mod 9 A Flashcards
basic principles of collecting urine
- always wear PPE
- verify w nurse the correct storages and mL
- Verify specific timing reequipments
Steps of collecting a urine sample
have the required container and biohazard bag
label the container or outside of biohazard bag
label the container with
- date, time, resident name, and date of birth
after the sample is collected and placed in biohazard bin removed gloves & wash hands
take to designated area
if taken to storage area report to nurse and tell exact time which it was taken
Urinary analysis (UA)
test that looks for bateria in the urine
- could mean there is a uti
other reasons:
- determining kidney function
- measuring electrolytes
- checkign drug levels
resident must be able to sit on toilet or commode to provide sample
if not nurse most perform straight catheterization
Why should you never obtain a sample via bedpan or urinal
They harbor bacteria which can containment
obtain sample only by collecting urine as it directly exists by the body
Steps for collecting UA
perform peri-care
can use towelettes if given in cup
- wipe 3 times (urethra to anus)
- ask resident to start then stop voiding
- when the cup is under them without touching them ask them to void again
- fill the cup as indicated by nrs (usually 50mL)
- if they are unable to start and stop, place cup under the stream of pee
- after place the lid on the container without touching the lids inside
- place in biohazard bag
Straining for kidney stones
after the urine is strained then it may be left in the strainer
collect all urine, place commode under pt and remind them not to throw tp in there
after voiding and tending to needs then empty the contents of the commode hat through the strainer an into the toilet
- see if stone is passed then put into labeled container, then into biohazard bag
fecal specimes
collect samples via commode hats and bedpans
try to keep from becoming contaminated w urine
male: ask to void in urinal first
place the commode under the seat back half
obtain sample through a wooden toung blade or plastic spoon
take a sample from three different areas (each end/middle)
fecal specimens collections
special container
- unscrew the top
use the small spoon to collect stool
shake w special liquid
attach and place in biohazard
give to nurse or place in designated storage area
occult blood “hidden”
stool guaiac, fecal occult blood test, hemosure, and hemoccult
after resident has bowel movement obtain a small sample with small wooden stick provided with test
if none use Tounge blade
wipe the stool on one area of the hemoccult card under window A and close the flap
window turns blue it is positive for occult blood
place card in biohazard then give to nrs
sputum specimes
respiratory illness a sputum specimen is required
sputum is mucous expelled from the lungs during illness
colored/thick
expel sputum into sterile container
if cannot, should tell resident to expel in container and notify cna when done
care of paitents with tubing
avoid any tugging or tension on the tubing
have a slack in the tubing at all times
always check for skin irritation and if it is working properly
if it is not working properly or skin integrity changes notify the nrs
Types of Catheters
straight or immediate cath
will have a opening which the urine will be dumped few hours/reg basis
straight catheters to obtain urine sampled
indwelling catheters (foley)
ballon is inflated to keep cathered from moving
inserted via urethra or lower abdomen
what is a suprapubic catheter
A catheter that is inserted through an opening in the abdomen into the bladder
CNA role in care of resident with a catheter
monitor for signs/symptoms of urinary tract infection
report any signs to nrs
Securing the Cath
always have it secure to prevent pulling and tugging which is painful
cath holder is attached to residents thigh/abdomen
enough slack to ensure there is not tugging to pulling
cleaning the cath
pt has a suprapubic cath, clean the tubing prior to peri-care
hold the cath w nondominant hand close to pt body
w dominant hand clean the cath w soapy washcloth in downward motion for 4 inches away from body
rineless product
if pt is not circumcised then retract the skin after
after cleaning rinsing and drying replace the foreskin
cath should be cleaned 2x daily
Chaning the collection bag to a leg bah
better alternative for ambulatory residents
requires cath system to be open
greater risk for UTI
empty and record urine (write down amount in notebook)
clamp the cath just below the junction of two ports, where cath meets tubing collection bag
clean the cath and leg bag port with alcohol wipes, after join the two
offer dry washcloth under
fasten leg straps
leg bag only used when in upright positon
always change resident back to collection bag when ready to lay down
protecting privacy of resident who use cath
the collection bag must be covered at all times
hung at foot of bed or under the wheelchair
place the collection bag into another bag to conceal it
Positions with collection bag
collection bag hung on bed frame toward foot of the bed
prior to reposition removed bag from bed frame
move bag to side of bed the resident will be facing
Emptying the collection or leg bag
place paper towel on floor
place container over
wipe drainage port with alcohol wipe
open and empty
