Unit 11-Resident Care Procedures

8/14/2019 Unit 11-Resident Care Procedures

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DHSR Approved Curriculum-Unit 11 1

Unit 11

Resident Care ProceduresNurse Aide I Course


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Resident Care Procedures

Introduction

Residents frequently require assistanceto meet their normal elimination needs.

They may also require specialprocedures that the nurse aide willperform.


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Introduction

(continued)This unit explores: helping the resident to the bathroom;

assisting with use of the bedsidecommode, bedpan and urinal; providing catheter care and emptying aurinary drainage bag;

collecting a routine urine specimen; applying and caring for condomcatheters;


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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 deepbreathing exercises.


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11.0 Describe what is meant byelimination needs.


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Elimination of Waste Products

Natural process

Healthy individuals

have regular

elimination habits


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Elimination of Waste Products(continued)

Equipment needed

Bedpan

regular size - used by female forurination and both men andwomen for defecation

fracture pan - smaller and flatterand usually used with fracture ofvertebrae, pelvis or leg


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(continued)

Equipment needed

Urinal

used by men

used for urination


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(continued)

Equipment needed

Bedside commode

portable chair brought to bedside contains opening for a bedpan or

similar type container

used for residents unable to walkto bathroom


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11.1 Review the guidelines to followwhen assisting the resident with

elimination needs.


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Guideline To Assist With Elimination

Assist to as close to a

sitting position as

possible


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Guideline To Assist With Elimination(continued)

Provide privacy and warmth

close doors, curtains, and drapes

assist with robe and footwearcover with cotton blanket or lap

robe when using bedside

commodeleave area if safe to leave alone


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Provide toilet paper and

place call signal within

the residents reach

Offer bedpan

periodically as residents

may be uncomfortablerequesting its use


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Do not leave on bedpan

for long periods of time

Cover and empty

bedpan immediately.


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Put on glove and assist

resident to clean genital

area as necessary

Assist with handwashing

at the sink

by providing soap andbasin of warm water


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11.2 Demonstrate the procedure tofollow when assisting the resident

to use the bathroom.


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11.3 Demonstrate the procedure tofollow when helping the resident

to use a bedside commode.


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11.4 Demonstrate the procedure tofollow when assisting the resident

to use a bedpan.


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11.5 Demonstrate the procedure tofollow when assisting a resident

to use a urinal.


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11.6 Discuss indwelling catheters andcatheter care.


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Indwelling Catheters

Used to continuously drainurine from bladder

Inserted by licensed nurse

or NA II after beingordered by physician

Attached to tubing that

connects to urinary

drainage bag


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Indwelling Catheters(continued)

Use

Residents with nerve injury:

following spinal cord injury after stroke

After surgery

Some incontinent residents


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Increased Risk of Urinary TractInfections

Urinary meatus andsurrounding area mustbe kept clean

Catheter care given atleast daily and PRN


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11.6.1 Identify guidelines to followwhen caring for residents with

indwelling catheters (Foley).


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Guidelines To Follow When

Caring For Residents With

Indwelling Catheters

Never pull on catheter and keep

catheter tubing and drainage tubingfree of kinks, so that urine can flow

freely

Report any leakage, complaints ofpain, burning, or need to urinate


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Observe and report any

swelling, skin irritation, ordiscoloration

Measure and record urinaryoutput accurately, noting color,

odor and appearance of urine


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Keep collection bag below bladder

Attach collection bags to bed frame,never to side rail

Never leave on floor

Follow facility policy for securingcatheter to residents leg withouttension on catheter

G id li T F ll Wh


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Never disconnect catheter

from tubing to drainagebag

When emptying urinary

drainage bag, never touchdrain with measuring

container or graduate


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11.7 Demonstrate the procedure forproviding catheter care.


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11.8 Demonstrate the procedure foremptying a urinary drainage bag.


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11.9 Discuss the collection of urinespecimens.


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Collecting Routine Urine Specimen

Collected for laboratory study

Aids physician in diagnosis

Evaluates effectiveness oftreatment

Laboratory requisition slip completed

and sent to laboratory with eachspecimen


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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 nottouch inside of lid or container

G l R l T F ll Wh


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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 discardtissue in bedpan when

collecting urine specimen


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11.10 Demonstrate the procedure forcollecting a routine urine

specimen.


