Nurse assisting skills ppt

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  • Show transparency #164
  • Fanfold the top bed linen down to open the bed, unpack the admission kit, place a bedpan/urinal in the bedside stand Check the room to make sure all necessary items are in their proper places
  • Also any prescriptions that have been ordered Follow up appointments
  • Make every attempt to alleviate anxiety and fear during admissions, transfers, and discharges Follow agency policy and use the proper forms Care for the patient’s belongings and valuables and always obtain proper signatures when these items are checked
  • CONTRACTURE—TIGHTENING OR SHORTENING OF A MUSCLE USUALLY DUE TO LACK OF MOVEMENT OR USAGE OF THE MUSCLE FOOT DROP IS COMMON CONTRACTURE—CAN BE PREVENTED IN PART BY KEEPING THE FOOT AT A RIGHT ANGLE TO THE LEG WITH FOOTBOARDS, HIGH TOP TENNIS SHOES, ROM EXERCISES
  • STAGE I—RED OR BLUE-GRAY DISCOLORATION THAT DOES NOT DISAPPEAR AFTER PRESSURE HAS BEEN RELIEVED STAGE II—CHARACTERIZED BY ABRASIONS, BRUISES, AND/OR OPEN SORES AS A RESULT OF TISSUE DAMAGE TO THE TOP LAYERS OF SKIN STAGE III—DEEP OPEN CRATER FORMS WHEN ALL LAYERS OF SKIN ARE DESTROYED STAGE IV—DAMAGE EXTENDS TO MUSCLE, TENDON, AND BONE TISSUE
  • BY NOTING THE CHANGES IN PULSE RATE, THE HEALTH CARE WORKER CAN DETERMINE HOW WELL THE PATIENT TOLERATES THE PROCEDURE— NOTE ABNORMAL INCREASES IN PULSE, LABORED RESPIRATIONS, PALE COLOR, DIAPHORESIS, DIZZINESS, WEAKNESS
  • DENTURE CARE—DENTURES ARE FRAGILE—NEVER FORCE THEM OUT—LINE THE SINK WITH PAPER TOWELS OR A WASH CLOTH, AND PUT SOME WATER IN THE SINK TO PROVIDE A CUSHION IF THEY ARE ACCIDENTALLY DROPPED ***NEVER USE HOT OR VERY COLD WATER ON DENTURES **INSERT UPPER DENTURE FIRST SPECIAL ORAL HYGIENE-- Toothettes or water picks— CLEANSE ALL PARTS OF THE PATIENT’S MOUTH, INCLUDING TEETH, GUMS, TONGUE, AND ROOF OF THE MOUTH. WORK FROM THE GUMS TO THE CUTTING EDGES OF THE TEETH USING A GENTLE MOTION **DISCARD USED TOOTHETTES IN PLASTIC BAG, USING CLEAN TOOTHETTES UNTIL ALL OF MOUTH IS CLEAN
  • Diabetics have poor circulation
  • Make certain the patient is not on anticoagulants
  • TRANSPARENCY#165
  • MAY USE CLEAN ANOTHER CONTAINER FOR URINE AS LONG AS IT HAS BEEN THOROUGHLY WASHED WITH SOAP AND WATER ***DO NOT USE CONTAINER PREVIOUSLY CONTAINING MEDICATIONS—MAY ALTER TEST RESULTS!!!
  • Nurse assisting skills ppt

    1. 1. Nurse Assisting Skills Diversified Health Occupations Chapter 20 pg. 617-737
    2. 2. Nurse Assisting OBJECTIVESUpon completion of this unit, the student should be able to… Admit, transfer, or discharge a patient, demonstrating proper care of pts belongings. Administer personal hygiene Measure and record intake and output Assist a patient with eating, feed a patient Collect stool specimens Ostomy care Catheter care
    3. 3. ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT This may be one of your responsibilities. Alleviating anxiety and fear  Admission can cause anxiety and fear for many pts and their families  Even a transfer from one room to another can cause anxiety because the individual will have to adjust to another environment  Essential for health care provider to create a positive first impression  Assistant can do much to alleviate fear by being courteous, supportive, and kind.
