nurse assisting skills ppt
TRANSCRIPT
Nurse Assisting SkillsDiversified Health Occupations
Chapter 20
pg. 617-737
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
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.
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
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
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!!
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!!
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
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
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.
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
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
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 chart
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
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-byeSay good-bye
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
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!!!!!!!!!!
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
Decubitus Ulcers
STAGE I STAGE II
STAGE III STAGE IV
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
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
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!!!
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
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
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
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
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
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
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
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!
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
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
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°)
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)
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
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
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
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
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
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
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
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
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)
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
BED BATHS STRAIGHTEN BED LINEN CHANGE GOWN AS NEEDED
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
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
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
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
BED BATHS Observe all checkpoints Clean and replace all equipment Proper charting procedures
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
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
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
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
TUB BATHS OR SHOWERS REPLACE ALL EQUIPMENT AND
SUPPLIES CLEAN BATH/SHOWER AREA USING
GLOVES WASH HANDS CHART ACCORDING TO POLICY
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
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
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
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
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!!!!
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
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
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
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
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
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
BEDPANS/URINALS
ELIMINATION TERMINOLOGY
URINATE, MICTURATE, VOID DEFECATE, BOWEL
MOVEMENTS (BM)
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
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
INTAKE Oral Tube feeding or enteral feedings IV Irrigation
OUTPUT BM Emesis Urine Irrigation
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
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
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
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
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
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
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
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
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
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
OSTOMY CARE OBJECTIVES DEFINE OSTOMY DIFFERENTIATE BETWEEN A
URETEROSTOMY, ILEOSTOMY, COLOSTOMY LIST BASIC PRINCIPLES FOR OSTOMY CARE IDENTIFY UNIVERSAL PRECAUTIONS
OBSERVED DURING OSTOMY CARE
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
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
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
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
URINE SPECIMENS CLEAN CATCH OR MIDSTREAM
SPECIAL METHOD OF OBTAINING URINE SPECIMEN FREE FROM CONTAMINATION
STERILE URINE SPECIMEN CATHETERIZATION REQUIRED
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
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
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
PRACTICE & CHECK OFF PCA REQUIREMENTS!!!