fear and anxiety for the patient

9
DISCHARGE
  • Doctors order usually required
  • If an individual plans to leave a facility
    without permission, report this immediately to
    your supervisor
  • Facilities have special policies that must be
    followed when a patient leaves against medical
    advice (AMA)
  • When an order for discharge is received,
    assistant must check and pack the patients
    belongings
  • Check the unit, including any drawers, closets,
    and storage areas carefully to find all items

10
DISCHARGE
  • Most agencies require a staff member to
    accompany the individual to the car
  • If a patient is transferred by ambulance, the
    ambulance attendants will bring a stretcher to
    the room
  • Most agencies have forms or checklists that are
    used during a discharge to ensure that all
    procedures have been followed.

11
ADMITTING
  • Obtain orders
  • Prepare the room for the admission
  • Greet and identify the patient
  • Introduce yourself
  • Ask the family to wait in the lounge or lobby
  • Close the door and screen the unit
  • Ask the patient to change into a gown
  • Position the patient comfortably in the bed

12
ADMITTING
  • Complete the admission form or checklist
  • Measure and record vital signs
  • Weigh and measure the patient
  • Complete the clothing list and make sure patient
    or family member checks the list
  • Obtain a urine specimen, if ordered
  • Orient the patient to the facility and explain
    all routines
  • Fill the water pitcher if patient is allowed to
    have liquids

13
ADMITTING
  • Observe all checkpoints
  • Patient is comfortable and in good alignment
  • S/R ? x 4
  • bed is at lowest position
  • Call light and supplies within reach
  • Area is neat and clean
  • When admission is complete, allow family members
    to return and answer any questions they have
  • Record required information on patients chart

14
DISCHARGING
  • Obtain orders
  • Check with patient to determine when relatives
    will arrive for discharge
  • Close the door or screen the room
  • Help the patient dress, if needed
  • Assemble all the patients personal belongings
  • Assemble any equipment that is given to the
    patient, such as the admission kit
  • Check to make sure patient has received d/c
    orders and instructions from the nurse or
    physician

15
DISCHARGING
  • Obtain the patients valuables if they are in a
    safe
  • Complete a d/c checklist
  • Place all patients belongings on a cart
  • Assist the patient into a w/c
  • Transport patient to exit area and help patient
    into the car
  • Observe all safety factors while transporting
    patient
  • Say good-bye J

16
DISCHARGING
  • Return to the unit, strip the bed, remove any
    equipment and follow agency policy for cleaning
    the room
  • Record all required information on the patients
    chart

17
WORDS TO THE WISE!!!
  • TALK WITH YOUR PATIENTS AT ALL TIMES
  • WATCH WHAT YOU SAY!!
  • UNCONSCIOUS AND SEMI-CONSCIOUS PATIENTS MAY BE
    ABLE TO HEAR YOU
  • ALWAYS BE KIND!!!!!!!!!!

18
Positioning, Turning, Moving, and Transferring
Patients
  • ALIGNMENT positioning body parts in relation to
    each other in order to maintain correct body
    posture
  • PREVENTS
  • Fatigue
  • Pressure ulcers (decubitus ulcers)
  • Contractures
  • FOOT DROP

19
Decubitus Ulcers
STAGE I
STAGE II
STAGE III
STAGE IV
20
PREVENTION
  • PROVIDING GOOD SKIN CARE
  • PROMPT CLEANING OF URINE AND FECES FROM SKIN
  • MASSAGING IN A CIRCULAR MOTION AROUND A REDDENED
    AREA
  • FREQUENT TURNING
  • POSITIONING TO AVOID PRESSURE ON IRRITATED AREAS
  • KEEPING LINEN CLEAN, DRY, AND WRINKLE FREE
  • APPLYING PROTECTORS TO BONY PROMINENCES (HEELS
    ELBOWS)
  • EGG CRATE, ALTERNATING PRESSURE MATTRESSES OR
    WATER/GEL FILLED MATTRESSES

