Unit 11-resident Care Procedures

Unit 11

Resident Care Procedures Nurse Aide I Course

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Resident Care Procedures Introduction Residents frequently require assistance to meet their normal elimination needs. They may also require special procedures that the nurse aide will perform.

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Resident Care Procedures Introduction (continued)

This unit explores: • helping the resident to the bathroom; • assisting with use of the bedside commode, bedpan and urinal; • providing catheter care and emptying a urinary drainage bag; • collecting a routine urine specimen; • applying and caring for condom catheters; DHSR Approved Curriculum-Unit 11

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Resident Care Procedures 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 deep breathing exercises. DHSR Approved Curriculum-Unit 11

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11.0 Describe what is meant by elimination 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 for urination and both men and women for defecation • fracture pan - smaller and flatter and usually used with fracture of vertebrae, pelvis or leg DHSR Approved Curriculum-Unit 11

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Elimination of Waste Products (continued) • Equipment needed – Urinal • used by men • used for urination

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Elimination of Waste Products (continued) • Equipment needed – Bedside commode • portable chair brought to bedside • contains opening for a bedpan or similar type container • used for residents unable to walk to bathroom DHSR Approved Curriculum-Unit 11

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11.1 Review the guidelines to follow when 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 footwear – cover with cotton blanket or lap robe when using bedside commode – leave area if safe to leave alone DHSR Approved Curriculum-Unit 11

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Guideline To Assist With Elimination (continued)

• Provide toilet paper and place call signal within the resident’s reach • Offer bedpan periodically as residents may be uncomfortable requesting its use DHSR Approved Curriculum-Unit 11

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Guideline To Assist With Elimination (continued)

• Do not leave on bedpan for long periods of time • Cover and empty bedpan immediately.

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Guideline To Assist With Elimination (continued)

• Put on glove and assist resident to clean genital area as necessary • Assist with handwashing – at the sink – by providing soap and basin of warm water DHSR Approved Curriculum-Unit 11

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11.2 Demonstrate the procedure to follow when assisting the resident to use the bathroom.

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11.3 Demonstrate the procedure to follow when helping the resident to use a bedside commode.

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11.4 Demonstrate the procedure to follow when assisting the resident to use a bedpan.

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11.5 Demonstrate the procedure to follow when assisting a resident to use a urinal.

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11.6 Discuss indwelling catheters and catheter care.

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Indwelling Catheters • 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 DHSR Approved Curriculum-Unit 11

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Indwelling Catheters (continued)

• Use – Residents with nerve injury: • following spinal cord injury • after stroke – After surgery – Some incontinent residents DHSR Approved Curriculum-Unit 11

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Indwelling Catheters (continued)

• Increased Risk of Urinary Tract Infections – Urinary meatus and surrounding area must be kept clean – Catheter care given at least daily and PRN DHSR Approved Curriculum-Unit 11

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11.6.1 Identify guidelines to follow when 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 tubing free of kinks, so that urine can flow freely • Report any leakage, complaints of pain, burning, or need to urinate DHSR Approved Curriculum-Unit 11

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Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)

• Observe and report any swelling, skin irritation, or discoloration • Measure and record urinary output accurately, noting color, odor and appearance of urine DHSR Approved Curriculum-Unit 11

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Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)

• Keep collection bag below bladder • Attach collection bags to bed frame, never to side rail • Never leave on floor • Follow facility policy for securing catheter to resident’s leg without tension on catheter DHSR Approved Curriculum-Unit 11

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Guidelines To Follow When Caring For Residents With Indwelling Catheters (continued)

• Never disconnect catheter from tubing to drainage bag • When emptying urinary drainage bag, never touch drain with measuring container or graduate DHSR Approved Curriculum-Unit 11

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11.7 Demonstrate the procedure for providing catheter care.

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11.8 Demonstrate the procedure for emptying a urinary drainage bag.

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11.9 Discuss the collection of urine specimens.

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Collecting Routine Urine Specimen • Collected for laboratory study – Aids physician in diagnosis – Evaluates effectiveness of treatment • Laboratory requisition slip completed and sent to laboratory with each specimen DHSR Approved Curriculum-Unit 11

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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 not touch inside of lid or container DHSR Approved Curriculum-Unit 11

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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 discard tissue in bedpan when collecting urine specimen DHSR Approved Curriculum-Unit 11

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11.10 Demonstrate the procedure for collecting a routine urine specimen.