    4. 4. ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT Alleviating anxiety and fear  Help patient become familiar with the unit  Provide clear instructions on how to operate equipment  Explain the type of routine to expect, such as times for meals  Do not hurry or rush  Allow the pt to ask questions and to express concerns  If you do not know the answers to specific questions, refer to your immediate supervisor
    5. 5. ADMISSION FORMS Forms list the procedures that must be performed Will vary slightly from facility to facility Important for health care worker to become familiar with required information on the form Much of the information on the admission form is used as a basis for the nursing care plan Must be complete and accurate! It the pt is unable to answer the questions, a relative or the person responsible for the pt is usually able to provide the information
    6. 6. PROCEDURES PERFORMED UPON ADMISSION Vital signs Height and weight measurements Collection of a routine urine specimen Protect patient’s possessions  Make a list of clothing, valuables, and personal items  In a hospital a family member will frequently take clothing home  Any personal items left in a room should be noted on a list, and the list should be signed by the pt and the assistant  At the time of transfer or discharge, the list of items is checked to make sure all of the belongings are returned  If the family member does not take items home, the items should be placed in a safe FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE PROCEDURES!!
    7. 7. PROCEDURES PERFORMED UPON ADMISSION Orient patient to facility  Provide instructions on how to operate the bed, call light, remote control for TV, etc.  Explain visiting hours, location of lounges, smoking regulations, availability of services, times for meals, and other rules and regulations  Many facilities have a pamphlet or paper listing this information, which is given to the patient and family members. FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE PROCEDURES!!
    8. 8. TRANSFERS Done for a variety of reasons  Change in the patient’s condition  Per patient request Agency policy must be followed during any transfer Reason for transfer should be explained to patient and family by the appropriate personnel New room or unit must be ready to receive the patient All personal items must be moved with patient Organized and efficient transfer will help prevent fear and anxiety for the patient
    9. 9. DISCHARGE Doctor’s order usually required If an individual plans to leave a facility without permission, report this immediately to your supervisor Facilities have special policies that must be followed when a patient leaves against medical advice (AMA) When an order for discharge is received, assistant must check and pack the patient’s belongings Check the unit, including any drawers, closets, and storage areas carefully to find all items
    10. 10. DISCHARGE Most agencies require a staff member to accompany the individual to the car If a patient is transferred by ambulance, the ambulance attendants will bring a stretcher to the room Most agencies have forms or checklists that are used during a discharge to ensure that all procedures have been followed.
    11. 11. ADMITTING Obtain orders Prepare the room for the admission Greet and identify the patient Introduce yourself Ask the family to wait in the lounge or lobby Close the door and screen the unit Ask the patient to change into a gown Position the patient comfortably in the bed
    12. 12. ADMITTING Complete the admission form or checklist Measure and record vital signs Weigh and measure the patient Complete the clothing list and make sure patient or family member checks the list Obtain a urine specimen, if ordered Orient the patient to the facility and explain all routines Fill the water pitcher if patient is allowed to have liquids
    13. 13. ADMITTING Observe all checkpoints  Patient is comfortable and in good alignment  S/R x 4  bed is at lowest position  Call light and supplies within reach  Area is neat and clean When admission is complete, allow family members to return and answer any questions they have Record required information on patient’s
    14. 14. DISCHARGING Obtain orders Check with patient to determine when relatives will arrive for discharge Close the door or screen the room Help the patient dress, if needed Assemble all the patient’s personal belongings Assemble any equipment that is given to the patient, such as the admission kit Check to make sure patient has received d/c orders and instructions from the nurse or physician
    15. 15. DISCHARGING Obtain the patient’s valuables if they are in a safe Complete a d/c checklist Place all patient’s belongings on a cart Assist the patient into a w/c Transport patient to exit area and help patient into the car Observe all safety factors while transporting patient Say good-bye 
    16. 16. DISCHARGING Return to the unit, strip the bed, remove any equipment and follow agency policy for cleaning the room Record all required information on the patient’s chart
    17. 17. WORDS TO THE WISE!!! TALK WITH YOUR PATIENTS AT ALL TIMES WATCH WHAT YOU SAY!! UNCONSCIOUS AND SEMI-CONSCIOUS PATIENTS MAY BE ABLE TO HEAR YOU ALWAYS BE KIND!!!!!!!!!!