21
TURNING
  • AT LEAST q 2 hr IF PERMITTED BY MD
  • PROVIDES EXERCISE FOR MUSCLES
  • STIMULATES CIRCULATION
  • PREVENTS DECUBITUS ULCERS AND CONTRACTURES
  • PROVIDES COMFORT TO PATIENT

22
DANGLING
  • FOR PATIENTS WHO HAVE BEEN CONFINED TO THE BED
    FOR A PERIOD OF TIME
  • DONE PRIOR TO PATIENT BEING TRANSFERRED FROM THE
    BED
  • SITTING WITH THE LEGS HANGING DOWN OVER THE SIDE
    OF THE BED
  • PULSE CHECKED AT LEAST 3 TIMES DURING THIS
    PROCEDURE!!!

23
DANGLING
  • PULSE CHECKED
  • BEFOREused as control, or resting rate
  • DURINGimmediately after positioning the patient
    in the dangling position
  • AFTERreturning the patient to the supine
    position
  • ALSO NOTE RESPIRATIONS, BALANCE, COLOR,
    PERSPIRATION, COLOR, OTHER CHARACTERISTICS
  • RETURN PATIENT TO SUPINE POSITION IMMEDIATELY IF
    DANGLING IS NOT TOLERATED!!
  • FOLLOW PROPER CHARTING AND NOTIFICATION TO
    SUPERVISOR

24
TRANSFERS
  • BED TO WHEELCHAIR OR CHAIR
  • WHEELCHAIR OR CHAIR TO BED
  • BED TO STRETCHER
  • MECHANICAL LIFT
  • NEVER TRANSFER WITHOUT PROPER AUTHORIZATION
  • OBSERVE PATIENT CLOSELY FOR CHANGES IN PULSE
    RATE, RESPIRATIONS, AND COLOR, DIZZINESS,
    INCREASED PERSPIRATION, OR DISCOMFORT

25
ADMINISTERING PERSONAL HYGIENE
  • Usually includes the bath, back care, perineal
    care, oral hygiene, hair care, nail care, and
    shaving when necessary.
  • Must be sensitive to the patients needs and
    respect the patients right to privacy while
    personal care is administered.
  • Reasons for providing personal hygiene
  • Promotes good habits of personal hygiene
  • Provides comfort and stimulates circulation
  • Provides health care worker an opportunity to
    develop a good and caring relationship with the
    patient

26
BATHS
  • Type of bath depends on the patients condition
    and ability to help.
  • Complete bed bath (CBB)
  • Health assistant bathes all parts of the body
    which includes oral hygiene
  • Partial bed bath (PB)
  • Health assistant bathes some parts of the body
    and also gathers supplies needed by the patient
  • Tub bath or shower
  • Assistant helps by providing towels and supplies,
    preparing tub or shower area

27
ORAL HYGIENE
  • Refers to the care of the mouth and teeth
  • Should be done at least 3 times a day and more
    often if patients condition requires frequent
    oral care
  • PURPOSES
  • Prevents disease, caries, and halitosis.
  • Stimulates appetite and provides comfort
  • ROUTINE ORAL HYGIENE
  • Refers to regular tooth brushing and flossing
  • Patient can often do self care, but assistant can
    help when needed

28
ORAL HYGIENE
  • Denture care
  • Many patients sensitive about dentures
  • Assistant must provide privacy and reassure the
    patient
  • Extreme care must be taken while handling
    dentures
  • NPO Patients
  • Special oral hygiene
  • Care provided to unconscious or semiconscious
    patient
  • Care must be taken to clean all parts of the
    mouth
  • Special supplies may be used for this procedure

29
HAIR CARE
  • Important aspect of personal care that is often
    neglected
  • Brushing will stimulate circulation to scalp and
    help prevent scalp disease
  • Shampooing must be approved by the doctor
  • Various types of dry or fluid shampoos are
    available for pts confined to bed
  • Special devices are available for use while
    giving a shampoo to a pt confined to bed

30
NAIL CARE
  • Should be done as part of daily hygiene and
    patient care
  • Often neglected area in personal care of the pt
  • Nails harbor dirt and can lead to infection and
    disease
  • Never cut the toenails!

