Resident Care Procedures Resident Care Procedures TerminologyTerminology

AdmissionAdmissionAnti-embolic stockingsAnti-embolic stockingsBandageBandageBindersBindersClean catchClean catchClosed bedClosed bedDefecateDefecateDischargeDischarge

Terminology #2Terminology #2DrawsheetDrawsheetEdematousEdematousElastic bandageElastic bandageElectric bedElectric bedEvacuationEvacuationExcoriatedExcoriatedExpectorateExpectorateFan foldFan fold

Terminology #3Terminology #3

FluidFluidGastrostomyGastrostomyGatchGatchHivesHivesIntakeIntakeIntegumentary systemIntegumentary systemIntravenousIntravenousLesionsLesions

Terminology #4Terminology #4

Manual bedManual bedMitered cornerMitered cornerMucusMucusNasogastricNasogastricNon-prescriptionNon-prescriptionOccupied bedOccupied bedOintmentOintmentOpen BedOpen Bed

Terminology #5Terminology #5

OutputOutput

PruritusPruritus

Reverse TrendlenbergReverse Trendlenberg

ScalingScaling

Semi-Fowler’s positionSemi-Fowler’s position

Side railsSide rails

SpecimenSpecimen

Terminology #6Terminology #6

SuppositorySuppository

T.E.D. hoseT.E.D. hose

TransferTransfer

TrendlenbergTrendlenberg

Unoccupied bedUnoccupied bed

Collecting sputum specimensCollecting sputum specimens

Reason for study sputumReason for study sputum

BloodBlood

MicroorganismsMicroorganisms

Abnormal cellsAbnormal cells

Collecting sputum specimens – Collecting sputum specimens – Role of NARole of NA

Usually coughed up in early AMUsually coughed up in early AM

Allow resident to rinse mouth with Allow resident to rinse mouth with waterwater

Do not use mouthwashDo not use mouthwash

May be embarrassing to the residentMay be embarrassing to the resident

Specimen may be perceived as Specimen may be perceived as unpleasantunpleasant

Collecting urine specimens – Collecting urine specimens – Methods of collectionMethods of collection

Mid-streamMid-stream

Clean catheter urine specimenClean catheter urine specimen

24-hour urine specimen24-hour urine specimen

Fresh-fractional urine (second void)Fresh-fractional urine (second void)

Collecting urine specimens – Collecting urine specimens – Role of NARole of NA

Wash hands before and afterWash hands before and after

Use Standard PrecautionsUse Standard Precautions

Use correct and clean containerUse correct and clean container

Label the container accuratelyLabel the container accurately

Collecting urine specimens – Collecting urine specimens – Role of NA #2Role of NA #2

Do not touch inside the containerDo not touch inside the container

Ask resident not to have a BM while Ask resident not to have a BM while specimen is being collectedspecimen is being collected

Take specimen and requisition slip to the Take specimen and requisition slip to the designated lab pick-up stationdesignated lab pick-up station

Document that specimen was obtainedDocument that specimen was obtained

Collecting stool specimens – Collecting stool specimens – PurposePurpose

BloodBlood

FatFat

Micro-organismsMicro-organisms

WormsWorms

Any abnormal contentsAny abnormal contents

Collecting stool specimens – Collecting stool specimens – Role of NARole of NA

Maintain privacyMaintain privacy

Use Standard PrecautionsUse Standard Precautions

Give clear instructionGive clear instruction

Label container accuratelyLabel container accurately

Clarify if specimen must be kept Clarify if specimen must be kept warm or at room temperaturewarm or at room temperature

Take specimen and requisition slip to Take specimen and requisition slip to the designated lab pick-up stationthe designated lab pick-up station

Bed making - Role of NABed making - Role of NA

Linen must be wrinkle-freeLinen must be wrinkle-free

Keep call bell clipped to linenKeep call bell clipped to linen

Keep resident reality-oriented by use Keep resident reality-oriented by use of resident’s personal pillow, afghan, of resident’s personal pillow, afghan, etc.etc.

Bed making - Role of NA #2Bed making - Role of NA #2

Wash hands before and afterWash hands before and after

Hold and carry linen away from Hold and carry linen away from uniformuniform

Do not shake linensDo not shake linens

Keep linens off the floor or bedside Keep linens off the floor or bedside tabletable