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11.11 Discuss the collection of two more 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 to collection reduces number of microbes that may contaminate specimen

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Clean Catch Urine Specimen (mid-stream) (continued)

• Procedure – resident begins voiding into appropriate receptacle and stops midstream; then container is placed and urine specimen is collected. – follow above general rules when collecting urine specimen – follow Standard Precautions DHSR Approved Curriculum-Unit 11

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24-Hour Urine Specimen • All urine voided in 24-hour period collected – urine chilled on ice to prevent growth of microorganisms – some tests may require preservative – sample usually collected in dark colored gallon jug DHSR Approved Curriculum-Unit 11

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24-Hour Urine Specimen (continued)

• Procedure – the resident voids to begin test with empty bladder – first voiding is discarded – all voidings for next 24 hours collected – if test interrupted, it must be restarted with new gallon jug DHSR Approved Curriculum-Unit 11

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24-Hour Urine Specimen (continued)

• Imperative that resident and staff understand procedure and exact time period for sample collection • Follow Standard Precautions DHSR Approved Curriculum-Unit 11

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11.12 Discuss guidelines to follow when caring for a resident with a condom catheter.

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Applying And Caring For Condom Catheters • Description and Use – External catheter used for incontinent men – Made of soft rubber sheath that fits over penis with tubing connected to urinary drainage bag – Ambulatory residents may prefer leg bags during day DHSR Approved Curriculum-Unit 11

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Applying And Caring For Condom Catheters (continued)

• Description and Use – New condom catheter is applied daily – Penis observed for reddened or open areas and reported to supervisor prior to new being applied DHSR Approved Curriculum-Unit 11

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11.12.1 Demonstrate the procedure for applying a condom catheter.

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11.13 Discuss the collection of stool specimens.

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Guidelines For Collecting Stool Specimen • Ordered by physician • Studied by laboratory to identify: – Blood in stool – Parasites – Fat – Microorganisms – Other abnormalities DHSR Approved Curriculum-Unit 11

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Guidelines For Collecting Stool Specimen • Specimen should not be mixed with urine • Use tongue blades to handle specimen • Prevent contaminating outside of specimen container • Properly label and transport specimen promptly DHSR Approved Curriculum-Unit 11

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11.14 Demonstrate the procedure for collecting a stool specimen.

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11.15 Define the term enema and identify some of the most common solutions.

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Cleansing Enemas • Definition - the introduction of fluid into the rectum and colon to remove feces • Physician orders: – Solution to be used – Amount of fluid to be used DHSR Approved Curriculum-Unit 11

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Cleansing Enemas (continued)

• Common solutions – Tap water – Saline solution – Soap suds – Oil retention – Prepackaged disposable, hypertonic solution DHSR Approved Curriculum-Unit 11

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11.15.1 Discuss the guidelines for giving an enema.

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Cleansing Enemas: Guidelines For Administration • Check temperature of enema solution with thermometer • Temperature no greater than 105° F • Container should not be higher than 12 inches above anus. Solution must run in slowly to avoid serious side effects DHSR Approved Curriculum-Unit 11

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Cleansing Enemas: Guidelines For Administration (continued)

• Resident should be positioned on left side with knees slightly flexed • If possible, enemas should be given before bath and before breakfast; otherwise, wait at least one hour after meals before giving DHSR Approved Curriculum-Unit 11

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Cleansing Enemas: Guidelines For Administration (continued)

• Be sure bathroom is available for use

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11.16 Demonstrate the procedure for administering a cleansing enema.

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11.17 Discuss the purposes and effects of warm and cold therapy.

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Warm And Cold Therapy • Requires physician’s order for type of therapy and length of time for application

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Warm And Cold Therapy (continued)

• Purposes and Effects – WARMTH: dilates blood vessels • increased blood supply to area • blood brings oxygen & nutrients for healing • fluids are absorbed • muscles relax • pain relieved DHSR Approved Curriculum-Unit 11

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Warm And Cold Therapy (continued)

• Purposes and Effects – COLD: constricts blood vessels • decreased blood supply to area • prevents swelling • controls bleeding • numbs skin, reducing pain • reduces body temperature DHSR Approved Curriculum-Unit 11

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11.17.1 Discuss the three types of warm and cold applications.

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Types Of Warmth And Cold • Dry cold - water does not touch skin – ice bags – ice caps – ice collars – disposable cold pack DHSR Approved Curriculum-Unit 11

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Types Of Warmth And Cold (continued)

• Moist cold - water touches skin – compresses – localized application – soaks - body part immersed in water – cool sponge bath DHSR Approved Curriculum-Unit 11

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Types Of Warmth And Cold (continued)

• Dry warmth – pads with circulating warm water • Moist warmth – compresses – soaks – sitz bath DHSR Approved Curriculum-Unit 11

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11.17.2 Discuss the guidelines for warm and cold applications.