31
SHAVING
  • Normal daily routine for most men
  • Important to provide when pt unable to shave
  • Both regular and electric razors may be used
  • Correct technique must be used to prevent injury
    to patient
  • Females usually appreciate shaving of legs and
    underarms
  • BE SURE YOU HAVE SPECIFIC ORDERS FROM DOCTOR OR
    IMMEDIATE SUPERVISOR

32
BED BATHS
  • As with any procedureobtain proper
    authorization, assemble equipment, knock,
    introduce yourself, identify the patient, screen
    the unit, eliminate drafts, adjust the
    thermostat, wash hands (you will need gloves for
    part of a complete bed bath), lock wheels on bed,
    elevate bed to proper level
  • As you bathe patient, take special care to expose
    ONLY the area of the body you are washing at the
    time
  • Keep patient warm and covered

33
BED BATHS
  • Lower side rail on side you are working
  • Replace top linen with bed blanket
  • Provide oral hygiene
  • Shave male patient or after face is washed
  • Fill basin 2/3 full with warm, not hot water
    (105-110)

34
BED BATHS
  • Help patient move to side of bed nearest you
  • Remove bedclothes keeping patient covered with
    bath blanket
  • Place towel over upper edge of bath blanket
  • With washcloth, form mitten around hand, tucking
    in edges (see figure 20-41, page 668)

35
BED BATHS
  • Wet washcloth, squeezing out extra water
  • Wash patients eyes, starting at inner area,
    moving to outside
  • Use different part of cloth for other eye
  • Rinse cloth
  • Wash face, neck, and ears, using soap on face if
    patient desires
  • Rinse and pat dry

36
BED BATHS
  • Towel lengthwise under arm on far side
  • Hand and nails in basin
  • Wash, rinse, and pat arm dry from axilla to hand
  • Nail care

37
BED BATHS
  • Bath towel over chest
  • Fold bath blanket down from under towel
  • Wash, rinse, and dry the chest and breasts
  • Pay particular attention to area under females
    breasts
  • Dry thoroughlyapply lotion as desired

38
BED BATHS
  • Turn towel lengthwise to cover chest and abdomen
  • Fold bath blanket down to pubic area
  • Wash, rinse, and dry abdomen
  • Replace bath blanket
  • Remove towel

39
BED BATHS
  • Fold bath blanket to expose patients far leg
  • Place towel lengthwise under leg and foot
  • Place foot in basin by flexing the knee
  • Wash and rinse leg and foot
  • Remove basin
  • Dry leg and foot
  • Repeat for other leg

40
BED BATHS
  • Provide nail care as needed
  • NEVER cut toenails
  • File straight across
  • Apply lotion to feet
  • Observe for any color changes or irritated areas
    that may signify problems

41
BED BATHS
  • ELEVATE SIDERAIL
  • CHANGE WATER IN BASIN
  • ALWAYS CHANGE WATER AT THIS TIME
  • WATER MAY BE CHANGED AT OTHER TIMES IF IT BECOMES
    TOO COOL, DIRTY, OR SOAPY

42
BED BATHS
  • Lower siderail
  • Turn patient onto side or prone
  • Place towel lengthwise on the bed along patients
    back
  • Wash, rinse, dry entire back thoroughly with
    towel
  • Observe for changes that may signify problems,
    especially bony areas
  • Give backrub

43
BACK RUBS
  • RUB SMALL AMOUNT OF LOTION INTO HANDS TO WARM
  • A.REPEAT 4 TIMES
  • B.REPEAT 4 TIMES
  • C.REPEAT 1 TIME
  • D. USE FIRST MOTION FOR 3-5 MINUTES
  • E. REPEAT FOR 1-2 MINUTES (RELAXATION AFTER
    STIMULATION)

44
BED BATHS
  • Turn patient onto back
  • Keep patient draped with bath blanket
  • If patient can wash perineal area, place basin
    with water, soap, washcloth, towel, and call
    signal within easy reach
  • Raise siderail and wait outside for patient to
    complete procedure

