unit 5 study guide Flashcards
- Describe procedure for inserting indwelling urinary catheter.
video
clean off-stick in there-do balloon-tug on it
- Maintain aseptic technique.
open sterile tracheostomy kit
unwrap sterile basin
open small brush
sterile gloves
Describe methods of caring for a patient with an indwelling urinary catheter
PROVIDE PRIVACY AND PROVIDE PERINEAL CARE
- STERILE FIELD
- FEMALE – CLEANSE WITH BETADINE IN DOWNWARD MOTION
- MALE – CLEANSE MEATUS FIRST, USING CIRCULAR MOTION OUTWARD
- USE A CATHETER SECURING DEVICE
- AGENCY UPDATES
- TESTING OF BALLOON PRIOR TO INSERTION,
ACCORDING TO AGENCY POLIC
- Describe care of ostomy.
SKIN BARRIER
* ODOR CONTROL
* SKIN CARE
- CHANGE APPLIANCE AT LEAST ONCE A WEEK
- CHANGE BAG MORE
FREQUENTLY- CAN REUSE, OR CAN BE DISPOSABLE
Identify nursing assessment for a patient with alternative methods of elimination (urinary and bowel).
colonoscopy
illeostomy
Describe techniques for obtaining specimens- urine, blood sputum, throat and stool.
URINE
MIDSTREAM/CLEAN CATCH URINE
* VOIDED SPECIMEN
* CATH SPECIMEN
COLLECTION
* KETONE CHECK
TYPE I DIABETES
* PEDIATRIC U-BAG
* 24- HOUR COLLECTION
STOOL
OCCULT BLOOD / HEMMOCULT
Sputum
DEEP COUGHS-from lungs
Throat
SWAB TONSILS NOT UVULA
- Describe technique for suctioning a tracheostomy.
Gather supplies- mask,
gown, sterile saline and
suction kit
- Open kit, remove sterile
container and pour sterile saline - Apply PPE, hold suction catheter in dominant hand- keep this hand sterile
- With other hand, attach catheter to suction, lubricate catheter tip with saline
- Insert catheter to point of resistance, back up, and apply suction while removing catheter
- Hyperoxygenate between suction swipes
- Describe assessment of a patient with a tracheostomy.
observe for tube dislodgment, ddecannulation, or obstruction
observe for any excess secrestions
observe skin around treacheal stoma
asess hydration status
Define terms used to describe common abnormal conditions related to elimination, specimen collection and tracheostomy suctioning and care
abnormal stoma-should not be black blue or purple
skin surrounding
stool appliance
abnormal stool-claycolored
melena-blood in stool
mucus-pus
high fat-foul smelling
Describe technique for care of patient with a tracheostomy
Gather supplies- mask, gown, trach cleaning kit, suction kit, sterile saline and hydrogen peroxide
- Wash hands and Apply PPE
- Identify your patient and provide privacy, assess your patient for pain, explain procedure, position patient
- Suction tracheostomy- remove soiled dressing- note drainage- remove gloves, hand hygiene
- Open trach cleaning kit- put on sterile gloves
- Keep dominant hand sterile- pour saline and peroxide into containers
- Remove inner cannula- soak in peroxide/ or throw away and replace with disposable unit
- Cleanse stoma with saline
- Clean inner cannula- rinse in saline
- Replace inner cannula- change dressing