2Unit 11 Resident Care Procedures Nurse Aide I Course
3Resident 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.
4Resident 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;
5Resident 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.
7Objective11.0 Describe what is meant by elimination needs.
8Elimination of Waste Products Natural processHealthy individuals have regular elimination habits
9Elimination of Waste Products (continued) Equipment neededBedpanregular size - used by female for urination and both men and women for defecationfracture pan - smaller and flatter and usually used with fracture of vertebrae, pelvis or leg
10Elimination of Waste Products (continued) Equipment neededUrinalused by menused for urination
11Elimination of Waste Products (continued) Equipment neededBedside commodeportable chair brought to bedsidecontains opening for a bedpan or similar type containerused for residents unable to walk to bathroom
12Objective11.1 Review the guidelines to follow when assisting the resident with elimination needs.
13Guideline To Assist With Elimination Assist to as close to a sitting position as possible
14Guideline To Assist With Elimination (continued) Provide privacy and warmthclose doors, curtains, and drapesassist with robe and footwearcover with cotton blanket or lap robe when using bedside commodeleave area if safe to leave alone
15Guideline To Assist With Elimination (continued) Provide toilet paper and place call signal within the resident’s reachOffer bedpan periodically as residents may be uncomfortable requesting its use
16Guideline To Assist With Elimination (continued) Do not leave on bedpan for long periods of timeCover and empty bedpan immediately.
17Guideline To Assist With Elimination (continued) Put on glove and assist resident to clean genital area as necessaryAssist with handwashingat the sinkby providing soap and basin of warm water
27Indwelling Catheters (continued) Increased Risk of Urinary Tract InfectionsUrinary meatus and surrounding area must be kept cleanCatheter care given at least daily and PRN
28ObjectiveIdentify guidelines to follow when caring for residents with indwelling catheters (Foley).
29Guidelines 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 freelyReport any leakage, complaints of pain, burning, or need to urinate
30Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued) Observe and report any swelling, skin irritation, or discolorationMeasure and record urinary output accurately, noting color, odor and appearance of urine
31Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued) Keep collection bag below bladderAttach collection bags to bed frame, never to side railNever leave on floorFollow facility policy for securing catheter to resident’s leg without tension on catheter
32Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued) Never disconnect catheter from tubing to drainage bagWhen emptying urinary drainage bag, never touch drain with measuring container or graduate
37Objective11.9 Discuss the collection of urine specimens.
38Collecting Routine Urine Specimen Collected for laboratory studyAids physician in diagnosisEvaluates effectiveness of treatmentLaboratory requisition slip completed and sent to laboratory with each specimenrequest form
39General Rules To Follow When Collecting Urine Specimens Wash hands carefully before and after collection of urine specimensWear glovesCollect specimen at appropriate timeUse proper container and do not touch inside of lid or container
40General Rules To Follow When Collecting Urine Specimens (continued) Label container accurately and transport to laboratory as soon as possibleTell resident not to have bowel movement or discard tissue in bedpan when collecting urine specimen10-20-Smith, AUrinalysis
44Objective11.11 Discuss the collection of two more types of urine sample collections: the clean catch and the 24-hour specimen.
45Clean Catch Urine Specimen (mid-stream) Cleaning of perineum prior to collection reduces number of microbes that may contaminate specimen
46Clean Catch Urine Specimen (mid-stream) (continued) Procedureresident begins voiding into appropriate receptacle and stops midstream; then container is placed and urine specimen is collected.follow above general rules when collecting urine specimenfollow Standard Precautions
4724-Hour Urine SpecimenAll urine voided in 24-hour period collectedurine chilled on ice to prevent growth of microorganismssome tests may require preservativesample usually collected in dark colored gallon jug24-hoururine
4824-Hour Urine Specimen (continued) Procedurethe resident voids to begin test with empty bladderfirst voiding is discardedall voidings for next 24 hours collectedif test interrupted, it must be restarted with new gallon jug
4924-Hour Urine Specimen (continued) Imperative that resident and staff understand procedure and exact time period for sample collectionFollow Standard Precautions
51Objective11.12 Discuss guidelines to follow when caring for a resident with a condom catheter.
52Applying And Caring For Condom Catheters Description and UseExternal catheter used for incontinent menMade of soft rubber sheath that fits over penis with tubing connected to urinary drainage bagAmbulatory residents may prefer leg bags during day
53Applying And Caring For Condom Catheters (continued) Description and UseNew condom catheter is applied dailyPenis observed for reddened or open areas and reported to supervisor prior to new being applied
57Objective11.13 Discuss the collection of stool specimens.