45
BED BATHS
  • STRAIGHTEN BED LINEN
  • CHANGE GOWN AS NEEDED

46
BED BATHS
  • If patient cannot wash perineal area
  • Put on gloves
  • Drape and position the female patient in dorsal
    recumbent position, male patient in horizontal
    recumbent position
  • Towel or disposable underpad under patient

47
PERINEAL CARE--FEMALE
  • Always wash from front to back (or rectal area)
  • Separate the labia, or lips
  • Cleanse area thoroughly with front to back motion
  • Use clean area of washcloth or rinse cloth
    between each wipe
  • Wash rectal area

48
PERINEAL CARE--MALE
  • Cleanse the tip of penis using a circular motion
    starting at urinary meatus working outward
  • Cleanse penis from top to bottom
  • If not circumcised, gently draw the foreskin back
    to wash the area
  • After rinsing and drying the area, gently return
    foreskin to normal position
  • Wash scrotum and scrotal area
  • Turn male patient on his side to wash rectal area

49
BED BATHS
  • When perineal area is rinsed, clean, and dry,
    reposition patient on his/her back
  • Remove towel or underpad
  • Remove gloves
  • Wash hands
  • Provide clean bedclothes
  • Provide hair care
  • Make bedoccupied bed

50
BED BATHS
  • Observe all checkpoints
  • Clean and replace all equipment
  • Proper charting procedures

51
TUB BATHS OR SHOWERS
  • MAKE SURE THE TIME IS APPROPRIATE FOR A SHOWER OR
    BATH
  • TAKE SUPPLIES TO BATH OR SHOWER AREA
  • TUBS SHOULD BE CLEANED BEFORE AND AFTER USE
  • NON SKID STRIPS OR RUBBER MAT IN TUB OR SHOWER
  • FILL TUB ½ FULL OF WARM WATER (105) OR ADJUST
    SHOWER TEMPERATURE

52
TUB BATHS OR SHOWERS
  • ASSIST PATIENT WITH ROBE AND SLIPPERS
  • ASSIST PATIENT TO TUB/SHOWER AREA USING
    WHEELCHAIR AS NEEDED
  • IF NECESSARY, OR IN ACCORDANCE WITH FACILITY
    POLICY, REMAIN WITH PATIENT OR INSTRUCT PATIENT
    ON USE OF EMERGENCY CALL LIGHT

53
TUB BATHS OR SHOWERS
  • CHECK ON PATIENT FREQUENTLY
  • IF PATIENT SHOWS SIGNS OF WEAKNESS OR DIZZINESS,
    USE CALL BUTTON TO GET HELP
  • ASSIST TO WHEELCHAIR/CHAIR FROM SHOWER
  • EMPTY TUB
  • KEEP PATIENT COVERED WITH TOWEL OR BATH BLANKET
    TO PREVENT CHILLING

54
TUB BATHS OR SHOWERS
  • HELP AS NEEDED AFTER TUB OR SHOWER
  • HELP WITH CLEAN BED CLOTHES
  • ADMINISTER BACK RUB, HAIR, OR NAIL CARE
  • OBSERVE ALL CHECKPOINTS BEFORE LEAVING PATIENT

55
TUB BATHS OR SHOWERS
  • REPLACE ALL EQUIPMENT AND SUPPLIES
  • CLEAN BATH/SHOWER AREA USING GLOVES
  • WASH HANDS
  • CHART ACCORDING TO POLICY

56
FEEDING A PATIENT
  • Good nutrition is an important part of patients
    treatment
  • Important to make mealtimes as pleasant as
    possible
  • Mealtimes are social times
  • Most people prefer to eat with others
  • People who eat alone often have poor appetites
    and poor nutrition
  • In LTCF, patients are encouraged to eat in the
    dining room and interact socially with others
  • If patient is confined to bedimportant to talk
    while serving or feeding

