Unit B Nurse Aide Resident Care Skills Essential Standard NA6.00
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Transcript of Unit B Nurse Aide Resident Care Skills Essential Standard NA6.00
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Unit B Nurse Aide Resident Care SkillsEssential Standard NA6.00 Understand nurse aide skills needed to provide for residents’ nutrition, hydration, elimination, and urination needs. Indicator 6.02 Understand nurse aide skills needed to provide care for residents' elimination and urination needs.
Understand NAI skills needed to provide care for residents' elimination and urination needs.
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6.02
6.02 Introduction
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Elimination is the process of expelling solid wastes made up of the waste products of food that are not absorbed into the cells of the body. Urination is the passage urine from the bladder to the outside of the body. Urine is made up of water and waste products filtered from the blood by the kidneys.
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6.02
6.02 Introduction
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Residents often require assistance from the nurse aide in caring for elimination and urination needs. Reviews of the body systems involved assist the nurse aide in understand the importance of these excretory functions.
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There is intentional
repeat of some HSII course content in Nursing
Fundamentals.
Repeating course content distributes learning over time and increases long term memory.
Academic and skill competence must be maintained at a very high level for direct resident care.
Be GREEN. Recycle knowledge and build on it! Nursing Fundamentals 7243 46.02
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Digestive System
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An excretory system
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Digestive System
• AKA gastrointestinal system
• Extends from mouth to anus
• Functions–Digestion–Absorption
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Digestive System - Structures
• Mouth
• Stomach – holds food until digestive juices chemically break it down into liquid chyme
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Digestive System - Structures
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• Intestines – small intestine • about 20 ft.
long • food digestion
completed and nutrients absorbed into bloodstream
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Digestive System - Structures
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• Intestines – large intestine• 6 ft. long• absorbs water,
mineral salts and vitamins• secretes mucus to
aid in movement of feces• has ability to add
or remove water from feces
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Digestive System – Accessory Organs
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– Liver – produces bile for breakdown of fats–Gallbladder – stores
bile produced by liver– Pancreas -
manufactures insulin and digestive enzymes
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Digestive System – Common Diseases
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D Ulcer - a lesion or erosion of the lining of the stomach or small intestine
D Hepatitis – inflammation of the liverD Cirrhosis – chronic disease of liver
where scar tissue replaces liver tissueD Cholelithiasis - stones in the
gallbladder
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Digestive System – Common Diseases
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D Pancreatitis – inflammation of the pancreas
D Cholecystitis – inflammation of the gallbladder
D Colitis – inflammatory disease of the colon
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Digestive System – Common Diseases
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D Gastritis – inflammation of the stomach lining
D Enteritis – inflammation of the intestines
D Gastroenteritis - inflammation of the stomach lining and intestines
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Digestive System – Common Diseases
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D Cancer - may occur anywhere along digestive tract
D Hernia – protrusion of organ through wall of cavity where it is normally contained
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Digestive System – Common Diseases
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DDiverticulosis - chronic disease in which many diverticula (small blind pouches) form in the lining and wall of the colon
DDiverticulitis – inflammation of diverticula
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Digestive System – Common Diseases
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D Diarrhea – watery bowel movementsD Constipation - difficulty in expelling
fecal material; incomplete or infrequent bowel movements- severe constipation leads to a FECAL IMPACTION
D Hemorrhoids - enlarged veins in anal area Care Point
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Digestive System – FECAL IMPACTION
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Be extra careful when inserting a thermometer, enema tip, or when cleaning the rectal area of a resident with hemorrhoids!
