This document provides an overview of nurse assisting skills including admitting, discharging, and transferring patients, administering personal hygiene such as bathing, positioning and moving patients, and collecting specimens. The key objectives are to properly care for patients and their belongings during admissions and discharges, and to provide personal hygiene like bathing while respecting privacy.

1. Nurse Assisting Skills
Diversified Health Occupations
Chapter 20
pg. 617-737

2. Nurse Assisting
OBJECTIVES
Upon 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Positioning, Turning, Moving, and
Transferring 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. Decubitus Ulcers
STAGE I STAGE II
STAGE III STAGE IV

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. BED BATHS
 STRAIGHTEN BED LINEN
 CHANGE GOWN AS NEEDED

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. 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. 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. 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. BED BATHS
 Observe all checkpoints
 Clean and replace all equipment
 Proper charting procedures

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. 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. 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. 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. TUB BATHS OR SHOWERS
 REPLACE ALL EQUIPMENT AND
SUPPLIES
 CLEAN BATH/SHOWER AREA USING
GLOVES
 WASH HANDS
 CHART ACCORDING TO POLICY

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. 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. 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. 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. 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. PRINCIPLES OF FEEDING A
PATIENT
 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. 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. 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. 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. 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. 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. BEDPANS/URINALS
 ELIMINATION
 TERMINOLOGY
 URINATE, MICTURATE, VOID
 DEFECATE, BOWEL
MOVEMENTS (BM)

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. 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. INTAKE
 Oral
 Tube feeding or enteral feedings
 IV
 Irrigation

71. OUTPUT
 BM
 Emesis
 Urine
 Irrigation

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. URINE SPECIMENS
 CLEAN CATCH OR MIDSTREAM
 SPECIAL METHOD OF OBTAINING URINE
SPECIMEN FREE FROM CONTAMINATION
 STERILE URINE SPECIMEN
 CATHETERIZATION REQUIRED

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. 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. 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. PRACTICE & CHECK OFF
 PCA REQUIREMENTS!!!