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11.11 Discuss the collection of twomore types of urine sample

collections: the clean catch and

the 24-hour specimen.


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Clean Catch Urine Specimen

(mid-stream)

Cleaning of perineum prior tocollection reduces number ofmicrobes that may contaminatespecimen

Cl C t h U i S i


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Clean Catch Urine Specimen

(mid-stream)

(continued) Procedureresident begins voiding into

appropriate receptacle andstops midstream; then containeris placed and urine specimen iscollected.

follow above general ruleswhen collecting urine specimen

follow Standard Precautions


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24-Hour Urine Specimen

All urine voided in 24-hourperiod collected

urine chilled on ice to prevent

growth of microorganismssome tests may require

preservative

sample usually collected in

dark colored gallon jug


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24-Hour Urine Specimen(continued)

Procedurethe resident voids to begin

test with empty bladder

first voiding is discarded

all voidings for next 24 hourscollected

if test interrupted, it must berestarted with new gallon jug


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24-Hour Urine Specimen(continued)

Imperative that

resident and staff

understand procedure

and exact time period

for sample collection

Follow StandardPrecautions


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11.12 Discuss guidelines to followwhen caring for a resident with a

condom catheter.


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Applying And Caring For

Condom Catheters

Description and Use

External catheter used forincontinent men

Made of soft rubber sheath that fitsover penis with tubing connected tourinary drainage bag

Ambulatory residents may preferleg bags during day



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Condom Catheters

(continued) Description and Use

New condom catheter is applied

dailyPenis observed for reddened or

open areas and reported to

supervisor prior to new beingapplied


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11.12.1 Demonstrate the procedurefor applying a condom

catheter.


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11.13 Discuss the collection of stoolspecimens.

G id li F C ll ti St l


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Guidelines For Collecting Stool

Specimen

Ordered by physician

Studied by laboratory to identify:

Blood in stoolParasites

Fat

MicroorganismsOther abnormalities

G id li F C ll ti St l


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Guidelines For Collecting Stool

Specimen

Specimen should not be mixed withurine

Use tongue blades to handlespecimen

Prevent contaminating outside of

specimen container Properly label and transport

specimen promptly


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11.14 Demonstrate the procedure forcollecting a stool specimen.


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11.15 Define the term enema andidentify some of the most

common solutions.


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Cleansing Enemas

Definition - the introduction of fluidinto the rectum and colon to removefeces

Physician orders:

Solution to be used

Amount of fluid to be used

Cl i E


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Cleansing Enemas(continued)

Common solutions

Tap water

Saline solutionSoap suds

Oil retention

Prepackaged disposable,hypertonic solution


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11.15.1 Discuss the guidelines forgiving an enema.

Cleansing Enemas:


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Cleansing Enemas:

Guidelines For Administration

Check temperature of enemasolution with thermometer

Temperature no greater than105 F

Container should not be higherthan 12 inches above anus.Solution must run in slowly toavoid serious side effects

Cleansing Enemas:


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Cleansing Enemas:


(continued) Resident should be positioned on

left side with knees slightly flexed

If possible, enemas should be givenbefore bath and before breakfast;otherwise, wait at least one hour

after meals before giving

Cleansing Enemas:


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Cleansing Enemas:


(continued)

Be sure bathroom isavailable for use


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11.16 Demonstrate the procedure foradministering a cleansing

enema.


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11.17 Discuss the purposes andeffects of warm and cold

therapy.


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Warm And Cold Therapy

Requires physicians

order for type of therapy

and length of time forapplication



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Warm And Cold Therapy(continued)

Purposes and EffectsWARMTH: dilates blood vessels

increased blood supply to area

blood brings oxygen & nutrientsfor healing

fluids are absorbed

muscles relax

pain relieved



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Warm And Cold Therapy(continued)

Purposes and EffectsCOLD: constricts blood vessels

decreased blood supply to area prevents swelling

controls bleeding

numbs skin, reducing pain

reduces body temperature


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11.17.1 Discuss the three types ofwarm and cold applications.


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Types Of Warmth And Cold

Dry cold - water does not touch

skin

ice bagsice caps

ice collars

disposable cold pack



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Types Of Warmth And Cold(continued)

Moist cold - water touches

skin

compresses localizedapplication

soaks - body part

immersed in watercool sponge bath



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Types Of Warmth And Cold(continued)

Dry warmth padswith circulating

warm water

Moist warmth

compresses

soakssitz bath


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11.17.2 Discuss the guidelines forwarm and cold applications.