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Digestive System – Changes Due to Aging
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• Loss of teeth and decreased number of taste buds• Decrease in amount of digestive enzymes and
saliva production• Difficulty chewing and swallowing• Altered taste and smell• Decreased appetite
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Digestive System – Changes Due to Aging
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• Slower absorption of nutrients• Slowing of peristalsis causing
constipation• Loss of bowel muscle tone
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Digestive System – Observations
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O Stool color and consistencyO Abdomen – flat or distendedO Date/time of last bowel
MmovementO Nausea and/or vomiting
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R Blood in emesis or stoolR Complaint of pain in stomachR Difficulty swallowingR Poor appetiteR Constipation and/or diarrhea6.02 Nursing Fundamentals 7243 22
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6.02 Nursing Fundamentals 7243 23
NAI SKILLSRelated to the Digestive System
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6.02 Nursing Fundamentals 7243 24
SKILL 6.02AAssist with use of
bathroom
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02BAssist with bedside
commode (BSC)
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02CAssist with bedpan
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02DApply adult briefs
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02EAdminister cleansing
enema
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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BowelRetraining
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Digestive System – Bowel Retraining
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Incontinence: Inability to control defecation
Embarrassing for residentUncomfortable
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Digestive System – Bowel Retraining
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• Information collected: bowel pattern before
incontinence present bowel pattern dietary practices
• Plan developed to assist to return to normal elimination pattern and
• Recorded on care plan
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Digestive System – Bowel Retraining
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• Participants in plan
–resident–family–all staff members
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Bowel Retraining - Guidelines
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G Enemas may be ordered by physician and given by nurse aide, as directed by supervisor
G Regular, specific times to evacuate bowels established
G Fluids encouraged on regular basis
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Bowel Retraining - Guidelines
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G High bulk foods given, (if not rrestricted)– fruits– vegetables– bread – bran cereals
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Bowel Retraining - Guidelines
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G Bowel aids ordered by physician and administered by licensed nurse only:• laxatives• suppositories• stool softeners
G Regular exercise encouraged
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C Offer bedpan on set schedule
C Assist to bathroom when request is made
C Provide privacyC Display unhurried attitude
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C Offer warm drinkC Be patientC Encourage with positive
remarksC Do not scold when accidents
happen (this is verbal abuse) C Check on resident frequently
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Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02FCollecting a stool
specimen
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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Urinary System
An excretory system
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Urinary System - Structure
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Kidneys:–Purplish brown, bean-
shaped organs–Located at back of
abdominal cavity–Weighs 4-6 ounces each
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Urinary System - Structure
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• Ureters - tubes that carry urine from kidneys to bladder
• Urinary bladder - muscular sac that expands to hold urine received from the kidney
• Urethra - tube extending from bladder to outside of body
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Urinary System - Functions
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–Filters waste products from blood–Produces urine–Aids in maintenance of water balance–Regulates acid-base balance of body–Stores urine until passed from body
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Urinary System
Characteristics of Normal Urine
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Pale yellow to amberClear (not cloudy)Acidic / pH 5.0 – 7.0Quantity (output)
1000-1500 ml. per day
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Urinary System
Common Disorders
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• Nephritis - inflammation of kidney due to infection• Cystitis - inflammation of
urinary bladder due to infection• Calculi – kidney or bladder
stones
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Urinary System
Common Disorders
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• Uremia - accumulation of urea in blood due to kidney disease• Urethritis -
inflammation of the urethra
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Urinary System
Common Disorders
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• Kidney failure – decreased ability of kidney to filter waste products from the blood• Urinary incontinence -inability
to control urination
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Urinary System
Common Disorders
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• UTI - Urinary Tract Infection• Retention - inability to
completely empty the bladder
• Hematuria - blood in the urine
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Urinary System
Affects of Aging
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• Decreased kidney size• Decreased elasticity of ureters,
bladder and urethra• Decreased muscle tone• Diminished blood flow to
kidneys
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Urinary System
Affects of Aging
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• Decreased ability of kidneys to concentrate urine• Difficulty emptying urinary
bladder• Enlarged prostate in males
which presses on urethra
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Elevated temperatureSugar and/or acetone in urine
(NAIIs may check blood sugar via finger stick)
Urine color other than clear, pale yellow
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Complaint of burning on urination
Incontinence Polyuria - excessive
amounts of urine per voiding
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Hematuria - blood in urine Nocturia – excessive urination at
night Urine having strong odor or cloudy
appearance Voiding small amounts of urine
frequently
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6.02 Nursing Fundamentals 7243 53
NAI SKILLSRelated to the Urinary System
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SKILL 6.02GAssist resident
with urinal
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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Urinary Bladder Retraining
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Urinary System
Bladder Retraining
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• Plan developed to assist to return to normal voiding pattern• Recorded on care plan• Staff must be consistent
and follow plan
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Urinary System
Bladder Retraining
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• Individualized plan includes:–schedule that specifies
time and amount of fluids to be given–schedule for attempting
to void
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Urinary System
Bladder Retraining Guidelines
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G Get resident’s cooperationG Record incontinent timesG Provide with opportunities to void:• when resident awakens• one hour before meals• every two hours between meals• before going to bed• during night, as needed
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Urinary System
Bladder Retraining Guidelines
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G Provide for comfortable voiding position
G Be supportive and sensitiveG Provide encouragementG Offer fluids according to schedule
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Urinary System
Bladder Retraining Guidelines
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G Provide stimuli as needed:–run water in sink–pour water over
perineum–offer fluids to drink–place hands in warm
water
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Urinary System
Bladder Retraining Guidelines
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G Provide good skin care to prevent skin breakdown
G Retraining may take 6-10 weeks– be patient– be supportive– ignore accidents– respect resident’s feelings
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Urinary System
Bladder Retraining Guidelines
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Follow facility procedure for use of:– incontinent pads– adult protective pants– incontinent briefs
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Indwelling Urinary Catheters
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Indwelling Catheters
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Balloons filled with fluid help prevent the catheter from slipping out of the bladder. Pulling on the catheter may damage soft
tissue if the inflated balloon is pulled.
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Hold the catheter securely near the meatus to prevent tugging while cleaning the indwelling catheter.