    18. 18. Positioning, Turning, Moving, andTransferring Patients ALIGNMENT “positioning body parts in relation to each other in order to maintain correct body posture” PREVENTS  Fatigue  Pressure ulcers (decubitus ulcers)  Contractures  FOOT DROP
    19. 19. Decubitus Ulcers STAGE I STAGE IISTAGE III STAGE IV
    20. 20. PREVENTION PROVIDING GOOD SKIN CARE PROMPT CLEANING OF URINE AND FECES FROM SKIN MASSAGING IN A CIRCULAR MOTION AROUND A REDDENED AREA FREQUENT TURNING POSITIONING TO AVOID PRESSURE ON IRRITATED AREAS KEEPING LINEN CLEAN, DRY, AND WRINKLE FREE APPLYING PROTECTORS TO BONY PROMINENCES (HEELS & ELBOWS) EGG CRATE, ALTERNATING PRESSURE MATTRESSES OR WATER/GEL FILLED MATTRESSES
    21. 21. TURNING AT LEAST q 2 hr IF PERMITTED BY MD PROVIDES EXERCISE FOR MUSCLES STIMULATES CIRCULATION PREVENTS DECUBITUS ULCERS AND CONTRACTURES PROVIDES COMFORT TO PATIENT
    22. 22. DANGLING FOR PATIENTS WHO HAVE BEEN CONFINED TO THE BED FOR A PERIOD OF TIME  DONE PRIOR TO PATIENT BEING TRANSFERRED FROM THE BED SITTING WITH THE LEGS HANGING DOWN OVER THE SIDE OF THE BED PULSE CHECKED AT LEAST 3 TIMES DURING THIS PROCEDURE!!!
    23. 23. DANGLING PULSE CHECKED BEFORE—used as control, or resting rate DURING—immediately after positioning the patient in the dangling position AFTER—returning the patient to the supine position ALSO NOTE RESPIRATIONS, BALANCE, COLOR, PERSPIRATION, COLOR, OTHER CHARACTERISTICS RETURN PATIENT TO SUPINE POSITION IMMEDIATELY IF DANGLING IS NOT TOLERATED!! FOLLOW PROPER CHARTING AND NOTIFICATION TO SUPERVISOR
    24. 24. TRANSFERS BED TO WHEELCHAIR OR CHAIR WHEELCHAIR OR CHAIR TO BED BED TO STRETCHER MECHANICAL LIFT NEVER TRANSFER WITHOUT PROPER AUTHORIZATION OBSERVE PATIENT CLOSELY FOR CHANGES IN PULSE RATE, RESPIRATIONS, AND COLOR, DIZZINESS, INCREASED PERSPIRATION, OR DISCOMFORT
    25. 25. ADMINISTERING PERSONAL HYGIENE Usually includes the bath, back care, perineal care, oral hygiene, hair care, nail care, and shaving when necessary. Must be sensitive to the patient’s needs and respect the patient’s right to privacy while personal care is administered. Reasons for providing personal hygiene  Promotes good habits of personal hygiene  Provides comfort and stimulates circulation  Provides health care worker an opportunity to develop a good and caring relationship with the patient
    26. 26. BATHS Type of bath depends on the patient’s condition and ability to help. Complete bed bath (CBB)  Health assistant bathes all parts of the body; which includes oral hygiene Partial bed bath (PB)  Health assistant bathes some parts of the body and also gathers supplies needed by the patient Tub bath or shower  Assistant helps by providing towels and supplies, preparing tub or shower area
    27. 27. ORAL HYGIENE Refers to the care of the mouth and teeth Should be done at least 3 times a day and more often if patient’s condition requires frequent oral care PURPOSES  Prevents disease, caries, and halitosis.  Stimulates appetite and provides comfort ROUTINE ORAL HYGIENE  Refers to regular tooth brushing and flossing  Patient can often do self care, but assistant can help when needed
    28. 28. ORAL HYGIENE Denture care  Many patients sensitive about dentures  Assistant must provide privacy and reassure the patient  Extreme care must be taken while handling dentures NPO Patients Special oral hygiene  Care provided to unconscious or semiconscious patient  Care must be taken to clean all parts of the mouth  Special supplies may be used for this procedure
    29. 29. HAIR CARE Important aspect of personal care that is often neglected Brushing will stimulate circulation to scalp and help prevent scalp disease Shampooing must be approved by the doctor  Various types of dry or fluid shampoos are available for pts confined to bed  Special devices are available for use while giving a shampoo to a pt confined to bed
    30. 30. NAIL CARE Should be done as part of daily hygiene and patient care Often neglected area in personal care of the pt Nails harbor dirt and can lead to infection and disease Never cut the toenails!
