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Nursing Assistant Resident Care Procedures. Respiratory disorders Secretion of mucous from –Lungs –Bronchi –Trachea Called sputum (not saliva) Expectorated.

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Presentation on theme: "Nursing Assistant Resident Care Procedures. Respiratory disorders Secretion of mucous from –Lungs –Bronchi –Trachea Called sputum (not saliva) Expectorated."— Presentation transcript:

1 Nursing Assistant Resident Care Procedures

2 Respiratory disorders Secretion of mucous from –Lungs –Bronchi –Trachea Called sputum (not saliva) Expectorated from mouth or trachea Reasons to study sputum –Blood –Microorganisms –Abnormal cells

3 Sputum collection Early a.m. best Allow to rinse with H20 NOT mouthwash –Decreases food particles –Decreases saliva Embarrassing & may be nauseating Container covered & in bag PRIVACY Standard Precautions Labeled –Full name –Room & bed number –Time & date specimen collected

4 Sputum collection (cont) Observations –Color –Odor –Consistency –Blood Document –Specimen obtained –Where you took it Need 1 – 2 Tbsp

5 Urine Specimens Can be sent to lab or tested on unit Methods –Clean catch midstream –Catheter –Routine –24 hour urine

6 Urine specimen Rules –Wash hands before & after collection –Standard Precautions –Use correct & clean container –Label Patient’s name Room & bed number Date & time specimen collected –Collect specimen directly into container –Don’t touch inside or lid

7 Rules for urine specimen No BM while specimen collected Put toilet paper in toilet or wastebasket Take specimen & requisition slip to designated lab pick-up site Document –Specimen obtained –Where it was taken

8 Observations about urine collection Difficulty obtaining specimen Color Clarity Odor Complaints of discomfort &/or urgency

9 Stool specimen Test for –Blood –Fat –Microorganisms –Worms or parasites –Any abnormal contents

10 Stool specimen rules Maintain privacy Standard precautions Use clean container No contamination with urine or toilet paper Label –Resident name –Room & bed number –Date & time collected See if can be refrigerated or at room temp Take specimen & requisition slip to designated area

11 Stool specimen observations Difficulty obtaining specimen Color Amount Consistency Where taken C/o pain & discomfort Document specimen obtained & where taken Use tongue blade & collect 2 Tbsp of stool

12 Enemas Introduction of fluids into rectum & lower colon Needs a dr’s order Purpose –Stimulate bowel movement –Relieve constipation or fecal impaction –Cleanse bowel of feces before surgery or diagnostic procedures –Remove flatus

13 Types of enemas Tap water Soap suds Saline Oil retention –Need to hold for 20 minutes Commercial – Fleet’s

14 Rules for giving enemas Nursing assistants ARE allowed to give if supervised by licensed nurse Temperature of solution – 105 degrees Amount if 500 –1000 cc for adults Position – left Sim’s Height of bag – no more than 18 inches about mattress ( 12 inches good) Insert tubing 2 – 4 inches into rectum Administer over 10 – 15 minutes Hold enema tube in place, avoid air in tubing Have toilet facilities available Record results

15 Suppositories Function –Stimulate bowel emptying –Lubricate stool to ease evacuation Rules –NA may NOT give medicated suppositories –Check arm band –Remove wrapper from suppository –Place 1 – 1 ½ inches past anal sphincter using gloved hand & index finger –Instruct resident to hold suppository as long as possible (15 – 20 minutes) –Observe results & report

16 Maintaining fluid balance After oxygen, water most important Death results from inadequate fluid intake or fluid loss –Water enters body through fluid & food –Water lost through sweat, feces, urine, lungs Balance fluid in & fluid out necessary to maintain health –Edema – fluid intake>fluid output, tissues swell –Dehydration – fluid intake< fluid output, tissues shrink Need about 2000 ml of fluid/day. –Residents depend of nursing staff for fluid needs

17 Force fluids Have resident drink increased amounts of fluids –May order specific amount each day –Maintains fluid balance –May be for general or specific amounts CNA role –Record amount in –Provide variety –Keep fluids within reach –Offer fluids frequently to residents who cannot feed themselves

