Nursing Assistant

Nursing Assistant Resident Care Procedures

Respiratory disorders • Secretion of mucous from • Lungs • Bronchi • Trachea • Called sputum (not saliva) • Expectorated from mouth or trachea • Reasons to study sputum • Blood • Microorganisms • Abnormal cells

Sputum collection • Early a.m. best • Allow to rinse with H20 NOT mouthwash • Decreases food particles • Decreases saliva • Embarrassing & may be nauseating • Container covered & in bag • PRIVACY • Standard Precautions • Labeled • Full name • Room & bed number • Time & date specimen collected

Sputum collection (cont) • Observations • Color • Odor • Consistency • Blood • Document • Specimen obtained • Where you took it • Need 1 – 2 Tbsp

Urine Specimens • Can be sent to lab or tested on unit • Methods • Clean catch midstream • Catheter • Routine • 24 hour urine

Urine specimen • Rules • Wash hands before & after collection • Standard Precautions • Use correct & clean container • Label • Patient’s name • Room & bed number • Date & time specimen collected • Collect specimen directly into container • Don’t touch inside or lid

Rules for urine specimen • No BM while specimen collected • Put toilet paper in toilet or wastebasket • Take specimen & requisition slip to designated lab pick-up site • Document • Specimen obtained • Where it was taken

Observations about urine collection • Difficulty obtaining specimen • Color • Clarity • Odor • Complaints of discomfort &/or urgency

Stool specimen • Test for • Blood • Fat • Microorganisms • Worms or parasites • Any abnormal contents

Stool specimen rules • Maintain privacy • Standard precautions • Use clean container • No contamination with urine or toilet paper • Label • Resident name • Room & bed number • Date & time collected • See if can be refrigerated or at room temp • Take specimen & requisition slip to designated area

Stool specimen observations • Difficulty obtaining specimen • Color • Amount • Consistency • Where taken • C/o pain & discomfort • Document specimen obtained & where taken • Use tongue blade & collect 2 Tbsp of stool

Enemas • Introduction of fluids into rectum & lower colon • Needs a dr’s order • Purpose • Stimulate bowel movement • Relieve constipation or fecal impaction • Cleanse bowel of feces before surgery or diagnostic procedures • Remove flatus

Types of enemas • Tap water • Soap suds • Saline • Oil retention • Need to hold for 20 minutes • Commercial – Fleet’s

Rules for giving enemas • Nursing assistants ARE allowed to give if supervised by licensed nurse • Temperature of solution – 105 degrees • Amount if 500 –1000 cc for adults • Position – left Sim’s • Height of bag – no more than 18 inches about mattress ( 12 inches good) • Insert tubing 2 – 4 inches into rectum • Administer over 10 – 15 minutes • Hold enema tube in place, avoid air in tubing • Have toilet facilities available • Record results

Suppositories • Function • Stimulate bowel emptying • Lubricate stool to ease evacuation • Rules • NA may NOT give medicated suppositories • Check arm band • Remove wrapper from suppository • Place 1 – 1 ½ inches past anal sphincter using gloved hand & index finger • Instruct resident to hold suppository as long as possible (15 – 20 minutes) • Observe results & report

Maintaining fluid balance • After oxygen, water most important • Death results from inadequate fluid intake or fluid loss • Water enters body through fluid & food • Water lost through sweat, feces, urine, lungs • Balance fluid in & fluid out necessary to maintain health • Edema – fluid intake>fluid output, tissues swell • Dehydration – fluid intake< fluid output, tissues shrink • Need about 2000 ml of fluid/day. • Residents depend of nursing staff for fluid needs

Force fluids • Have resident drink increased amounts of fluids • May order specific amount each day • Maintains fluid balance • May be for general or specific amounts • CNA role • Record amount in • Provide variety • Keep fluids within reach • Offer fluids frequently to residents who cannot feed themselves

Restrict fluids • Physician’s order to limit fluids to a specific amount • CNA responsibilities • Sign posted above bed • Offer water in small amounts • No water pitcher at bedside • Keep accurate I & O • Be aware of shift fluid requirements • Provide resident with frequent oral hygiene • Explain to resident & family the reason for limiting fluids

