Subacute Care

Chapter 25

Subacute CareCare for Residents With Specific Needs

• Formerly cared for in Hospital

• Rehabilitation

• Complicated Respiratory Care

• Special Equipment

                                                                                             

               

Rehabilitation

Rehabilitation

• Overcoming effects of stroke or disease

• Traumatic Injury

• May be younger than general population

• Stay for shorter period of time

Mechanical Ventilator

Mechanical Ventilator

• Artificial Respiration

• May prevent immediate death and prolong life

• Not your responsibility – do not adjust dials or controls

• Meeting the residents needs

Important Tips

• Ventilator panel turned away from resident• Remember even unconscious residents can hear• Be sure call signal within reach• Answer call signal immediately• Two people frequently needed for care• Weaning will require additional support• Will require a tracheostomy

Tracheostomy

Tracheostomy

• Surgical opening to create an artificial airway

• Tube inserted into the trachea

• Resident breathes through tube rather than nose or mouth

• Secured by tapes, ties or Velcro

CNA Responsibilities

• Mouth care q 2 hours

• Avoid getting dressings wet during care

• Report anything unusual

• Assist with tracheostomy care or suctioning

• Report to nurse any symptoms that indicate resident needs to be suctioned

• Remember Standard Precautions

IV

IV

• Needle or special catheter placed in vein

• Provides fluids, nutrients, or medications

• Tubing connected to bag which hangs from an IV pole

CNA Responsibilities

• Keep IV bag above insertion site• Tubing should not be kinked, tangled, or under the

resident’s body• Call nurse if tubing becomes disconnected• Report leaking around site, swelling, redness,

bleeding, pain, or burning• Do not use IV arm for BP’s• Record shift total on I&O• Store pump properly

Feeding Tubes

Gastrostomy Tubes

Nasogastric (NG) TubesGastrostomy (G) Tubes

• May be connected all the time or only during feedings

• Resident is usually NPO• Resident should not lie flat – at least 30

0

• Check nose or abdominal site for irritation and report redness, rash, bleeding, or drainage

• Report to nurse if pump alarms or tube becomes plugged

• Report any nausea, fullness, diarrhea

Gastrointestinal Suctioning

Suctioning

• Portable or wall suction

• May be low to suction continuously

• May be high intermittently

CNA Responsibility

• Keep containers at appropriate levels

• Empty containers each shift or as instructed

• Report change in drainage – color or amount

• Report nausea or abdominal pain

Chest Tubes

• Hollow drainage tube inserted into chest

• Drains air, blood, or fluid from pleural cavity

• Also allows for full expansion of the lung

Pleural Cavity

• Space between the layers of the pleura

• Pleura is the thin membrane that covers and protects the lungs

Conditions requiring chest tube insertion

• Pneumothorax – air or gas in the pleural space

• Hemothorax – blood in the pleural space

Left Hemothorax

Conditions requiring chest tube insertion

• Empyema – pus in the pleural space

• Certain types of surgery

• Chest trauma or injuries

Right Empyema

A chest tube is used to remove fluid from the space between the lungs and the wall of the chest. The tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space).

Chest tube connected to a bottle of sterile water. Suction is sometimes attached to the system to encourage drainage. The

system must be sealed so that air cannot enter the pleural cavity.