18 Restrict fluids Physician’s order to limit fluids to a specific amount CNA responsibilities –Sign posted above bed –Offer water in small amounts –No water pitcher at bedside –Keep accurate I & O –Be aware of shift fluid requirements –Provide resident with frequent oral hygiene –Explain to resident & family the reason for limiting fluids

19 NPO Nothing by mouth –Before & after surgery –Before certain lab tests/xrays –Treatment of some illnesses CNA responsibility –NPO sign over bed –Remove water pitcher & glass –Offer frequent oral hygiene –No swallowing of ANY fluid

20 Intake & Output Can evaluate fluid balance, kidney function, or medical treatment Place on I & O record Done in ml or cc Use graduated cylinder to measure Conversion table is usually found on I&O record

21 Output All liquid output –Urine –Emesis –Liquid stools –Suctions –Drains –Blood loss Plastic urinals & emesis basins may be calibrated Use Standard Precautions

22 Recording I & O I & O record kept at bedside Document amounts as resident takes in or puts out Amounts totaled at end of each shift & entered into record Report –Refusing fluids –Special fluid likes or dislikes –Blood in urine

23 Gastrointestinal Tubes Nasogastric tubes (NG) –Inserted through nose into stomach or intestine to Drain GI tract by suction to prevent post-op vomiting, obstruction, or flatus Dx diseases Wash out stomach contents Provide route for feeding Gastrostomy tube –Surgically inserted through abd wall into stomach to feed resident

24 Nursing care for residents with nasogastric tubes Frequent oral hygiene Nostril cleaning Secure tubing with clamp or tape to clothing Check for kinking of tubing (don’t let resident lie on it) Check if suction working properly If allowed, permit resident to suck on ice chips, throat lozenges, or hard candy to keep throat moist (USUALLY NPO) During feedings, HOB 45 degrees during feeding & 30-60 min after, then at 30 degrees

25 Nursing care for mental & emotional comfort for NG tubes Keep env’t clean – sensitive to odors Answer call light promptly Check freq, give emotional support Extra back rub Straighten & change linen prn Let resident express concerns about tube Encourage resident to get up, dress, & become involved in activities Assist resident to attend family & group activities

26 NG tubes – Observations to report & record NVD Discomfort Distended abd Coughing C/o indigestion, heartburn Fever Respiratory distress Tachycardia Flatulence

27 Gastrostomy tubes – nursing care Freq oral hygiene, moist lips Secure tube to clothing Keep tubing free of kinks If allowed, have resident suck on ice chips, throat lozenges, or hard candy HOB at 20 – 30 degrees always, to prevent reflux Remove drsg, clean & dry area, replace drsg Report unusual conditions –Same as NG tube –Redness, swelling, drainage, odor, pain at site

28 Gastrostomy tube – mental comfort Keep env’t clean – avoid odors Answer call lights promptly Check on resident freq, TLC Extra back rub Straighten or change linens prn Encourage expression of concerns Encourage resident to get up, dressed, & become active Assist resident to attend family & group activities

29 Intravenous therapy Provides body with needed elements that can’t be given as rapidly or efficiently by other means –Blood –Plasma –Nutritional requirements Water Salt Sugar –Meds Rate of flow often controlled by infusion pump

30 Nursing care for IV Keep tubing free of twists or kinks Observe for infiltration –Catheter has come out of vein & IV fluid leaks into tissue, causes swelling –REPORT immediately to licensed nurse Painful Infections Meds that can damage integument Check restraints to be sure they do not block vein

31 Nursing responsibilities for IV Bathing –Wash gently around insertion site –Do NOT loosen tape holding catheter in place –When drying, do NOT rub over area, instead pat gently to avoid dislodging needle Eating –Cut foods, prepare liquids, arrange utensils –Assist with feeding as little as possible to encourage self care

32 Nursing responsibilities (CONT) Ambulation –Provide a portable IV stand –Assist OOB –Observe closely for weakness –Support IV arm to ensure continuous flow, may need splint or sling –Can hold the IV pole for support (even with IV arm) Provides support for arm Allows resident to move at own pace and leaves other hand free to keep balance

33 Use of bandages & binders Apply pressure (Compression) to stop bleeding, swelling, or absorb tissue fluids Provide immobilization of injuries Hold dressings in place Protect open wounds from contaminants Apply warmth to a joint (tx for arthritis) Provide support & aid in venous return –Varicose veins or residents with limited circulation in arms & legs