    31. 31. SHAVING Normal daily routine for most men Important to provide when pt unable to shave Both regular and electric razors may be used Correct technique must be used to prevent injury to patient Females usually appreciate shaving of legs and underarms BE SURE YOU HAVE SPECIFIC ORDERS FROM DOCTOR OR IMMEDIATE SUPERVISOR
    32. 32. BED BATHS As with any procedure—obtain proper authorization, assemble equipment, knock, introduce yourself, identify the patient, screen the unit, eliminate drafts, adjust the thermostat, wash hands (you will need gloves for part of a complete bed bath), lock wheels on bed, & elevate bed to proper level As you bathe patient, take special care to expose ONLY the area of the body you are washing at the time Keep patient warm and covered
    33. 33. BED BATHS Lower side rail on side you are working Replace top linen with bed blanket Provide oral hygiene Shave male patient or after face is washed Fill basin 2/3 full with warm, not hot water (105°-110°)
    34. 34. BED BATHS Help patient move to side of bed nearest you Remove bedclothes keeping patient covered with bath blanket Place towel over upper edge of bath blanket With washcloth, form mitten around hand, tucking in edges (see figure 20-41, page 668)
    35. 35. BED BATHS Wet washcloth, squeezing out extra water Wash patient’s eyes, starting at inner area, moving to outside Use different part of cloth for other eye Rinse cloth Wash face, neck, and ears, using soap on face if patient desires Rinse and pat dry
    36. 36. BED BATHS Towel lengthwise under arm on ***far side Hand and nails in basin Wash, rinse, and pat arm dry from axilla to hand Nail care
    37. 37. BED BATHS Bath towel over chest Fold bath blanket down from under towel Wash, rinse, and dry the chest and breasts Pay particular attention to area under female’s breasts Dry thoroughly—apply lotion as desired
    38. 38. BED BATHS Turn towel lengthwise to cover chest and abdomen Fold bath blanket down to pubic area Wash, rinse, and dry abdomen Replace bath blanket Remove towel
    39. 39. BED BATHS Fold bath blanket to expose patient’s far leg Place towel lengthwise under leg and foot Place foot in basin by flexing the knee Wash and rinse leg and foot Remove basin Dry leg and foot Repeat for other leg
    40. 40. BED BATHS Provide nail care as needed NEVER cut toenails File straight across Apply lotion to feet Observe for any color changes or irritated areas that may signify problems
    41. 41. BED BATHS ELEVATE SIDERAIL CHANGE WATER IN BASIN ALWAYS CHANGE WATER AT THIS TIME WATER MAY BE CHANGED AT OTHER TIMES IF IT BECOMES TOO COOL, DIRTY, OR SOAPY
    42. 42. BED BATHS Lower siderail Turn patient onto side or prone Place towel lengthwise on the bed along patient’s back Wash, rinse, dry entire back thoroughly with towel Observe for changes that may signify problems, especially bony areas Give backrub
    43. 43. BACK RUBS RUB SMALL AMOUNT OF LOTION INTO HANDS TO WARM A.—REPEAT 4 TIMES B.—REPEAT 4 TIMES C.—REPEAT 1 TIME D. –USE FIRST MOTION FOR 3-5 MINUTES E. –REPEAT FOR 1-2 MINUTES (RELAXATION AFTER STIMULATION)
    44. 44. BED BATHS Turn patient onto back Keep patient draped with bath blanket If patient can wash perineal area, place basin with water, soap, washcloth, towel, and call signal within easy reach Raise siderail and wait outside for patient to complete procedure
    45. 45. BED BATHS STRAIGHTEN BED LINEN CHANGE GOWN AS NEEDED
    46. 46. BED BATHS If patient cannot wash perineal area: Put on gloves Drape and position the female patient in dorsal recumbent position, male patient in horizontal recumbent position Towel or disposable underpad under patient