NPO • Nothing by mouth • Before & after surgery • Before certain lab tests/xrays • Treatment of some illnesses • CNA responsibility • NPO sign over bed • Remove water pitcher & glass • Offer frequent oral hygiene • No swallowing of ANY fluid

Intake & Output • Can evaluate fluid balance, kidney function, or medical treatment • Place on I & O record • Done in ml or cc • Use graduated cylinder to measure • Conversion table is usually found on I&O record

Output • All liquid output • Urine • Emesis • Liquid stools • Suctions • Drains • Blood loss • Plastic urinals & emesis basins may be calibrated • Use Standard Precautions

Recording I & O • I & O record kept at bedside • Document amounts as resident takes in or puts out • Amounts totaled at end of each shift & entered into record • Report • Refusing fluids • Special fluid likes or dislikes • Blood in urine

Gastrointestinal Tubes • Nasogastric tubes (NG) • Inserted through nose into stomach or intestine to • Drain GI tract by suction to prevent post-op vomiting, obstruction, or flatus • Dx diseases • Wash out stomach contents • Provide route for feeding • Gastrostomy tube • Surgically inserted through abd wall into stomach to feed resident

Nursing care for residents with nasogastric tubes • Frequent oral hygiene • Nostril cleaning • Secure tubing with clamp or tape to clothing • Check for kinking of tubing (don’t let resident lie on it) • Check if suction working properly • If allowed, permit resident to suck on ice chips, throat lozenges, or hard candy to keep throat moist (USUALLY NPO) • During feedings, HOB 45 degrees during feeding & 30-60 min after, then at 30 degrees

Nursing care for mental & emotional comfort for NG tubes • Keep env’t clean – sensitive to odors • Answer call light promptly • Check freq, give emotional support • Extra back rub • Straighten & change linen prn • Let resident express concerns about tube • Encourage resident to get up, dress, & become involved in activities • Assist resident to attend family & group activities

NG tubes – Observations to report & record • NVD • Discomfort • Distended abd • Coughing • C/o indigestion, heartburn • Fever • Respiratory distress • Tachycardia • Flatulence

Gastrostomy tubes – nursing care • Freq oral hygiene, moist lips • Secure tube to clothing • Keep tubing free of kinks • If allowed, have resident suck on ice chips, throat lozenges, or hard candy • HOB at 20 – 30 degrees always, to prevent reflux • Remove drsg, clean & dry area, replace drsg • Report unusual conditions • Same as NG tube • Redness, swelling, drainage, odor, pain at site

Gastrostomy tube – mental comfort • Keep env’t clean – avoid odors • Answer call lights promptly • Check on resident freq, TLC • Extra back rub • Straighten or change linens prn • Encourage expression of concerns • Encourage resident to get up, dressed, & become active • Assist resident to attend family & group activities

Intravenous therapy • Provides body with needed elements that can’t be given as rapidly or efficiently by other means • Blood • Plasma • Nutritional requirements • Water • Salt • Sugar • Meds • Rate of flow often controlled by infusion pump

Nursing care for IV • Keep tubing free of twists or kinks • Observe for infiltration • Catheter has come out of vein & IV fluid leaks into tissue, causes swelling • REPORT immediately to licensed nurse • Painful • Infections • Meds that can damage integument • Check restraints to be sure they do not block vein

Nursing responsibilities for IV • Bathing • Wash gently around insertion site • Do NOT loosen tape holding catheter in place • When drying, do NOT rub over area, instead pat gently to avoid dislodging needle • Eating • Cut foods, prepare liquids, arrange utensils • Assist with feeding as little as possible to encourage self care

Nursing responsibilities (CONT) • Ambulation • Provide a portable IV stand • Assist OOB • Observe closely for weakness • Support IV arm to ensure continuous flow, may need splint or sling • Can hold the IV pole for support (even with IV arm) • Provides support for arm • Allows resident to move at own pace and leaves other hand free to keep balance