G id li F W A li ti


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Guidelines For Warm Applications

Guidelines for ApplicationsUse bath thermometer to measurethe temperature of moist heatsolutions.

Do not operate equipment you havenot been trained to use.

Temperature never over 105 F.Check skin frequently and reportany signs of complications.

Guidelines For Cold Applications


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Guidelines For Cold Applications

Guidelines for ApplicationsApply ice caps with metal or

plastic lids away from skin

Cover ice caps/bags/collars priorto application

Check skin frequently and report

any signs of complicationsNever leave in place longer than

directed by supervisor


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11.18 Demonstrate the procedure forapplying warm or cold

applications.


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11.19 Discuss the application ofnonsterile bandages.

B d


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Bandages

Purposes

hold dressing in place

secure splints

support and protect body parts Materials in various types and sizes

roller gauze

elastic bandages

triangular


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11.19.1 Review the guidelines to beconsidered with the use of

bandages.

G id li F U Of B d


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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 extremitychecked below bandage



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Guidelines For Use Of Bandages(continued)

Signs/symptoms that indicate poorcirculation should be reportedimmediately to supervisor such as:

swellingcyanotic skinnumbness

tinglingskin cold to touchpain or discomfort



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Guidelines For Use Of Bandages(continued)

Loosen bandages if any signs ofimpaired circulation noted and reportto supervisor immediately.


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11.19.2 Demonstrate the procedurefor applying elastic bandages.


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11.20 Discuss reasons for coughingand deep breathing exercises.

Coughing And Deep Breathing


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PurposesTo prevent respiratory

complications in certain at-risk

residents persons on bed rest or reducedactivity

following surgery person with respiratory disorders



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Coughing And Deep Breathing(continued)

PurposesTwo major complications prevented

by coughing and deep breathing:

pneumonia - inflammation of lung atelectasis - collapse of portion oflung



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Coughing And Deep Breathing(continued)

Physiology

Deep Breathing

increases level ofoxygen in blood

increases lung

expansion



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g g p g(continued)

PhysiologyCoughing

removes mucus from

airways and lungs

may cause collapse of

lung if congestion not

present



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g g p g(continued)

Considerations with deep

breathing and coughing

Doctors order exercises

Frequency of

performing exercisevaries per doctors

order



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g g g(continued)

Considerations with deepbreathing and coughing

Nurse aides receive

instructions from

supervisor

Coughing may cause painand be difficult to perform


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11.20.1 Demonstrate the procedurefor assisting with coughing

and deep breathing exercises.


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11.21 Discuss the purpose of elasticstockings.

Elastic Stockings


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(Anti-embolitic Hose)

Purpose

Provide support

Provide comfortPromote circulation by

providing pressure

Reduce risk of thrombusformation


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11.21.1 Discuss indications for use ofelastic stockings.

Elastic Stockings

(A ti b liti H )


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(Anti-embolitic Hose)(continued)

Indications for use

Residents with heart disease and

circulatory disordersResidents on bed rest

Residents who recently had

surgery


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11.21.2 Discuss action of elasticstockings in the prevention of

blood clots.

Elastic Stockings

(Anti embolitic Hose)


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Prevention of blood clots (thrombi)

blood clots form (blood flow issluggish)

usually develop in deep legveins

can break loose and travelthough blood stream (thenknown as embolus)

Elastic Stockings

(Anti embolitic Hose)


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Prevention of blood clots (thrombi)

embolus can travel to the lungs

and possibly cause deathelastic stockings exert pressureon veins, promoting venous blood

flow to heartalso known as anti-emboliticstockings or TED hose

Elastic Stockings

(A ti b liti H )


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Fitting of stockings

Come in thigh

high or knee highlengths

Resident must be

measured toensure proper fit


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11.22 Discuss purpose of applying anonsterile dressing.

Applying Nonsterile Dressing


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pp y g g

Covering applied to wound orinjured body part where slight riskof infection or re-injury

Materials come in various typesand sizes:

Gauze pads

Band-aidsThick compresses


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11.22.1 Demonstrate the procedurefor applying a nonsterile

dressing.


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Unit 11-Resident Care Procedures

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