2. Unit 11 Resident Care Procedures
Nurse Aide I Course

3. 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.

4. 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;

5. 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.

6. Elimination Of
Waste Products

7. Objective
11.0 Describe what is meant by elimination needs.

8. Elimination of Waste Products
Natural process
Healthy individuals have regular elimination habits

9. 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

10. Elimination of Waste Products (continued)
Equipment needed
Urinal
used by men
used for urination

11. 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

12. Objective
11.1 Review the guidelines to follow when assisting the resident with elimination needs.

13. Guideline To Assist With Elimination
Assist to as close to a sitting position as possible

14. 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

15. 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

16. Guideline To Assist With Elimination (continued)
Do not leave on bedpan for long periods of time
Cover and empty bedpan immediately.

17. 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

18. Demonstration
and
Return

19. Objective
11.2 Demonstrate the procedure to follow when assisting the resident to use the bathroom.

20. Objective
11.3 Demonstrate the procedure to follow when helping the resident to use a bedside commode.

21. Objective
11.4 Demonstrate the procedure to follow when assisting the resident to use a bedpan.

22. Objective
11.5 Demonstrate the procedure to follow when assisting a resident to use a urinal.

23. Indwelling
Catheters

24. Objective
11.6 Discuss indwelling catheters and catheter care.

25. 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

26. Indwelling Catheters (continued)
Use
Residents with nerve injury:
following spinal cord injury
after stroke
After surgery
Some incontinent residents

27. 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

28. Objective
Identify guidelines to follow when caring for residents with indwelling catheters (Foley).

29. 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

30. 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

31. 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

32. 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

33. Demonstration
and
Return

34. Objective
11.7 Demonstrate the procedure for providing catheter care.

35. Objective
11.8 Demonstrate the procedure for emptying a urinary drainage bag.

36. Collecting
Routine
Urine Specimen

37. Objective
11.9 Discuss the collection of urine specimens.

38. 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
request form

39. 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

40. 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
10-20-
Smith, A
Urinalysis

41. Demonstration
and
Return

42. Objective
11.10 Demonstrate the procedure for collecting a routine urine specimen.

43. Types of
Urine Collections

44. Objective
11.11 Discuss the collection of two more types of urine sample collections: the clean catch and the 24-hour specimen.

45. Clean Catch Urine Specimen (mid-stream)
Cleaning of perineum prior to collection reduces number of microbes that may contaminate specimen 

46. 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

47. 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

48. 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

49. 24-Hour Urine Specimen (continued)
Imperative that resident and staff understand procedure and exact time period for sample collection
Follow Standard Precautions

50. Applying and
Caring For
Condom Catheters

51. Objective
11.12 Discuss guidelines to follow when caring for a resident with a condom catheter.

52. 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

53. 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

54. Demonstration
and
Return

55. Objective
Demonstrate the procedure for applying a condom catheter.

56. Guidelines For
Collecting
Stool Specimen

57. Objective
11.13 Discuss the collection of stool specimens.

58. Guidelines For Collecting Stool Specimen
Ordered by physician
Studied by laboratory to identify:
Blood in stool
Parasites
Fat
Microorganisms
Other abnormalities

59. 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

60. Demonstration
and
Return

61. Objective
11.14 Demonstrate the procedure for collecting a stool specimen.

62. Cleansing
Enemas

63. Objective
11.15 Define the term enema and identify some of the most common solutions.

64. 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

65. Cleansing Enemas (continued)
Common solutions
Tap water
Saline solution
Soap suds
Oil retention
Prepackaged disposable, hypertonic solution
Disposable
Hypertonic
Solution

66. Objective
Discuss the guidelines for giving an enema.

67. 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

68. 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

69. Cleansing Enemas: Guidelines For Administration (continued)
Bathroom
Be sure bathroom is available for use

70. Demonstration
and
Return

71. Objective
11.16 Demonstrate the procedure for administering a cleansing enema.

72. Warm and
Cold Therapy

73. Objective
11.17 Discuss the purposes and effects of warm and cold therapy.

74. Warm And Cold Therapy
Requires physician’s order for type of therapy and length of time for application

75. 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

76. 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

77. Objective
Discuss the three types of warm and cold applications.

78. Types Of Warmth And Cold
Dry cold - water does not touch skin
ice bags
ice caps
ice collars
disposable cold pack

79. Types Of Warmth And Cold (continued)
Moist cold - water touches skin
compresses – localized application
soaks - body part immersed in water
cool sponge bath

80. Types Of Warmth And Cold (continued)
Dry warmth – pads with circulating warm water
Moist warmth
compresses
soaks
sitz bath

81. Objective
Discuss the guidelines for warm and cold applications.

82. 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.
WARM

83. 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

84. Demonstration
and
Return

85. Objective
11.18 Demonstrate the procedure for applying warm or cold applications.

86. Nonsterile
Bandages

87. Objective
11.19 Discuss the application of nonsterile bandages.

88. Bandages
Purposes
hold dressing in place
secure splints
support and protect body parts
Materials in various types and sizes
roller gauze
elastic bandages
triangular

89. Objective
Review the guidelines to be considered with the use of bandages.

90. 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

91. 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

92. Guidelines For Use Of Bandages (continued)
Loosen bandages if any signs of impaired circulation noted and report to supervisor immediately.

93. Demonstration
and
Return

94. Objective
Demonstrate the procedure for applying elastic bandages.

95. Coughing
And
Deep Breathing

96. Objective
11.20 Discuss reasons for coughing and deep breathing exercises.

97. 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

98. 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

99. Coughing And Deep Breathing (continued)
Physiology
Deep Breathing
increases level of oxygen in blood
increases lung expansion

100. Coughing And Deep Breathing (continued)
Physiology
Coughing
removes mucus from airways and lungs
may cause collapse of lung if congestion not present

101. Coughing And Deep Breathing (continued)
Considerations with deep breathing and coughing
Doctors order exercises
Frequency of performing exercise varies per doctor’s order

102. 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

103. Demonstration
and
Return

104. Objective
Demonstrate the procedure for assisting with coughing and deep breathing exercises.

105. (Anti-embolitic Hose)
Elastic Stockings
(Anti-embolitic Hose)

106. Objective
11.21 Discuss the purpose of elastic stockings.

107. Elastic Stockings (Anti-embolitic Hose)
Purpose
Provide support
Provide comfort
Promote circulation by providing pressure
Reduce risk of thrombus formation

108. Objective
Discuss indications for use of elastic stockings.

109. 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

110. Objective
Discuss action of elastic stockings in the prevention of blood clots.

111. 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)

112. 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

113. 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

114. Demonstration
and
Return

115. Objective
Demonstrate the procedure for applying and removing elastic stockings or TED hose.

116. Applying
Nonsterile
Dressing

117. Objective
11.22 Discuss purpose of applying a nonsterile dressing.

118. 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

119. Demonstration
and
Return

120. Objective
Demonstrate the procedure for applying a nonsterile dressing.

121. The End