58Guidelines For Collecting Stool Specimen Ordered by physicianStudied by laboratory to identify:Blood in stoolParasitesFatMicroorganismsOther abnormalities
59Guidelines For Collecting Stool Specimen Specimen should not be mixed with urineUse tongue blades to handle specimenPrevent contaminating outside of specimen containerProperly label and transport specimen promptly
66ObjectiveDiscuss the guidelines for giving an enema.
67Cleansing Enemas: Guidelines For Administration Check temperature of enema solution with thermometerTemperature no greater than 105 FContainer should not be higher than 12 inches above anus. Solution must run in slowly to avoid serious side effects
68Cleansing Enemas: Guidelines For Administration (continued) Resident should be positioned on left side with knees slightly flexedIf possible, enemas should be given before bath and before breakfast; otherwise, wait at least one hour after meals before giving
69Cleansing Enemas: Guidelines For Administration (continued) BathroomBe sure bathroom is available for use
73Objective11.17 Discuss the purposes and effects of warm and cold therapy.
74Warm And Cold TherapyRequires physician’s order for type of therapy and length of time for application
75Warm And Cold Therapy (continued) Purposes and EffectsWARMTH: dilates blood vesselsincreased blood supply to areablood brings oxygen & nutrients for healingfluids are absorbedmuscles relaxpain relieved
76Warm And Cold Therapy (continued) Purposes and EffectsCOLD: constricts blood vesselsdecreased blood supply to areaprevents swellingcontrols bleedingnumbs skin, reducing painreduces body temperature
77ObjectiveDiscuss the three types of warm and cold applications.
78Types Of Warmth And Cold Dry cold - water does not touch skinice bagsice capsice collarsdisposable cold pack
79Types Of Warmth And Cold (continued) Moist cold - water touches skincompresses – localized applicationsoaks - body part immersed in watercool sponge bath
80Types Of Warmth And Cold (continued) Dry warmth – pads with circulating warm waterMoist warmthcompressessoakssitz bath
81ObjectiveDiscuss the guidelines for warm and cold applications.
82Guidelines For Warm Applications Guidelines for ApplicationsUse 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
83Guidelines For Cold Applications Guidelines for ApplicationsApply ice caps with metal or plastic lids away from skinCover ice caps/bags/collars prior to applicationCheck skin frequently and report any signs of complicationsNever leave in place longer than directed by supervisor
87Objective11.19 Discuss the application of nonsterile bandages.
88BandagesPurposeshold dressing in placesecure splintssupport and protect body partsMaterials in various types and sizesroller gauzeelastic bandagestriangular
89ObjectiveReview the guidelines to be considered with the use of bandages.
90Guidelines For Use Of Bandages Applied snug enough to control bleeding and prevent movement of dressingsShould not be so tight that they interfere with circulationCirculation of extremity checked below bandage
91Guidelines For Use Of Bandages (continued) Signs/symptoms that indicate poor circulation should be reported immediately to supervisor such as:swellingcyanotic skinnumbnesstinglingskin cold to touchpain or discomfort
92Guidelines For Use Of Bandages (continued) Loosen bandages if any signs of impaired circulation noted and report to supervisor immediately.
106Objective11.21 Discuss the purpose of elastic stockings.
107Elastic Stockings (Anti-embolitic Hose) PurposeProvide supportProvide comfortPromote circulation by providing pressureReduce risk of thrombus formation
108ObjectiveDiscuss indications for use of elastic stockings.
109Elastic Stockings (Anti-embolitic Hose) (continued) Indications for useResidents with heart disease and circulatory disordersResidents on bed restResidents who recently had surgery
110ObjectiveDiscuss action of elastic stockings in the prevention of blood clots.
111Elastic Stockings (Anti-embolitic Hose) (continued) Prevention of blood clots (thrombi)blood clots form (blood flow is sluggish)usually develop in deep leg veinscan break loose and travel though blood stream (then known as embolus)
112Elastic Stockings (Anti-embolitic Hose) (continued) Prevention of blood clots (thrombi)embolus can travel to the lungs and possibly cause deathelastic stockings exert pressure on veins, promoting venous blood flow to heartalso known as anti-embolitic stockings or TED hose
113Elastic Stockings (Anti-embolitic Hose) (continued) Fitting of stockingsCome in thigh high or knee high lengthsResident must be measured to ensure proper fit