1. HS2 Medical and Nursing Services Created by: Dana Cashion, Spring 2016
Part 3, PP#2
Admitting, transferring, discharging patient
Turning and transferring patient to wheelchair
Measuring Input and Output
Assisting with Urinal
Catheter Care

2. 21:1 Admitting, Transferring, and Discharging Patients DHO pg 782
HCW in hospital and LTC facility may have to admit, transfer, and discharge pts
Admission can cause anxiety and fear for pt and family
HCW needs to be positive, courteous, and supportive to alleviate fear
Give clear instructions on what to expect- how to operate equipment and routines )

3. Admission Complete required forms
Information on forms used for nursing care plans
If pt cannot answer questions, have relative or responsible person answer
Questions re: medications and allergies fall under RN scope of practice

4. Admission Procedures Besides paperwork, specific procedures performedVS
Height and weight
Routine urine specimen

5. Patient and Family Orientation
Instructions on how to operate call light, bed controls, television, and telephone
Visiting hours, pt lounges, religious services, mealtime, and other routines explained to pt and family
Pt and family given info pamphlet, but still verbally go over the information

6. Patient Transfer
Can be done for a variety of reasons-r/t change in pt condition ie. To ICU
Transfer may be at pt request, such as to a private room
Reason for transfer should be explain to pt and family (usually MD or RN)
Gather all of patient’s personal items
And consider how to transport pt to new room-pt ambulate, wheelchair, stretcher

7. Discharge Physician’s order required to discharge pt
Most facilities require HCW to accompany individuals to their car, and most require individual to be in a wheelchair
Pt can leave facility against doctor’s orders. Called AMA-against medical advice

8. 21:2 Turning and Transferring Patients DHO pg 790
If procedure done correctly, provides patient with optimum comfort and care
Improper moving, turning, or transferring can result in serious injury to patient
Correct body mechanics essential for either of these procedures
If you are unable to move or turn a patient by yourself, always get help
Always have proper authorization before procedure

9. Patient Positioning
Pt confined to bed-Pt position must be changed every 2 hours, ie 6,8,10,noon
Frequent turning provides exercise for muscles, stimulates circulation, prevents pressure ulcers and contractures, and provides pt comfort
You are responsible for reading DHO CH 21, procedure 21:2A

10. Transferring Pt from Bed to Wheelchair
Different ways to move a pt from bed to wheelchair
Mechanical lift transfer weak or paralyzed pt
Can also use a transfer belt to move pt
Observe proper body mechanics during transfer
Once pt moved and belt removed, observe pt for signs of distress
Read Ch 21 procedure 21:2F pg 803

11. Applying elastic stockings DHO CH 21.13, pg 915
AKA surgical hose or TED hose
Can be ordered to support the veins of the legs and increase circulation
Also help prevent formation of blood clots in the legs
Must be applied correctly-if too tight, they can interfere with circulation
Prevent wrinkles, smooth out sock
Top should be just below the knee
Provide toe room

12. Checking the elastic hose
Check hose at intervals
Look for signs of impaired circulation
Abnormal skin color or temperature
Swelling
Report abnormalities to supervisor immediately
Remove hose at least once/8 hrs
Perform skin care to skin under the hose
Read Procedure 21:13D on page 915

13. 21:5 Measuring and Recording Intake and Output DHO pg 849
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
Swelling or edema results from excessive fluid ie heart or kidney disease
Dehydration is excessive fluid loss ie vomiting, diarrhea, perspiration, bleeding
Either condition can result in death )

14. Input Intake: fluids taken in by patient
This can be liquids such as water, tea, soups, ice cream
Can also be tube feedings, or enteral feeding for pts unable to swallow or comatose
Also can be IV fluids, such as blood or plasma
Can be irrigation fluids which are fluids placed into tubes that have been placed in the body, such as NG tube irrigation
You record only the amount of irrigation fluid that is left in the body

15. Output Output: fluids eliminated by patient
Should include bowel movements (BM), both liquid and solid (feces)
Emesis=vomit
Urine-voided and drained via catheter is measured and recorded. Should be more than 30ml/hr
Irrigation-any irrigation or suction drainage from NG tubes, hemo-vacs, chest tubes

16. Recording Intake and Output
Must be accurate
Measure it in graduates, container that measures in mL/cm cubed or ounces
Recorded in 8 hr and/or 24 hr increments
Usually record in metric units
1 mL=1 cc=15 gtts (drops)
5mL=1 tsp
15mL=1 tbsp
30mL=1 ounce

17. Basic Principles of I&Os
Various agencies can have different policies for recording I&Os
Where the I&O form is kept-BS vs chart
Who actually records the info-MA, RN, unit secretary
Patients need to understand what is intake and output-when it is considered I&O, what is considered I&O, and how to collect output=bedpan/urinal, nun’s cap

18. 21:7 Assisting with a Bedpan DHO 21:7, pg 859
Elimination of body waste is essential
Many patients sensitive about using bedpan/urinal
Provide privacy
Make patient comfortable
Provide bedpan immediately when called for
Offer bedpan frequently
Accurate observations important re: frequency, amount, and appearance of urine and stool

19. Terminology R/T Elimination
Urinate, micturate, or void: emptying the bladder of urine produced by the kidneys
Urinal used by males
Bedpan used by females (either fracture or orthopedic bedpan and standard bedpan)
Defecate: discharge of waste (feces or stool) thru rectum

20. Standard Precautions MUST be observed when handling urine or feces
Hands washed and gloves worn
One glove technique: used to protect the environment while assisting with bedpans
Two gloves worn while handling bedpan
Then remove one glove and hold in other gloved hand
Ungloved hand is used to open doors, turn on faucets, raise siderails
NEVER place bedpan on overbed table or bedside stand

21. At the end: Rinse the bedpan thoroughly Then disinfect bedpan
Use for only one patient
After d/c, dispose of bedpan or sterilize
Patient’s should have opportunity to wash their hands and receive perineal care afterwards
You are responsible for reading 21:7 with procedure 21:7A

22. 21:8 Providing Catheter Care DHO pg 864
A catheter may be inserted into the bladder if a patient cannot urinate or void
The catheter is attached to a drainage unit to collect the urine
French or straight cath-inserted and removed; for sterile urine specimen
Foley or indwelling or retention cath-used over an extended period of time. This catheter must be kept sterile at all times
Insertion of cath is a sterile technique

23. Drainage Unit
Closed unit to keep microorganisms from entering catheter and prevent infection
Unit is the tubing attached to catheter and extends to the bag that collects urine
Careful observation of catheter and drainage unit is required and should be checked frequently
10 listed items to monitor on page 866

24. Monitoring the Catheter and Drainage Unit
Make sure the connection between catheter and drainage unit secure
Tubing free from kinks and bends that stop urine flow
Bag below the level of the bladder
Urine is flowing freely into bag
Catheter is taped, strapped, or tied to patient’s leg
Bad is emptied frequently (q8h)
Bag is not lying on the floor

25. Monitoring Continued
No loops of drainage tub are hanging below the bag
Drainage tubing leading to the bag is above the level of the urine
Pt complains of burning, pain, irritation, or tenderness in urethral area, report to supervisor immediately
Careful observation of the urine drained should be made-amount, color, type, and presence of other substances should be noted

26. Providing Catheter Care
Urinary meatus must be kept clean and free from secretions
Catheter care provided for this purpose
Administered q8h
Usually provided during the bath and as a part of perineal care
Standard precautions used during procedure
You are responsible for reading 21:8A r/t female catheter care