once again clean drainage pot with alcohol wipe
place paper towels to place container
measure to closest 25mL, rounding up or down as needed
cleaning collection/leg bags
sometimes equal parts water/vinegar
sometimes 1 part bleach to 10 parts water
empty and clean it
supplies typically found in 2/3 drawer
Intravenous therpay
continous IV therapy, always connected
before transfer iv must be next to pt
when pt has their own clothes, remove iv from pole
bag goes through first and followed by arm
place iv back on pole when done
chronic condition- supplemental o2
chronic conditions: disease, inj, illness lasts for long period of time
less concentrated
used for those with chronic obstructive pulmonary disease (COPD) and emphysema
lung removed/lung cancer
1 to 6 liters per min
Acute O2
short-lived new illness or injury may be unsolved
require supplemental oxygen can include:
asthma attack, allergic reactions, tramua w large blood loss
oxygen for those often highly concentrated
CNA role in oxygen therpay
change over portable cylinder or concertation vice versa
must verify it is working and running correct flow rate
role to verify correct flow rate if not tell nrs
Delivery routes- nasal and face mask
nasal cannula: deliver up to 6 liters
place upward in nose and goes behind ears/head
face mask: higher amounts of concentrated oxygen or meds with it
metal clip on top of mask, after on resident face slightly pinch the metal nose
can often be very drying, causing nosebleeds. o2 can be humified. distilled or sterile water accomplished this.
if resident complains then K-Y jelly can be used
oxygen cylinders
small: attached to wheelchair, can move freely
4 t 6 hrs. running at 2L/ min
large: in room
regulators can be conserving
these deliver one puff of oxygen with every breath
conventional reg: delivers a constant stream of oxygen- last longer
important to check tank life.
oxygen concentrator
more economical way to deliver oxygen, never needs refilling
removed o2 from air then puts back in
plugs into sockets
1 to 6 liters per min
reg is on the front of machine
tubing connected directly to machine or humidification bottle
switch to portable oxygen
Interventions to help breathing and ease anxiety
relaxation exercises
answer call light promptly
reassure you are there to help her
positioning, assist to comfortable position
tripod or fowlers position
coughing and deep breathing execrises
help maintain lung function by expanding lung tissues and clearing it of mucus
help with those of respiratory illness
taught by nr, reinforced by cna
remind to take several deep breaths and cough
deep breaths by nose and hold 5 sec and exhale
after ask to cough
let them take breaks
offer tissues for ay phlegma
incentive spirometry
medical exercise used to maintain lung function or to increase lung function during respiratory illness
asked to exhale all air from his lungs when mouthpiece is in mouth
slowly breaths in, once inhaled or has reached target volume
mouthpiece is removed and pt exhales
take breaks, normally this is repeated 5-10 times per sitting
incentive spirometry required care plan should say how many
input and outake
record output: urine feces vomit
notebook only use room numbers or initial for HIPPA
urine: commode in front
Feeces: commode in back
both: front and back
linens
linens: bedding that covers the matters
clean linen: promote healthy skin, prevent germs, and promote comfort
incontinent: 1-2 incontinent pad used
incontinent pad: used to protect bed from getting soiled
alternating pressure mattress or alternating pressure bad: a disposable pad
mattress pads: never used on any hospital mattress
changed: 1 to 2 times a week
acute care: daily
should be changed: soiled, wrinkled, sweating excessively
What is the collection order of linens
1) bath blanket, if used by facility
2) fitted sheet
3) draw sheet- lift sheet
4) reusable incontinence pad
5) top sheet
6) blanket
7) bedspread
8) pillowcase
Infection control- linens
keep linens away from body
place linens on clean surface
before putting linen down, flip them over
do no shake out linens
pillow becomes soiled/ wet should be turn out
linens not used: dirty linens
never go on floor, if fall: dirty linens
gloves before removing linens
body mechincas
release breaks and move away from wall
raise bed to good working height (waist)
lower rails
occupied bed: only lower rail of side working on
once down place to original position (low and call light, brakes)
closed bed
made with all linens in place over mattress
prior to admission
LTC: made once the resident gets up for day
mitered corners , wrinkle free, tidy bed
open bed
invites resident to go lay down
fanfold to side of bed when transferring from stretcher
cover resident with linens
pul upward on linens to make a toe peat
pleat reduces risk of pressure injuries
uncopied bed
pt gets out of bed
may sit in wheelchair while perform the task
bed must be completely changed every bath day
heavily soiled/wrinkled, resident discharge
occupied bed
unable to get out of bed (bed bound)
asked to roll over to opposite side of process
never lie on bare mattress
soiled linened rolled inward
clean tucked under soiled linens
always have side roll up to side pt is o
some facilities do not have side rails, so roll pt toward you
what to do if a over the counter enema does not work?
