Unit 11 Resident Care Procedures Nurse Aide I Course
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.
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;
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.
11.0Describe what is meant by elimination needs.
Elimination of Waste Products Natural process Healthy individuals have regular elimination habits
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
Elimination of Waste Products (continued) Equipment needed –Urinal used by men used for urination
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
11.1Review the guidelines to follow when assisting the resident with elimination needs.
Guideline To Assist With Elimination Assist to as close to a sitting position as possible
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
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
Guideline To Assist With Elimination (continued) Do not leave on bedpan for long periods of time Cover and empty bedpan immediately.
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
11.6Discuss indwelling catheters and catheter care.
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
Indwelling Catheters (continued) Use –Residents with nerve injury: following spinal cord injury after stroke –After surgery –Some incontinent residents
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
11.6.1Identify guidelines to follow when caring for residents with indwelling catheters (Foley).
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
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
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
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
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
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
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
11.11Discuss the collection of two more types of urine sample collections: the clean catch and the 24-hour specimen.
Clean Catch Urine Specimen (mid-stream) Cleaning of perineum prior to collection reduces number of microbes that may contaminate specimen
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
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
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
24-Hour Urine Specimen (continued) Imperative that resident and staff understand procedure and exact time period for sample collection Follow Standard Precautions
11.12Discuss guidelines to follow when caring for a resident with a condom catheter.
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
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
11.13Discuss the collection of stool specimens.
Guidelines For Collecting Stool Specimen Ordered by physician Studied by laboratory to identify: –Blood in stool –Parasites –Fat –Microorganisms –Other abnormalities
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
11.15Define the term enema and identify some of the most common solutions.
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
Cleansing Enemas (continued) Common solutions –Tap water –Saline solution –Soap suds –Oil retention –Prepackaged disposable, hypertonic solution
11.15.1Discuss the guidelines for giving an enema.
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
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
Cleansing Enemas: Guidelines For Administration (continued) Be sure bathroom is available for use
11.17Discuss the purposes and effects of warm and cold therapy.
Warm And Cold Therapy Requires physician’s order for type of therapy and length of time for application
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
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
11.17.1Discuss the three types of warm and cold applications.
Types Of Warmth And Cold Dry cold - water does not touch skin –ice bags –ice caps –ice collars –disposable cold pack
Types Of Warmth And Cold (continued) Moist cold - water touches skin –compresses – localized application –soaks - body part immersed in water –cool sponge bath
Types Of Warmth And Cold (continued) Dry warmth – pads with circulating warm water Moist warmth –compresses –soaks –sitz bath
11.17.2Discuss the guidelines for warm and cold applications.
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.
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
11.19Discuss the application of nonsterile bandages.
Bandages Purposes –hold dressing in place –secure splints –support and protect body parts Materials in various types and sizes –roller gauze –elastic bandages –triangular
11.19.1Review the guidelines to be considered with the use of bandages.
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
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
Guidelines For Use Of Bandages (continued) Loosen bandages if any signs of impaired circulation noted and report to supervisor immediately.
11.21Discuss the purpose of elastic stockings.
Elastic Stockings (Anti-embolitic Hose) Purpose –Provide support –Provide comfort –Promote circulation by providing pressure –Reduce risk of thrombus formation
11.21.1Discuss indications for use of elastic stockings.
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
11.21.2Discuss action of elastic stockings in the prevention of blood clots.
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)
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
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
11.22Discuss purpose of applying a nonsterile dressing.
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