57
FEEDING A PATIENT--Preparation
  • Patient should be ready to eat when tray arrives
  • Offer bedpan/urinal or assist to bathroom
  • Clear room of offensive odors
  • Allow patient to wash hands face
  • Provide oral hygiene
  • Position patient comfortably, in sitting
    position, if able
  • Clear overbed table position it for meal tray
  • Remove objects such as emesis basin urinal from
    patients view

58
FEEDING A PATIENT
  • If patients tray is delayed due to tests, etc.,
    explain this to patient
  • Check food tray carefully before serving
  • Check patients name, room number, type of diet
  • Note anything that seems out of place, such as
  • Salt shaker on low salt diet
  • Sugar on diabetic diet
  • Inform supervisor of any problems
  • Never add any food to tray without checking diet
    order

59
FEEDING A PATIENT
  • ALWAYS allow patient to feed him/herself if
    possible
  • Assist by cutting meat, opening milk cartons,
    buttering bread
  • If patient is blind or visually impaired
  • Tell patient what food is on plate by comparing
    it to clock face
  • Ex Swiss steak at 12 peas and carrots at 4,
    mashed potatoes at 9
  • Make sure all utensils are conveniently placed
  • Position towel or napkin under the patients chin

60
FEEDING A PATIENT
  • Test temperature of hot foods before feeding
    patient
  • Place small amount on your wrist (NOT the
    patients!!) to check temperature
  • NEVER blow on hot food to cool it!!!!

61
PRINCIPLES OF FEEDING A PATIENT
  • Alternate the foods by giving sips of liquids
    between solid foods, but dont mix foods
  • Use straws for liquids whenever possible
  • Do not use straws if patient has dysphagia or
    difficulty in swallowing
  • Straws can force liquids down the throat faster
    and cause choking
  • Thick-It solidifies liquids slightly to make
    easier to swallow, but must be ordered by MD or
    dietician

62
FEEDING A PATIENT
  • Hold spoon or fork at right angles to patients
    mouth so you are feeding them from the tip
  • Place small amounts on the spoon1/3 to ½ full
  • Tell the patient what s/he is eating
  • Encourage the patient to eat as much as possible

63
FEEDING A PATIENT
  • Provide relaxed, unhurried atmosphere
  • Allow patient sufficient time to chew food
  • Observe how much patient eats
  • Keep record of nutritional intake
  • If patient does not like a certain food, check
    with supervisor to see if substitutions can be
    made
  • Record the intake if patient is on IO

64
FEEDING A PATIENT
  • Always be alert to signs of choking while feeding
    a patient
  • Make every effort to prevent choking
  • Feed small quantities
  • Allow patient time to chew and swallow
  • Provide liquids to keep the mouth moist and make
    chewing and swallowing easier

65
FEEDING A PATIENT
  • If patient has had a stroke, one side of mouth
    might be affected
  • As you feed the patient, direct the food to
    unaffected side
  • Watch patients throat to check swallowing
  • Watch for food that may be lodged in the affected
    side of the mouth
  • If patient chokes, be prepared to proved
    abdominal thrusts or Heimlich maneuver

66
FEEDING A PATIENT
  • Allow patient to hold bread or help to extent the
    patient is able
  • Use towel or napkin to wipe mouth as necessary
  • Be alert at all times to signs of dysphagia and
    or choking
  • When meal is complete, allow patient to wash
    hands and face and provide oral hygiene
  • Note amount of food eaten record IO

67
BEDPANS/URINALS
  • ELIMINATION
  • TERMINOLOGY
  • URINATE, MICTURATE, VOID
  • DEFECATE, BOWEL MOVEMENTS (BM)

68
INTAKE AND OUTPUT
  • A large part of the body is fluid, so there must
    be a balance between the amount of fluid taken
    into the body and the amount lost from the body
  • Fluid balance may be abnormal in certain pts
  • Heart or kidney disease
  • Loss of fluid through diarrhea, vomiting,
    diarrhea, excessive perspiration, or bleeding
  • Swelling or edema occurs when excessive fluid is
    retained