34 NA role in use of dressings Ordered by physician & initially applied by licensed nurse Your role –Apply simple, DRY, NONSTERILE dressings only to uncomplicated wounds –Assist licensed nurse with complex wounds –Licensed nurse will inform you when to change a dressing & what supplies to use

35 Materials used for dressings & bandages Dressings –Usually gauze –2, 3, or 4 inch squares –Size depends on area of body & purpose of dressing Bandages & binders –Muslin, gauze, flannel, rubber, & elastic fiber Dressings held in place –Hypoallergenic tape, plastic tape, elastic tape, paper tape, silk tape, adhesive tape –Binders or bandages –Type depends on purpose & resident

36 Principles of bandaging Apply bandage so pressure is evenly distributed to area –Support joint in comfortable position with slight flexion –Attach bandage securely to avoid friction & rubbing of underlying tissue which could cause irritation Start at lower (distal) part of extremity Work upward to top (proximal) part of extremity

37 Observations related to dressings Report if –Swelling –Pain –Change in color –Decrease or increase in temperature –Drainage – color, consistency, amount –Odor

38 Elastic bandages Remove every 8 hours unless ordered more frequently to check underlying skin Replace moist or soiled bandage Reapply loose or wrinkle bandage

39 Anti-embolic hose (TEDS) Used to increase circulation by improving venous return from legs to heart Remember –Always apply before resident gets OOB –Check for wrinkles –Check skin color & temperature –Check popliteal pulse

40 Non-prescription ointments, lotions, or powders CNA can apply OTC ointments, lotions, or powders to INTACT skin only –Do NOT apply to irritated skin or open lesions CAN provide care for these problems –Foot care –Dandruff –Dry skin

41 Report skin conditions to nurse Acne Minor burn Rash Excoriation, abrasions, skin tears Eczema, psoriasis Poison ivy, poison oak Minor wounds Insect bites or stings

42 OTC products that you can apply to INTACT skin Ointments –Zinc oxide –A & D ointment Lotions –Clearasil –Stri-dex medicated pads –Selsun blue –Keri lotion –Corn Huskers Powders –Johnson’s medicated powder –Tinactin foot powder

43 Rules in applying OTC products Prepare resident Position resident & cleanse skin Protect surrounding skin Apply –Wear gloves –Creams & liniments are rubbed in by hand –Lotions are applied by cotton ball –Ointments applied with wooden tongue blade or cotton swab –Sprinkle powder on hand or cloth, then apply

44 Observations about OTC products Note skin appearance & describe changes Identify signs of irritation

45 Admitting resident to facility Admission is stressful –First impressions important for adjustment –Feelings of loss Home Possessions Independence Family Freedom Privacy Control over own life

46 Admission Welcome resident –Greet them by name –Introduce yourself –Explain what you will be doing –Convey warm welcome through tone of voice & facial expression

47 Admisison Collect baseline info –Measure ht & wt –Measure VS –Observe Grooming Condition of hair & nails Condition of skin Mental alertness Sight & hearing Prosthesis Ability to move

48 Admission Report all questions & concerns to licensed nurse Orient resident & family to facility –Review facility routine –Introduce resident to roommate & staff –Tour facility –Explain operation of bed controls, TV controls & call light

49 Admission Care for personal belongings –Residents have control over possession & can decide where to put them –Fill out facility list of possessions Encourage resident to send valuables home with family Objectively describe valuables kept at facility –Label items with resident’s name

50 Transfers Tell resident about transfer & reason for moving Collect all belongings & take them to new room –Be careful not to lose anything –Check all drawers & closets for personal items Introduce resident to new roommates –New surrounding may cause confusion, orient resident to new room –Continue to remind resident of new room

51 Discharges Collect baseline information –Ht & wt –VS –Observe Grooming Condition of skin & nails Condition of skin Mental alertness Sight & hearing Presence of prosthesis Ability to move around

52 Discharges Collect personal belongings –Check all drawers & closets for personal items –Review facility list of possessions for items that might be in the safe or locked cabinet Assist resident to vehicle or mode of transportation

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