Soiled linen hampers kept coveredSoiled linen hampers kept covered

Hospital Bed – Functions and Hospital Bed – Functions and structuresstructures

Manually operated bedsManually operated beds

Electric bedsElectric beds

Side railsSide rails

Bed PositionsBed Positions

High positionsHigh positions

Low positionsLow positions

Fowler’s positionFowler’s position

Semi-Fowler’s positionSemi-Fowler’s position

Bed making – Body MechanicsBed making – Body Mechanics

Know your limitationsKnow your limitations

Get close to sides of bedGet close to sides of bed

Keep back straight and knees bentKeep back straight and knees bent

Keep feet apartKeep feet apart

Move feet to turnMove feet to turn

Face in the direction you are workingFace in the direction you are working

Maintaining Environment – Maintaining Environment – Role of NA Role of NA

Rooms should be comfortableRooms should be comfortable

Rooms should be safeRooms should be safe

Maintaining Environment – Maintaining Environment – Role of NA #2Role of NA #2

Make sure resident can reach Make sure resident can reach bedside standbedside stand

Arrange personal belongings as per Arrange personal belongings as per resident’s preferenceresident’s preference

Keep call bell within reachKeep call bell within reach

Make sure resident can reach equip.Make sure resident can reach equip.

Provide tissues and toilet paperProvide tissues and toilet paper

Enemas - PurposeEnemas - Purpose

Stimulate a bowel movementStimulate a bowel movement

Cleanse bowel prior to surgeryCleanse bowel prior to surgery

Remove flatus (gas)Remove flatus (gas)

Enemas - TypesEnemas - Types

Cleansing enemasCleansing enemas

Oil retention enemasOil retention enemas

Commercial mixtures (i.e. Fleet’s)Commercial mixtures (i.e. Fleet’s)

Enemas – Role of NAEnemas – Role of NA

Temperature of solutionTemperature of solution

Amount of solutionAmount of solution

Resident positionResident position

Height of enema bagHeight of enema bag

Depth of tube insertionDepth of tube insertion

Enemas – Role of NA #2Enemas – Role of NA #2

Administer solution slowlyAdminister solution slowly

Hold enema tube in placeHold enema tube in place

Make sure toilet facility is nearby and Make sure toilet facility is nearby and availableavailable

Observe the results of the enemaObserve the results of the enema

Use Standard PrecautionsUse Standard Precautions

Rectal TubeRectal Tube

Inserted into rectum to relieve Inserted into rectum to relieve flatulence and intestinal distentionflatulence and intestinal distention

Equipment: Equipment:

Tube and flatus bag or folded Tube and flatus bag or folded waterproof padwaterproof pad

Method: See bookMethod: See book

Suppository - PurposeSuppository - Purpose

Stimulate one to empty the bowelStimulate one to empty the bowel

Lubricate the stool to ease Lubricate the stool to ease evacuationevacuation

Suppository – Role of NASuppository – Role of NA

Identify the residentIdentify the resident

Remove wrapper from suppositoryRemove wrapper from suppository

Place suppositoryPlace suppository

Instruct resident to hold the Instruct resident to hold the suppository in the rectum as long as suppository in the rectum as long as possiblepossible

Observe resultsObserve results

Report resultsReport results

Gastrointestinal tubesGastrointestinal tubes

Nasogastric tubes ( inserted through Nasogastric tubes ( inserted through nose ) nose )

Gastrostomy tubes ( inserted through Gastrostomy tubes ( inserted through abdominal wall )abdominal wall )

Gastrointestinal tubes – Gastrointestinal tubes – Nursing CareNursing Care

Frequent oral hygieneFrequent oral hygiene

Securing tubing with clamp or tape Securing tubing with clamp or tape to clothingto clothing

Tubing free of kinksTubing free of kinks

Checking if suction machine Checking if suction machine operating satisfactorilyoperating satisfactorily

Position head of bed elevated at all Position head of bed elevated at all times to prevent refluxtimes to prevent reflux

Gastrointestinal tubes – Gastrointestinal tubes – Nursing Care #2Nursing Care #2

Keep environment cleanKeep environment cleanAnswer call lights promptlyAnswer call lights promptlyGive emotional supportGive emotional supportGiving an extra back rubGiving an extra back rubStraightening or changing bed linenStraightening or changing bed linenAsking resident to express concernsAsking resident to express concernsEncourage resident to be up, dress in Encourage resident to be up, dress in day clothes and join in activitiesday clothes and join in activities

Intravenous (I.V.) TherapyIntravenous (I.V.) Therapy

Provides the body with needed Provides the body with needed elements that cannot be given elements that cannot be given rapidly or efficiently by other means.rapidly or efficiently by other means.

Blood, plasmaBlood, plasma

Nutritional – water, salt, sugar, etc.Nutritional – water, salt, sugar, etc.