69
INTAKE AND OUTPUT
  • Dehydration occurs if excessive fluid is lost
  • Edema or dehydration can lead to death if not
    treated
  • I and O record used to record all fluids taken in
    and discharged from the body
  • Forms vary but most contain separate sections for
    intake and output

70
INTAKE
  • Oral
  • Tube feeding or enteral feedings
  • IV
  • Irrigation

71
OUTPUT
  • BM
  • Emesis
  • Urine
  • Irrigation

72
INPUT AND OUTPUT
  • Records must be accurate
  • Care must be taken when adding or totaling the
    columns
  • Totals are calculated for 8 hour and 24 hours
    periods
  • Careful instruction must be given to patients AND
    their families on IOs

73
Procedure for recording IO
  • Use a blue or black pen
  • Find the correct time line and column to record
    the information
  • Note the number of ccs or mls for standard
    containers such as coffee cup, glass, and other
    containers at the top of the chart
  • Recheck all entries for accuracy
  • Enter observations about colors, types, solutions
    used, and other information in the remarks column

74
Procedure for recording IO
  • After all the information for an 8-hour time
    period is recorded, total each column separately
    to calculate the 8-hour total
  • When all 8-hour time periods have been totaled,
    add the three 8-hour totals together for each
    separate column
  • On some charts, all 24-hour totals for intake are
    added together for a 24-hour intake total, and
    all 24-hour totals for output are added together
    for a 24-hour output total

75
Procedure for recording IO
  • If you make an error
  • Draw one line through the error
  • Initial, and record the correct information
  • Do a final check of the I O
  • Make sure all entries are correct
  • Make sure comments are noted in comment section
  • Make sure all additions are accurate and legible

76
CATHETER CARE
  • Provided to keep urinary meatus clean and free of
    secretions
  • Helps prevent bladder and kidney infections
  • Done AT LEAST once every 8 hours
  • Careful observation of urine
  • Amount, color, presence of other substances
  • Report unusual observations immediately

77
CATHETER CARE
  • Obtain proper authorization
  • Knock, pause, introduce self, identify patient,
    explain procedure, provide privacy
  • Safety points standard precautions
  • Female patient in dorsal recumbent position
  • Male patient in horizontal recumbent position
  • Drape patient to expose only perineal area
  • Sterile applicator moistened with antiseptic
    solution or soap and water

78
CATHETER CARE--FEMALE
  • Gently separate labia or lips to expose urinary
    meatus
  • Wipe from front to back with sterile applicator
  • Place used applicator in plastic waste bag
  • Use clean, sterile applicator each time, and
    continue to wipe from front to back until area is
    clean

79
CATHETER CARE--MALE
  • Gently grasp penis and draw foreskin back
  • Use circular motion to clean around meatus
  • Use sterile applicator to wipe from meatus down
    the shaft
  • Place used applicator in plastic waste bag
  • Use clean sterile applicator each time, and
    continue to wipe from meatus down shaft until
    area clean
  • After the area is clean, gently return the
    foreskin to its normal position

80
CATHETER CARE
  • Use sterile applicator to clean catheter from
    meatus down about 4 inches
  • Take care not to pull on catheter
  • Place used applicator in plastic waste bag
  • Use clean sterile applicator and repeat until
    clean
  • Observe area carefully for any signs of
    irritation, abnormal discharges, or crusting

81
CATHETER CARE
  • Reposition patient comfortably in correct
    alignment
  • Check all points on catheter and urinary drainage
    unit
  • Always check patient for safety and comfort
    before leaving
  • Record and/or report all required information

82
OSTOMY CARE
  • OBJECTIVES
  • DEFINE OSTOMY
  • DIFFERENTIATE BETWEEN A URETEROSTOMY, ILEOSTOMY,
    COLOSTOMY
  • LIST BASIC PRINCIPLES FOR OSTOMY CARE
  • IDENTIFY UNIVERSAL PRECAUTIONS OBSERVED DURING
    OSTOMY CARE