    47. 47. PERINEAL CARE--FEMALE Always wash from front to back (or rectal area) Separate the labia, or lips Cleanse area thoroughly with front to back motion Use clean area of washcloth or rinse cloth between each wipe Wash rectal area
    48. 48. PERINEAL CARE--MALE Cleanse the tip of penis using a circular motion starting at urinary meatus working outward Cleanse penis from top to bottom If not circumcised, gently draw the foreskin back to wash the area After rinsing and drying the area, gently return foreskin to normal position Wash scrotum and scrotal area Turn male patient on his side to wash rectal area
    49. 49. BED BATHS When perineal area is rinsed, clean, and dry, reposition patient on his/her back Remove towel or underpad Remove gloves Wash hands Provide clean bedclothes Provide hair care Make bed—occupied bed
    50. 50. BED BATHS Observe all checkpoints Clean and replace all equipment Proper charting procedures
    51. 51. TUB BATHS OR SHOWERS MAKE SURE THE TIME IS APPROPRIATE FOR A SHOWER OR BATH TAKE SUPPLIES TO BATH OR SHOWER AREA TUBS SHOULD BE CLEANED BEFORE AND AFTER USE NON SKID STRIPS OR RUBBER MAT IN TUB OR SHOWER FILL TUB ½ FULL OF WARM WATER (105°) OR ADJUST SHOWER TEMPERATURE
    52. 52. TUB BATHS OR SHOWERS ASSIST PATIENT WITH ROBE AND SLIPPERS ASSIST PATIENT TO TUB/SHOWER AREA USING WHEELCHAIR AS NEEDED IF NECESSARY, OR IN ACCORDANCE WITH FACILITY POLICY, REMAIN WITH PATIENT OR INSTRUCT PATIENT ON USE OF EMERGENCY CALL LIGHT
    53. 53. TUB BATHS OR SHOWERS CHECK ON PATIENT FREQUENTLY IF PATIENT SHOWS SIGNS OF WEAKNESS OR DIZZINESS, USE CALL BUTTON TO GET HELP ASSIST TO WHEELCHAIR/CHAIR FROM SHOWER EMPTY TUB KEEP PATIENT COVERED WITH TOWEL OR BATH BLANKET TO PREVENT CHILLING
    54. 54. TUB BATHS OR SHOWERS HELP AS NEEDED AFTER TUB OR SHOWER HELP WITH CLEAN BED CLOTHES ADMINISTER BACK RUB, HAIR, OR NAIL CARE OBSERVE ALL CHECKPOINTS BEFORE LEAVING PATIENT
    55. 55. TUB BATHS OR SHOWERS REPLACE ALL EQUIPMENT AND SUPPLIES CLEAN BATH/SHOWER AREA USING GLOVES WASH HANDS CHART ACCORDING TO POLICY
    56. 56. FEEDING A PATIENT Good nutrition is an important part of patient’s treatment Important to make mealtimes as pleasant as possible  Mealtimes are social times  Most people prefer to eat with others  People who eat alone often have poor appetites and poor nutrition  In LTCF, patients are encouraged to eat in the dining room and interact socially with others  If patient is confined to bed—important to talk while serving or feeding
    57. 57. FEEDING A PATIENT--Preparation Patient should be ready to eat when tray arrives Offer bedpan/urinal or assist to bathroom Clear room of offensive odors Allow patient to wash hands & face Provide oral hygiene Position patient comfortably, in sitting position, if able Clear overbed table & position it for meal tray Remove objects such as emesis basin & urinal from patient’s view
    58. 58. FEEDING A PATIENT If patient’s tray is delayed due to tests, etc., explain this to patient Check food tray carefully before serving Check patient’s name, room number, & type of diet Note anything that seems out of place, such as:  Salt shaker on low salt diet  Sugar on diabetic diet Inform supervisor of any problems Never add any food to tray without checking diet order
    59. 59. FEEDING A PATIENT ALWAYS allow patient to feed him/herself if possible Assist by cutting meat, opening milk cartons, buttering bread If patient is blind or visually impaired;  Tell patient what food is on plate by comparing it to clock face  Ex: Swiss steak at 12; peas and carrots at 4, mashed potatoes at 9 Make sure all utensils are conveniently placed Position towel or napkin under the patient’s chin
    60. 60. FEEDING A PATIENT Test temperature of hot foods before feeding patient Place small amount on your wrist (NOT the patient’s!!) to check temperature NEVER blow on hot food to cool it!!!!
