Unit 11 Resident Care Procedures

2. Unit 11Resident Care Procedures Nurse Aide I Course

3. 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.

4. 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;

5. 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.

6. Elimination Of Waste Products

7. Objective 11.0 Describe what is meant by elimination needs.

8. Elimination of Waste Products • Natural process • Healthy individuals have regular elimination habits

9. 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

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

11. 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

12. Objective 11.1 Review the guidelines to follow when assisting the resident with elimination needs.

13. Guideline To Assist With Elimination • Assist to as close to a sitting position as possible

14. 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

15. 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

16. Guideline To Assist With Elimination(continued) • Do not leave on bedpan for long periods of time • Cover and empty bedpan immediately.

17. 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

18. Demonstration and Return Demonstration

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

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

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

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

23. Indwelling Catheters

24. Objective 11.6 Discuss indwelling catheters and catheter care.

25. 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

26. Indwelling Catheters(continued) • Use • Residents with nerve injury: • following spinal cord injury • after stroke • After surgery • Some incontinent residents

27. Increased Risk of Urinary Tract Infections Urinary meatus and surrounding area must be kept clean Catheter care given at least daily and PRN Indwelling Catheters(continued)

28. Objective 11.6.1 Identify guidelines to follow when caring for residents with indwelling catheters (Foley).

29. Guidelines To Follow When Caring For Residents WithIndwelling 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

30. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Observe and report any swelling, skin irritation, or discoloration • Measure and record urinary output accurately, noting color, odor and appearance of urine

31. Guidelines To Follow When Caring For Residents WithIndwelling 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

32. Guidelines To Follow When Caring For Residents WithIndwelling Catheters(continued) • Never disconnect catheter from tubing to drainage bag • When emptying urinary drainage bag, never touch drain with measuring container or graduate

33. Demonstration and Return Demonstration

34. Objective 11.7 Demonstrate the procedure for providing catheter care.

35. Objective 11.8 Demonstrate the procedure for emptying a urinary drainage bag.

36. Collecting Routine Urine Specimen

37. Objective 11.9 Discuss the collection of urine specimens.

38. request form 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

39. 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

40. 10-20- Smith, A Urinalysis 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

41. Demonstration and Return Demonstration

42. Objective 11.10 Demonstrate the procedure for collecting a routine urine specimen.

43. Types of Urine Collections

44. Objective 11.11 Discuss the collection of two more types of urine sample collections: the clean catch and the 24-hour specimen.

45. Clean Catch Urine Specimen(mid-stream) • Cleaning of perineum prior to collection reduces number of microbes that may contaminate specimen 

46. 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

47. 24-hour urine 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

48. 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

49. 24-Hour Urine Specimen(continued) • Imperative that resident and staff understand procedure and exact time period for sample collection • Follow Standard Precautions

50. Applying and Caring For Condom Catheters