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Guidelines For Warm Applications • Guidelines for Applications – Use bath thermometer to measure the temperature of moist heat solutions. – Do not operate equipment you have not been trained to use. – Temperature never over 105° F. Check skin frequently and report any signs of complications. DHSR Approved Curriculum-Unit 11

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Guidelines For Cold Applications • Guidelines for Applications – Apply ice caps with metal or plastic lids away from skin – Cover ice caps/bags/collars prior to application – Check skin frequently and report any signs of complications – Never leave in place longer than directed by supervisor DHSR Approved Curriculum-Unit 11

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11.18 Demonstrate the procedure for applying warm or cold applications.

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11.19 Discuss the application of nonsterile bandages.

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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 DHSR Approved Curriculum-Unit 11

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11.19.1 Review the guidelines to be considered with the use of bandages.

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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 extremity checked below bandage DHSR Approved Curriculum-Unit 11

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Guidelines For Use Of Bandages (continued)

• Signs/symptoms that indicate poor circulation should be reported immediately to supervisor such as: – swelling – cyanotic skin – numbness – tingling – skin cold to touch – pain or discomfort DHSR Approved Curriculum-Unit 11

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Guidelines For Use Of Bandages (continued)

• Loosen bandages if any signs of impaired circulation noted and report to supervisor immediately.

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11.19.2 Demonstrate the procedure for applying elastic bandages.

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11.20 Discuss reasons for coughing and deep breathing exercises.

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Coughing And Deep Breathing • Purposes – To prevent respiratory complications in certain at-risk residents • persons on bed rest or reduced activity • following surgery • person with respiratory disorders DHSR Approved Curriculum-Unit 11

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Coughing And Deep Breathing (continued)

• Purposes – Two major complications prevented by coughing and deep breathing: • pneumonia - inflammation of lung • atelectasis - collapse of portion of lung

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Coughing And Deep Breathing (continued)

• Physiology – Deep Breathing • increases level of oxygen in blood • increases lung expansion DHSR Approved Curriculum-Unit 11

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Coughing And Deep Breathing (continued)

• Physiology – Coughing • removes mucus from airways and lungs • may cause collapse of lung if congestion not present DHSR Approved Curriculum-Unit 11

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Coughing And Deep Breathing (continued)

• Considerations with deep breathing and coughing – Doctors order exercises – Frequency of performing exercise varies per doctor’s order DHSR Approved Curriculum-Unit 11

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Coughing And Deep Breathing (continued)

• Considerations with deep breathing and coughing – Nurse aides receive instructions from supervisor – Coughing may cause pain and be difficult to perform DHSR Approved Curriculum-Unit 11

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11.20.1 Demonstrate the procedure for assisting with coughing and deep breathing exercises.

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11.21 Discuss the purpose of elastic stockings.

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Elastic Stockings (Anti-embolitic Hose) • Purpose – Provide support – Provide comfort – Promote circulation by providing pressure – Reduce risk of thrombus formation DHSR Approved Curriculum-Unit 11

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11.21.1 Discuss indications for use of elastic stockings.

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Elastic Stockings (Anti-embolitic Hose) (continued)

• Indications for use – Residents with heart disease and circulatory disorders – Residents on bed rest – Residents who recently had surgery DHSR Approved Curriculum-Unit 11

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11.21.2 Discuss action of elastic stockings in the prevention of blood clots.

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Elastic Stockings (Anti-embolitic Hose) (continued)

• Prevention of blood clots (thrombi) – blood clots form (blood flow is sluggish) – usually develop in deep leg veins – can break loose and travel though blood stream (then known as embolus) DHSR Approved Curriculum-Unit 11

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Elastic Stockings (Anti-embolitic Hose) (continued)

• Prevention of blood clots (thrombi) – embolus can travel to the lungs and possibly cause death – elastic stockings exert pressure on veins, promoting venous blood flow to heart – also known as anti-embolitic stockings or TED hose DHSR Approved Curriculum-Unit 11

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Elastic Stockings (Anti-embolitic Hose) (continued)

• Fitting of stockings – Come in thigh high or knee high lengths – Resident must be measured to ensure proper fit DHSR Approved Curriculum-Unit 11

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11.21.3 Demonstrate the procedure for applying and removing elastic stockings or TED hose.

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11.22 Discuss purpose of applying a nonsterile dressing.

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Applying Nonsterile Dressing • Covering applied to wound or injured body part where slight risk of infection or re-injury • Materials come in various types and sizes: – Gauze pads – Band-aids – Thick compresses DHSR Approved Curriculum-Unit 11

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11.22.1 Demonstrate the procedure for applying a nonsterile dressing.

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