    61. 61. PRINCIPLES OF FEEDING APATIENT Alternate the foods by giving sips of liquids between solid foods, but don’t mix foods Use straws for liquids whenever possible  Do not use straws if patient has dysphagia or difficulty in swallowing  Straws can force liquids down the throat faster and cause choking  “Thick-It” solidifies liquids slightly to make easier to swallow, but must be ordered by MD or dietician
    62. 62. FEEDING A PATIENT Hold spoon or fork at right angles to patient’s mouth so you are feeding them from the tip Place small amounts on the spoon—1/3 to ½ full Tell the patient what s/he is eating Encourage the patient to eat as much as possible
    63. 63. FEEDING A PATIENT Provide relaxed, unhurried atmosphere Allow patient sufficient time to chew food Observe how much patient eats  Keep record of nutritional intake  If patient does not like a certain food, check with supervisor to see if substitutions can be made  Record the intake if patient is on I&O
    64. 64. FEEDING A PATIENT Always be alert to signs of choking while feeding a patient Make every effort to prevent choking Feed small quantities Allow patient time to chew and swallow Provide liquids to keep the mouth moist and make chewing and swallowing easier
    65. 65. FEEDING A PATIENT If patient has had a stroke, one side of mouth might be affected As you feed the patient, direct the food to unaffected side Watch patient’s throat to check swallowing Watch for food that may be lodged in the affected side of the mouth If patient chokes, be prepared to proved abdominal thrusts or Heimlich maneuver
    66. 66. FEEDING A PATIENT Allow patient to hold bread or help to extent the patient is able Use towel or napkin to wipe mouth as necessary Be alert at all times to signs of dysphagia and or choking When meal is complete, allow patient to wash hands and face and provide oral hygiene Note amount of food eaten & record I&O
    67. 67. BEDPANS/URINALS ELIMINATION TERMINOLOGY  URINATE, MICTURATE, VOID  DEFECATE, BOWEL MOVEMENTS (BM)
    68. 68. INTAKE AND OUTPUT 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 Fluid balance may be abnormal in certain pts  Heart or kidney disease  Loss of fluid through diarrhea, vomiting, diarrhea, excessive perspiration, or bleeding Swelling or edema occurs when excessive fluid is retained
    69. 69. INTAKE AND OUTPUT Dehydration occurs if excessive fluid is lost Edema or dehydration can lead to death if not treated I and O record used to record all fluids taken in and discharged from the body Forms vary but most contain separate sections for intake and output
    70. 70. INTAKE Oral Tube feeding or enteral feedings IV Irrigation
    71. 71. OUTPUT BM Emesis Urine Irrigation
    72. 72. INPUT AND OUTPUT Records must be accurate Care must be taken when adding or totaling the columns Totals are calculated for 8 hour and 24 hours periods Careful instruction must be given to patients AND their families on I&O’s
    73. 73. Procedure for recording I&O Use a blue or black pen Find the correct time line and column to record the information Note the number of cc’s or ml’s for standard containers such as coffee cup, glass, and other containers at the top of the chart Recheck all entries for accuracy Enter observations about colors, types, solutions used, and other information in the remarks column
    74. 74. Procedure for recording I&O After all the information for an 8-hour time period is recorded, total each column separately to calculate the 8-hour total When all 8-hour time periods have been totaled, add the three 8-hour totals together for each separate column On some charts, all 24-hour totals for intake are added together for a 24-hour intake total, and all 24- hour totals for output are added together for a 24- hour output total
    75. 75. Procedure for recording I&O If you make an error  Draw one line through the error  Initial, and record the correct information Do a final check of the I & O  Make sure all entries are correct  Make sure comments are noted in comment section  Make sure all additions are accurate and legible
    76. 76. CATHETER CARE Provided to keep urinary meatus clean and free of secretions Helps prevent bladder and kidney infections Done AT LEAST once every 8 hours Careful observation of urine  Amount, color, presence of other substances Report unusual observations immediately