high-volume enema
are used prior to surgies/procedures
bucket filled with water and castile soap
contains 1,000 mL
fluid inserted into rectum via a tube connected to bucket
hold fluid in until a bowel movement
no bowel movement may be obwel obstruction which require further treatment
report to nrs: complains of pain any changes in vital or bleeding
always lie on left side
admin, transfer, discharge
admission: vitals, height, weight
settle into room
transfer; communication
discharge: helping the resident pack up personal belonging and communicate
transfer/discharge
pt has right to stay at their chosen facilities
cannot be honored when:
- facility cannot meet residents need
- resident no longer needs skilled nrs services
- threatening safety
- cannot pay for services
can be discharged for nonpayment after 30 day notice
discharge must include:
- why and date of discharge
- where they are going
- contact info for states ombudsman
- info on bed hold and readmission policies
copy sent to pt or power of attorney to pt
hospital and nursing facility transfers
3 night qualifying and needs care continued (Medicare pays)
special needs prior to going to hospital for things like pneumonia
the medical resident
chronic/acute medical illness which needs to be closely monitored
issues include:
bowel obstruction
pneumonia
uncontrolled diabetes
heart attack, stroke
congestive hr fail
chronic obstructive pulmonary disease (COPD)
vital signs every 4 hr
ambulation every shift - 2 hr
postsurgical resident- inpatients
inpatients (stay overnight)
joint replacements
heart procedures
bowel surgeries
amputations
higher risk for complications, need to be monitored
surgical resident make up a large % of residents in hospitals
what is ambulatory surgery
does not require overnight stay, performed on same day that they are admitted and discharged
outpatients or same day surgery
diets for post surgery
NPO- nothing by mouth
bowel movements, pass faults, or gas before anything by mouth
after directive is given clear liquid diet
then onto full liquids, then soft diet, then reg diet
not tolerating update the nrs
activity for postsurgical pt
activity helps w strengthen her and preventing comp
common comp: pneumonia, atelectasis, constipation, bowl obstruction
level of activity limited: repositions every 2 hr
if can: walk 1 per shift
talk to nr if refuse to walk
what is atelectasis?
it is a resp disorder in which gas Exhange is limited due to either alveoli collapse or fluid build up
weight bearing stat
orthopedic surgery may be assigned weight- Bering stat
% is given for affected leg or foot
50% weight bearing on left- only allowed to place half weight on left leg
toe touch ( toes can touch floor but no weight on them)
weight bearing as tolerated (WBAT)
respiratory complications
immobility after surgery or caused by medical illness
most often atelectasis or pneumonia
complete depth breathing/ cough exercises and incentive spirometer
abdominal pain, chest or bowel surgery-
to lessen discomfort encourage resident to splint
what is spilting
it is a process that supports the chest and abdomen during coughing and deep breathing to decrease pain.
places a pillow lengthwise across the abdomen
arms are place on top of pillow
remind pt to bear down then do execrises
cardaic complications
immobility or medical illness
most common: blood clot form in legs
symptoms of blood clot: pain, heat, redness in lower legs
if blood clot breaks free it can travel to heart or lungs which can cause death
best preventions:
anticoagulant meds or ted hose
what to do completely immolbie or strict bed rt use
sequential stocking
sleeves w blood clot backing attached
connected to air pump
air is pumped moving from bottom to top in sequence
actions moved blood
worn entire time in bed
bandages and Non legend topical ointments
keep wound dry and clean some are to absorb and protect the skin
allows follow nrs directive
to change non sterile
wash hands
have supplies ready on clean surface
remove old bandage, throw away
open other only touching edges
can apply no med ointments
if skin is open do not apply any creams or ointments
non adherent pads
absorbent dressing for wounds that aave some drainage
can absurd more than gauze
surface ensure they will not stick to wound bed
foam dressing
used for woumds wiht moedrate/ heavy drainage
used to pressure inj
calcium alginates
used for moderate/significant drainage
great for venous or arterial ulcers
mold to skin
hydrogel dressings
wounds with limited/minimal drainage
used for wounds w dead tissue
offers protections ad padding for wound
can be used for pressure inj
transparent dressings
used for wounds with limited drainage
offers flexible protection to wounds
can act as second skin for skin tears and blisters