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Indwelling Catheters
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Used to continuously drain urine from bladder
Inserted by licensed nurse or NA II after being ordered by physician
Attached to tubing that connects to urinary drainage bag
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Indwelling Catheters
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When are they ordered?–Residents with nerve injury:• following spinal cord injury• after stroke
–After surgery–Some incontinent residents
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Indwelling Catheters
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Increased Risk of Urinary Tract Infections
–Urinary meatus and surrounding area must be kept clean–Catheter care given at least daily
and PRN
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Indwelling Catheters Guidelinesmaintain-drainage-bag-dependent-position.html
nih.gov/ccc/patient_education/pepubs/bladder/foley
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G Never pull on catheterG Keep catheter tubing and
drainage tubing free of kinks, so that urine can flow freely
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Indwelling Catheters Guidelines
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G Keep collection bag below bladderG Attach collection bags to bed frame,
never to side railG Never leave on floorG Follow facility policy for securing
catheter to resident’s leg without tension on catheter
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Indwelling Catheters Guidelines
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G Never disconnect catheter from tubing to drainage bag
G When emptying urinary drainage bag, never touch drain with measuring container or graduate
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LeakageComplaints of painBurningNeed to urinate
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SwellingSkin irritationDiscoloration
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When measuring urinary output note color, odor and appearance of urine.
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NAI SKILLSRelated to Catheters
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SKILL 6.02HProviding catheter care
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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SKILL 6.02IEmptying a urinary
drainage bag
Training Lab AssignmentEngage in the Skill Acquisition Process for:
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Collecting a routine urine specimen
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Routine Urine Specimens
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• Collected for laboratory study–Aids physician in diagnosis–Evaluates effectiveness of treatment
• Laboratory requisition slip completed and sent to laboratory with each specimen
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Routine Urine Specimens - Guidelines
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G Wash hands carefully before and after collection of urine specimens
G Wear glovesG Collect specimen at appropriate
timeG Use proper container and do not
touch inside of lid or container
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Routine Urine Specimens - Guidelines
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G Label container accurately and transport to laboratory as soon as possible
G Tell resident not to have bowel movement or discard tissue in bedpan when collecting urine specimen
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Other Types of Urine Collections
1. Clean Catch Urine Specimen2. 24-Hour Urine Collection3. Straining Urine for Stones
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Clean Catch Urine SpecimenAKA: Mid-Stream Specimen
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Cleansing of perineum prior to collection of urine reduces number of microbes that may contaminate specimen
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Clean Catch Urine Specimen - Procedure
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1. Follow standard precautions2. Assure resident’s perineum is cleaned
prior to collection3. Instruct resident to begins voiding into
appropriate receptacle and stop midstream
4. Place container in urine stream and collect specimen
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24-Hour Urine Collection
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All urine voided in 24-hour period collected
Urine chilled on ice to prevent growth of microorganisms
Some tests may require preservativeUrine usually collected in dark
colored gallon jug
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24-Hour Urine Collection
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Imperative that resident and staff understand procedure and exact time period for urine collection
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24-Hour Urine Collection - Procedure
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1. Follow Standard Precautions 2. Begin test with resident’s bladder
empty 3. Discard first voiding4. Collect all voidings for next 24
hours 5. Restarted collection with new
gallon jug if test is interrupted
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Straining for Kidney Stones
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The Endocrine System
Endocrine glands secrete chemicals called hormones directly into the blood stream. Why discuss it?
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The Endocrine System
Endrocrine System
affects the function of
the
Urinary System
and other body functions
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Endocrine System - Function
Secretes hormones that regulate: growth and development,metabolism and reproduction, and the immune response.
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Diabetes Mellitus
The most common disorder of the endocrine system.
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Diabetes Mellitus 80% of diabetics over 40
years of age Incidence increases as
people age 5% of people over age 65
require treatment
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Diabetes MellitusUSA has highest morbidity
and mortality ratesDisorder of carbohydrate
metabolism with decreased insulin production from pancreas
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Diabetes Mellitus Uncontrolled diabetes leads to
damage to eyes, kidneys, circulation Diabetes characterized by consistent,
elevated blood glucose levels requiring oral medication to stimulate pancreas or insulin injections
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Diabetes Mellitus
HypoglycemiaLW
Low blood sugar
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Diabetes Mellitus
Hyperlycemia
High blood sugar
lava
ted
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Endocrine System – Changes Due to Aging
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• Decrease in thyroid, parathyroid, adrenal and sex hormone secretions
• Decreased glucose tolerance (Diabetes M)
• Multiple physical changes due to decrease of sex hormones
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Endocrine System – Observations
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O Irritability & restlessnessO NervousnessO ConfusionO Weight lossO DiaphoresisO EdemaO Excessive thirstO Sweet, fruity odor to breath
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Endocrine System – Observations
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O Complaint of headacheO DrowsinessO Rapid, weak pulseO Low blood pressureO Nausea or vomitingO Flushed, dry, hot skinO Excessive urination
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Observations previously listed must be reported
to the nurse.
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Understand nurse aide skills needed to care for residents' elimination and
urination needs.
END 6.02
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