    77. 77. CATHETER CARE Obtain proper authorization Knock, pause, introduce self, identify patient, explain procedure, provide privacy Safety points & standard precautions Female patient in dorsal recumbent position Male patient in horizontal recumbent position Drape patient to expose only perineal area Sterile applicator moistened with antiseptic solution or soap and water
    78. 78. CATHETER CARE--FEMALE Gently separate labia or lips to expose urinary meatus Wipe from front to back with sterile applicator Place used applicator in plastic waste bag Use clean, sterile applicator each time, and continue to wipe from front to back until area is clean
    79. 79. CATHETER CARE--MALE Gently grasp penis and draw foreskin back Use circular motion to clean around meatus Use sterile applicator to wipe from meatus down the shaft Place used applicator in plastic waste bag Use clean sterile applicator each time, and continue to wipe from meatus down shaft until area clean After the area is clean, gently return the foreskin to its normal position
    80. 80. CATHETER CARE Use sterile applicator to clean catheter from meatus down about 4 inches Take care not to pull on catheter Place used applicator in plastic waste bag Use clean sterile applicator and repeat until clean Observe area carefully for any signs of irritation, abnormal discharges, or crusting
    81. 81. CATHETER CARE Reposition patient comfortably in correct alignment Check all points on catheter and urinary drainage unit Always check patient for safety and comfort before leaving Record and/or report all required information
    82. 82. OSTOMY CARE OBJECTIVES DEFINE OSTOMY DIFFERENTIATE BETWEEN A URETEROSTOMY, ILEOSTOMY, COLOSTOMY LIST BASIC PRINCIPLES FOR OSTOMY CARE IDENTIFY UNIVERSAL PRECAUTIONS OBSERVED DURING OSTOMY CARE
    83. 83. OSTOMY CARE Ostomy  Surgical procedure in which an opening, called a stoma, is created in the abdominal wall  Allows wastes such as urine or stool (feces) to be expelled through the opening  Most often done due to tumors/cancers in urinary bladder or intestine  Birth defects, ulcerative colitis, bowel obstruction, injuries  Permanent or temporary
    84. 84. TYPES OF OSTOMIES Ureterostomy  Opening into one of the ureters  Ureter is brought to the surface of abdomen to drain urine Ileostomy  Opening in ileum (small intestine), with loop brought to abdomen  Entire large intestine is bypassed  Stool expelled—liquid and frequent  Contains digestive enzymes that irritate skin
    85. 85. TYPES OF OSTOMIES Colostomy Opening into large intestine or colon Different kinds of colostomies depending on the area of large intestine involved Stool expelled through an ascending colostomy is usually more liquid Transverse or descending colostomy more solid and formed Sigmoid colostomy is similar to normal stool  Digestive products have moved through most of the intestine  Water and other substances have been reabsorbed
    86. 86. OSTOMY CARE Bags or pouches to collect urine or stool Held in place by belt or adhesive seal Problems include leakage, odor, irritation of skin surrounding stoma Pouch must be emptied frequently Good stoma and skin care essential since these areas are irritated by the urine or stool drainage Skin barriers
    87. 87. OSTOMY CARE New colostomies are cared for by RNs “older” ostomies may be cared for by trained health care assistants Know facility policy and legal responsibilities Eventual self care of ostomy
    88. 88. OSTOMY CARE-Pyschological Loss of self worth and dignity Patient feels different even though clothes cover bag Sometimes difficulty maintaining normal sex life Anger, anxiety, depression, fear, hopelessness (especially with CA diagnosis) Allow expression of feelings, verbalize fears Understanding Support groups
    89. 89. OSTOMY CARE--Observations Stoma is mucous membrane-no nerve endings Bright to dark red with wet appearance Rubbing or pressure can cause bleeding Report any abnormal appearance  Blue to black color indicates interference with blood supply  Pale or pink color can indicate low hemoglobin  Dry or dull appearance signifies dehydration
    90. 90. OSTOMY CARE-Observations Profuse bleeding, ulceration or cuts, or formation of crystals on the stoma indicate problems Discharge in bag should be observed  Note amount, color, type (liquid, semi-formed, formed)  REPORT and RECORD anything unusual