Use of bandages & binders • Apply pressure (Compression) to stop bleeding, swelling, or absorb tissue fluids • Provide immobilization of injuries • Hold dressings in place • Protect open wounds from contaminants • Apply warmth to a joint (tx for arthritis) • Provide support & aid in venous return • Varicose veins or residents with limited circulation in arms & legs

NA role in use of dressings • Ordered by physician & initially applied by licensed nurse • Your role • Apply simple, DRY, NONSTERILE dressings only to uncomplicated wounds • Assist licensed nurse with complex wounds • Licensed nurse will inform you when to change a dressing & what supplies to use

Materials used for dressings & bandages • Dressings • Usually gauze • 2, 3, or 4 inch squares • Size depends on area of body & purpose of dressing • Bandages & binders • Muslin, gauze, flannel, rubber, & elastic fiber • Dressings held in place • Hypoallergenic tape, plastic tape, elastic tape, paper tape, silk tape, adhesive tape • Binders or bandages • Type depends on purpose & resident

Principles of bandaging • Apply bandage so pressure is evenly distributed to area • Support joint in comfortable position with slight flexion • Attach bandage securely to avoid friction & rubbing of underlying tissue which could cause irritation • Start at lower (distal) part of extremity • Work upward to top (proximal) part of extremity

Observations related to dressings • Report if • Swelling • Pain • Change in color • Decrease or increase in temperature • Drainage – color, consistency, amount • Odor

Elastic bandages • Remove every 8 hours unless ordered more frequently to check underlying skin • Replace moist or soiled bandage • Reapply loose or wrinkle bandage

Anti-embolic hose (TEDS) • Used to increase circulation by improving venous return from legs to heart • Remember • Always apply before resident gets OOB • Check for wrinkles • Check skin color & temperature • Check popliteal pulse

Non-prescription ointments, lotions, or powders • CNA can apply OTC ointments, lotions, or powders to INTACT skin only • Do NOT apply to irritated skin or open lesions • CAN provide care for these problems • Foot care • Dandruff • Dry skin

Report skin conditions to nurse • Acne • Minor burn • Rash • Excoriation, abrasions, skin tears • Eczema, psoriasis • Poison ivy, poison oak • Minor wounds • Insect bites or stings

OTC products that you can apply to INTACT skin • Ointments • Zinc oxide • A & D ointment • Lotions • Clearasil • Stri-dex medicated pads • Selsun blue • Keri lotion • Corn Huskers • Powders • Johnson’s medicated powder • Tinactin foot powder

Rules in applying OTC products • Prepare resident • Position resident & cleanse skin • Protect surrounding skin • Apply • Wear gloves • Creams & liniments are rubbed in by hand • Lotions are applied by cotton ball • Ointments applied with wooden tongue blade or cotton swab • Sprinkle powder on hand or cloth, then apply

Observations about OTC products • Note skin appearance & describe changes • Identify signs of irritation

Admitting resident to facility • Admission is stressful • First impressions important for adjustment • Feelings of loss • Home • Possessions • Independence • Family • Freedom • Privacy • Control over own life

Admission • Welcome resident • Greet them by name • Introduce yourself • Explain what you will be doing • Convey warm welcome through tone of voice & facial expression

Admisison • Collect baseline info • Measure ht & wt • Measure VS • Observe • Grooming • Condition of hair & nails • Condition of skin • Mental alertness • Sight & hearing • Prosthesis • Ability to move

Admission • Report all questions & concerns to licensed nurse • Orient resident & family to facility • Review facility routine • Introduce resident to roommate & staff • Tour facility • Explain operation of bed controls, TV controls & call light

Admission • Care for personal belongings • Residents have control over possession & can decide where to put them • Fill out facility list of possessions • Encourage resident to send valuables home with family • Objectively describe valuables kept at facility • Label items with resident’s name

Transfers • Tell resident about transfer & reason for moving • Collect all belongings & take them to new room • Be careful not to lose anything • Check all drawers & closets for personal items • Introduce resident to new roommates • New surrounding may cause confusion, orient resident to new room • Continue to remind resident of new room

Nursing Assistant