83
OSTOMY CARE
  • Ostomy
  • Surgical procedure in which an opening, called a
    stoma, is created in the abdominal wall
  • Allows wastes such as urine or stool (feces) to
    be expelled through the opening
  • Most often done due to tumors/cancers in urinary
    bladder or intestine
  • Birth defects, ulcerative colitis, bowel
    obstruction, injuries
  • Permanent or temporary

84
TYPES OF OSTOMIES
  • Ureterostomy
  • Opening into one of the ureters
  • Ureter is brought to the surface of abdomen to
    drain urine
  • Ileostomy
  • Opening in ileum (small intestine), with loop
    brought to abdomen
  • Entire large intestine is bypassed
  • Stool expelledliquid and frequent
  • Contains digestive enzymes that irritate skin

85
TYPES OF OSTOMIES
  • Colostomy
  • Opening into large intestine or colon
  • Different kinds of colostomies depending on the
    area of large intestine involved
  • Stool expelled through an ascending colostomy is
    usually more liquid
  • Transverse or descending colostomy more solid and
    formed
  • Sigmoid colostomy is similar to normal stool
  • Digestive products have moved through most of the
    intestine
  • Water and other substances have been reabsorbed

86
OSTOMY CARE
  • Bags or pouches to collect urine or stool
  • Held in place by belt or adhesive seal
  • Problems include leakage, odor, irritation of
    skin surrounding stoma
  • Pouch must be emptied frequently
  • Good stoma and skin care essential since these
    areas are irritated by the urine or stool
    drainage
  • Skin barriers

87
OSTOMY CARE
  • New colostomies are cared for by RNs
  • older ostomies may be cared for by trained
    health care assistants
  • Know facility policy and legal responsibilities
  • Eventual self care of ostomy

88
OSTOMY CARE-Pyschological
  • Loss of self worth and dignity
  • Patient feels different even though clothes cover
    bag
  • Sometimes difficulty maintaining normal sex life
  • Anger, anxiety, depression, fear, hopelessness
    (especially with CA diagnosis)
  • Allow expression of feelings, verbalize fears
  • Understanding
  • Support groups

89
OSTOMY CARE--Observations
  • Stoma is mucous membrane-no nerve endings
  • Bright to dark red with wet appearance
  • Rubbing or pressure can cause bleeding
  • Report any abnormal appearance
  • Blue to black color indicates interference with
    blood supply
  • Pale or pink color can indicate low hemoglobin
  • Dry or dull appearance signifies dehydration

90
OSTOMY CARE-Observations
  • Profuse bleeding, ulceration or cuts, or
    formation of crystals on the stoma indicate
    problems
  • Discharge in bag should be observed
  • Note amount, color, type (liquid, semi-formed,
    formed)
  • REPORT and RECORD anything unusual

91
OSTOMY CARE
  • Standard precautions
  • Gloves, wash hands often, eye protection
  • Discard pouch in biohazard bag
  • If bedpan is used, it must be cleaned and
    disinfected
  • Any areas contaminated with urine or stool must
    be cleaned with disinfectant

92
OSTOMY CARE
  • Obtain proper authorization
  • Knock, pause, introduce yourself, identify
    patient, explain the procedure, provide privacy
  • Observe all safety points regarding body
    mechanics, siderails, height of bed, and patient
    safety
  • Observe standard precautions

93
OSTOMY CARE
  • Cover the patient with a bath blanket
  • Place bed protector or underpad under the
    patients hips on the side of the stoma
  • Fill basin with water (105-110F)
  • Place the bedpan and plastic waste bag within
    easy reach and put on gloves

94
OSTOMY CARE
  • Open belt and carefully remove ostomy bag
  • Be gentle when peeling bag away from stoma
  • Note amount, color, and type of drainage in the
    bag
  • Place bag in bedpan or biohazard bag (if ostomy
    bag is disposable)

95
OSTOMY CARE
  • If bag is reusable
  • Drain the fecal material (or urine) by placing
    the clamp end of the bag over a bedpan
  • Release the clamp and allow the fecal material to
    empty into the bedpan
  • Wash the inside of the bag with soap and water
    and allow it to dry before reapplying the bag
  • Most people use a second bag while the first is
    drying
  • Use toilet tissue to gently wipe around the stoma
    to remove feces or drainage