    91. 91. OSTOMY CARE Standard precautions Gloves, wash hands often, eye protection Discard pouch in biohazard bag If bedpan is used, it must be cleaned and disinfected Any areas contaminated with urine or stool must be cleaned with disinfectant
    92. 92. OSTOMY CARE Obtain proper authorization Knock, pause, introduce yourself, identify patient, explain the procedure, provide privacy Observe all safety points regarding body mechanics, siderails, height of bed, and patient safety Observe standard precautions
    93. 93. OSTOMY CARE Cover the patient with a bath blanket Place bed protector or underpad under the patient’s hips on the side of the stoma Fill basin with water (105-110°F) Place the bedpan and plastic waste bag within easy reach and put on gloves
    94. 94. OSTOMY CARE Open belt and carefully remove ostomy bag Be gentle when peeling bag away from stoma Note amount, color, and type of drainage in the bag Place bag in bedpan or biohazard bag (if ostomy bag is disposable)
    95. 95. OSTOMY CARE If bag is reusable  Drain the fecal material (or urine) by placing the clamp end of the bag over a bedpan  Release the clamp and allow the fecal material to empty into the bedpan  Wash the inside of the bag with soap and water and allow it to dry before reapplying the bag  Most people use a second bag while the first is drying Use toilet tissue to gently wipe around the stoma to remove feces or drainage
    96. 96. OSTOMY CARE Look at the stoma and surrounding skin carefully  Check for irritated areas, bleeding, edema or swelling, or discharge  Report unusual observations Wash ostomy area gently with soap and water, using a circular motion, working from the stoma outward Rinse entire area well to remove any soapy residue and dry the area gently Use measuring chart to determine the correct size barrier wafer
    97. 97. OSTOMY CARE If the wafer is not self-adhesive  Apply adhesive stoma paste to the skin around the stoma  Allow paste to dry if necessary  Peel the paper backing from the wafer  Position the wafer, adhesive side down, over the adhesive paste Position the belt around the patient
    98. 98. OSTOMY CARE Place a clean ostomy bag in place over the wafer and seal bag tightly to wafer to prevent leakage If the pouch has a drainage area, make sure the clip or clamp is secure Remove underpad Reposition patient comfortably in correct alignment Check patient for comfort and safety before leaving Observe standard precautions while discarding the used ostomy bag, drainage, and other contaminated equipment REPORT AND RECORD
    99. 99. URINE SPECIMENS SPECIMEN USUALLY COLLECTED FROM FIRST URINE VOIDED IN AM  URINE IS MORE CONCENTRATED  MORE SHOW MORE ABNORMALITIES  USUALLY HAS ACID pH, WHICH HELPS PRESERVED CELL PRESENT IF TEST FOR GLUCOSE AND ACETONE, SPECIMEN MUST BE FRESH AND COLLECTED JUST BEFORE TESTING
    100. 100. URINE SPECIMENS MAY BE COLLECTED IN BEDPAN/URINAL OR SPECIAL URINE COLLECTOR AND POURED INTO SPECIMEN CONTAINER MAY VOID DIRECTLY INTO CONTAINER USUALLY 120cc SUFFICIENT FOR TESTING PLACE IN BIOHAZARD BAG TO SEND TO LAB REFRIGERATE UNTIL TESTING
    101. 101. URINE SPECIMENS CLEAN CATCH OR MIDSTREAM  SPECIAL METHOD OF OBTAINING URINE SPECIMEN FREE FROM CONTAMINATION STERILE URINE SPECIMEN  CATHETERIZATION REQUIRED
    102. 102. URINE SPECIMENS 24 HOUR SPECIMEN  USED FOR KIDNEY FUNCTION & FOR COMPONENTS SUCH AS PROTEIN, CREATININE, UROBILINOGEN, HORMONES, CALCIUM PT VOIDS, URINE DISCARDED-TIME NOTED BEGINNING 24 HOUR PERIOD  ALL URINE VOIDED IN NEXT 24 HOURS SAVED  LAST URINE VOIDED AT END OF 24 HOUR PERIOD SAVED FOR FINAL COLLECTION
    103. 103. STOOL SPECIMENS Specimen of feces or stool examined by lab personnel Usually done for ova and parasites (O&P)—eggs and worms!! Specimen must be kept warm at body temperature Should be tested within 30 minutes for accurate results Can be examined for presence of fats, microorganisms, and other abnormal substances or OCCULT BLOOD Special stool specimen container
    104. 104. STOOL SPECIMENS-Hemoccult Blood from intestinal tract in stool—occult (hidden) blood Test requires very small amount of stool Special card with chemical Uses developing solution Color change indicates positive results=presence of blood No requirements for immediate testing or special temperature
    105. 105. PRACTICE & CHECK OFF PCA REQUIREMENTS!!!

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