nursing assistant - procedures

7/27/2019 Nursing Assistant - Procedures

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Nursing Assistant

Resident Care Procedures


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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


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Sputum collection

Early a.m. bestAllow 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


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Sputum collection (cont)

Observations Color

Odor

Consistency

Blood

Document

Specimen obtained Where you took it

Need 1 2 Tbsp


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Urine Specimens

Can be sent to lab or tested on unit

Methods

Clean catch midstream

Catheter

Routine

24 hour urine


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Urine specimen

Rules Wash hands before & after collection

Standard Precautions

Use correct & clean container

Label Patients name

Room & bed number

Date & time specimen collected

Collect specimen directly into container

Dont touch inside or lid


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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


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Observations about urine

collection Difficulty obtaining specimen

Color

Clarity

Odor

Complaints of discomfort &/or urgency


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Stool specimen

Test for

Blood

Fat

Microorganisms

Worms or parasites

Any abnormal contents


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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 todesignated area


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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


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Enemas

Introduction of fluids into rectum & lower

colon

Needs a drs order Purpose

Stimulate bowel movement

Relieve constipation or fecal impaction

Cleanse bowel of feces before surgery or

diagnostic procedures

Remove flatus


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Types of enemas

Tap water

Soap suds

Saline

Oil retention

Need to hold for 20 minutes

CommercialFleets


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Rules for giving enemas

Nursing assistants ARE allowed to give ifsupervised by licensed nurse

Temperature of solution 105 degrees

Amount if 5001000 cc for adults

Positionleft Sims 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


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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 inches past anal sphincter usinggloved hand & index finger

Instruct resident to hold suppository as long aspossible (15 20 minutes)

Observe results & report


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Maintaining fluid balanceAfter 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 tomaintain health Edema fluid intake>fluid output, tissues swell

Dehydration fluid intake< fluid output, tissuesshrink

Need about 2000 ml of fluid/day. Residents depend of nursing staff for fluid needs


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Force fluids

Have resident drink increased amounts offluids 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 cannotfeed themselves


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Restrict fluids

Physicians order to limit fluids to a specificamount

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 limitingfluids


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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


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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


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Output

All liquid output Urine

Emesis

Liquid stools

Suctions

Drains

Blood loss

Plastic urinals & emesis basins may becalibrated

Use Standard Precautions


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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


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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 stomachto feed resident


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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 (dont let residentlie on it)

Check if suction working properly

If allowed, permit resident to suck on icechips, throat lozenges, or hard candy to keepthroat moist (USUALLY NPO)

During feedings, HOB 45 degrees during

feeding & 30-60 min after, then at 30 degrees


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Nursing care for mental &

emotional comfort for NG tubes Keep envt 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 & groupactivities


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NG tubesObservations to

report & record NVD

Discomfort

Distended abd Coughing

C/o indigestion, heartburn

Fever

Respiratory distress

Tachycardia

Flatulence


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Gastrostomy tubesnursing 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 preventreflux

Remove drsg, clean & dry area, replace drsg Report unusual conditions

Same as NG tube

Redness, swelling, drainage, odor, pain at site


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Gastrostomy tubemental

comfort Keep envt 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 & groupactivities


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Intravenous therapy

Provides body with needed elements thatcant be given as rapidly or efficiently by othermeans Blood

Plasma

Nutritional requirements Water

Salt Sugar

Meds

Rate of flow often controlled by infusion pump


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Nursing care for IV

Keep tubing free of twists or kinks

Observe for infiltration

Catheter has come out of vein & IV fluid leaks intotissue, causes swelling

REPORT immediately to licensed nurse Painful

Infections

Meds that can damage integument

Check restraints to be sure they do not blockvein


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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


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Nursing responsibilities (CONT)

Ambulation Provide a portable IV stand

Assist OOB

Observe closely for weakness

Support IV arm to ensure continuous flow, mayneed 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 otherhand free to keep balance


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Use of bandages & binders

Apply pressure (Compression) to stopbleeding, 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


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NA role in use of dressings

Ordered by physician & initially applied

by licensed nurse

Your roleApply 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

M t i l d f d i &


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Materials used for dressings &

bandages

Dressings Usually gauze

2, 3, or 4 inch squares

Size depends on area of body & purpose ofdressing

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


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Principles of bandaging

Apply bandage so pressure is evenlydistributed to area Support joint in comfortable position with slight

flexion Attach bandage securely to avoid friction &

rubbing of underlying tissue which could causeirritation

Start at lower (distal) part of extremity Work upward to top (proximal) part of

extremity


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Observations related to dressings

Report if

Swelling

Pain

Change in color

Decrease or increase in temperature

Drainage color, consistency, amount Odor


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Elastic bandages

Remove every 8 hours unless ordered

more frequently to check underlying

skin Replace moist or soiled bandage

Reapply loose or wrinkle bandage


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Anti-embolic hose (TEDS)

Used to increase circulation byimproving venous return from legs to

heart Remember

Always apply before resident gets OOB

Check for wrinkles

Check skin color & temperature

Check popliteal pulse


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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 openlesions

CAN provide care for these problems

Foot care

Dandruff

Dry skin


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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 prod cts that o can appl


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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 Johnsons medicated powder

Tinactin foot powder


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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


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Observations about OTC

products Note skin appearance & describe

changes

Identify signs of irritation


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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


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Admission

Welcome resident

Greet them by name

Introduce yourself Explain what you will be doing

Convey warm welcome through tone of

voice & facial expression


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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


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Admission

Report all questions & concerns tolicensed nurse

Orient resident & family to facility Review facility routine

Introduce resident to roommate & staff

Tour facility

Explain operation of bed controls, TVcontrols & call light


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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 residents name


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Transfers

Tell resident about transfer & reason formoving

Collect all belongings & take them to newroom Be careful not to lose anything

Check all drawers & closets for personal items

Introduce resident to new roommates New surrounding may cause confusion, orientresident to new room

Continue to remind resident of new room


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Discharges

Collect baseline information Ht & wt

VS

Observe Grooming

Condition of skin & nails

Condition of skin

Mental alertness Sight & hearing

Presence of prosthesis

Ability to move around


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Discharges

Collect personal belongings

Check all drawers & closets for personal

items Review facility list of possessions for items

that might be in the safe or locked cabinet

Assist resident to vehicle or mode oftransportation

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