96
OSTOMY CARE
  • Look at the stoma and surrounding skin carefully
  • Check for irritated areas, bleeding, edema or
    swelling, or discharge
  • Report unusual observations
  • Wash ostomy area gently with soap and water,
    using a circular motion, working from the stoma
    outward
  • Rinse entire area well to remove any soapy
    residue and dry the area gently
  • Use measuring chart to determine the correct size
    barrier wafer

97
OSTOMY CARE
  • If the wafer is not self-adhesive
  • Apply adhesive stoma paste to the skin around the
    stoma
  • Allow paste to dry if necessary
  • Peel the paper backing from the wafer
  • Position the wafer, adhesive side down, over the
    adhesive paste
  • Position the belt around the patient

98
OSTOMY CARE
  • Place a clean ostomy bag in place over the wafer
    and seal bag tightly to wafer to prevent leakage
  • If the pouch has a drainage area, make sure the
    clip or clamp is secure
  • Remove underpad
  • Reposition patient comfortably in correct
    alignment
  • Check patient for comfort and safety before
    leaving
  • Observe standard precautions while discarding the
    used ostomy bag, drainage, and other contaminated
    equipment
  • REPORT AND RECORD

99
URINE SPECIMENS
  • SPECIMEN USUALLY COLLECTED FROM FIRST URINE
    VOIDED IN AM
  • URINE IS MORE CONCENTRATED
  • MORE SHOW MORE ABNORMALITIES
  • USUALLY HAS ACID pH, WHICH HELPS PRESERVED CELL
    PRESENT
  • IF TEST FOR GLUCOSE AND ACETONE, SPECIMEN MUST BE
    FRESH AND COLLECTED JUST BEFORE TESTING

100
URINE SPECIMENS
  • MAY BE COLLECTED IN BEDPAN/URINAL OR SPECIAL
    URINE COLLECTOR AND POURED INTO SPECIMEN
    CONTAINER
  • MAY VOID DIRECTLY INTO CONTAINER
  • USUALLY 120cc SUFFICIENT FOR TESTING
  • PLACE IN BIOHAZARD BAG TO SEND TO LAB
  • REFRIGERATE UNTIL TESTING

101
URINE SPECIMENS
  • CLEAN CATCH OR MIDSTREAM
  • SPECIAL METHOD OF OBTAINING URINE SPECIMEN FREE
    FROM CONTAMINATION
  • STERILE URINE SPECIMEN
  • CATHETERIZATION REQUIRED

102
URINE SPECIMENS
  • 24 HOUR SPECIMEN
  • USED FOR KIDNEY FUNCTION FOR COMPONENTS SUCH AS
    PROTEIN, CREATININE, UROBILINOGEN, HORMONES,
    CALCIUM
  • PT VOIDS, URINE DISCARDED-TIME NOTED BEGINNING 24
    HOUR PERIOD
  • ALL URINE VOIDED IN NEXT 24 HOURS SAVED
  • LAST URINE VOIDED AT END OF 24 HOUR PERIOD SAVED
    FOR FINAL COLLECTION

103
STOOL SPECIMENS
  • Specimen of feces or stool examined by lab
    personnel
  • Usually done for ova and parasites (OP)eggs and
    worms!!
  • Specimen must be kept warm at body temperature
  • Should be tested within 30 minutes for accurate
    results
  • Can be examined for presence of fats,
    microorganisms, and other abnormal substances or
    OCCULT BLOOD
  • Special stool specimen container

104
STOOL SPECIMENS-Hemoccult
  • Blood from intestinal tract in stooloccult
    (hidden) blood
  • Test requires very small amount of stool
  • Special card with chemical
  • Uses developing solution
  • Color change indicates positive resultspresence
    of blood
  • No requirements for immediate testing or special
    temperature

105
PRACTICE CHECK OFF
  • PCA REQUIREMENTS!!!
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