MedicationsMedications

Intravenous (I.V.) Therapy – Intravenous (I.V.) Therapy – Role of NARole of NA

Keep tubing free of kinksKeep tubing free of kinks

Observe tube and condition of Observe tube and condition of injection site for any infiltrationinjection site for any infiltration

Wash gently around the areaWash gently around the area

Assist resident with ADLsAssist resident with ADLs

Assist resident to ambulateAssist resident to ambulate

Maintaining fluid body balanceMaintaining fluid body balance

Death can result from taking Death can result from taking inadequate fluids or loosing too much inadequate fluids or loosing too much fluidsfluids

Amount of fluid taken in and amount Amount of fluid taken in and amount lost must be equallost must be equal

EdemaEdema

DehydrationDehydration

An adult needs 2000 ml of fluids/dayAn adult needs 2000 ml of fluids/day

Force fluidsForce fluids

Resident drink an increased amount Resident drink an increased amount of fluidsof fluids

May order specific amount of fluid for May order specific amount of fluid for 24-hour period24-hour period

Maintains fluid balanceMaintains fluid balance

May be for general or specific May be for general or specific amount of fluidamount of fluid

Nurse assistant responsibilityNurse assistant responsibility

Keep record of amount taken inKeep record of amount taken in

Provide variety of fluidsProvide variety of fluids

Place within resident’s reachPlace within resident’s reach

Offer fluids frequently to residents Offer fluids frequently to residents who cannot feed themselveswho cannot feed themselves

Restrict fluidsRestrict fluids

Sign posted above bedSign posted above bed

Water is offered in small amountsWater is offered in small amounts

Keep accurate intake and output Keep accurate intake and output recordrecord

Provide resident with frequent oral Provide resident with frequent oral hygienehygiene

Explain to resident and family the Explain to resident and family the reason for limiting fluidreason for limiting fluid

Nothing by mouth (NPO)Nothing by mouth (NPO)

Reasons-before and after surgery, Reasons-before and after surgery, before certain lab tests and x-rays, before certain lab tests and x-rays, and in the treatment of some and in the treatment of some illnessesillnesses

Nurse assistant responsibilitiesNurse assistant responsibilities

NPO sign above bedNPO sign above bed

Remove water pitcher and glassRemove water pitcher and glass

Offer frequent oral hygiene; no Offer frequent oral hygiene; no swallowing of any fluidswallowing of any fluid

““Intake and Output”Intake and Output”

The doctor or nurse may want to The doctor or nurse may want to keep track of a resident’s fluid intake keep track of a resident’s fluid intake and outputand output

To evaluate fluid balance and kidney To evaluate fluid balance and kidney function, or medical treatmentfunction, or medical treatment

Measuring the amount of fluid Measuring the amount of fluid taken in by the residenttaken in by the resident

Measurement of resident’s intake is Measurement of resident’s intake is done in milliliters (ml) or cubic done in milliliters (ml) or cubic centimeters (cc)centimeters (cc)Determine the fluid capacityDetermine the fluid capacityA conversion table is on the intake A conversion table is on the intake and output record used to chart and output record used to chart intakeintakeA graduated cylinder is used to A graduated cylinder is used to measure fluidmeasure fluid

Measuring the amount of fluids Measuring the amount of fluids excreted by the residentexcreted by the resident

Measurement of resident’s output is Measurement of resident’s output is also done in ml or ccalso done in ml or cc

Plastic urinals and emesis basins Plastic urinals and emesis basins may be calibratedmay be calibrated

Use universal precautions when Use universal precautions when measuring output measuring output

Recording intake and outputRecording intake and output

Document amounts when fluid is Document amounts when fluid is taken or excretedtaken or excreted

Amounts are totaled at end of shift Amounts are totaled at end of shift and entered in the patient’s recordand entered in the patient’s record

Other special forms may be required Other special forms may be required by facilityby facility

Report any unusual occurencesReport any unusual occurences

Reasons for using bandages and Reasons for using bandages and bindersbinders

To apply pressureTo apply pressure

To provide for immobilization To provide for immobilization

To hold dressings in placeTo hold dressings in place

To protect open wounds from To protect open wounds from contaminantscontaminants

To apply warmthTo apply warmth

To provide support and aid in venous To provide support and aid in venous circulationcirculation

Materials used for dressings and Materials used for dressings and bandagesbandages

GauzeGauze

BandagesBandages

BindersBinders

Principles of bandagingPrinciples of bandaging

Apply bandage so pressure is evenly Apply bandage so pressure is evenly distributed to areadistributed to area

Support joint in a comfortable Support joint in a comfortable position with a slight flexionposition with a slight flexion

Attach bandage securely to avoid Attach bandage securely to avoid friction of underlying tissuefriction of underlying tissue

Observations that should be Observations that should be reportedreported

SwellingSwelling

PainPain

Change in colorChange in color

Decreased temperatureDecreased temperature

Use and method of applying Use and method of applying antiembolic hose (T.E.D. hose)antiembolic hose (T.E.D. hose)

Anti-embolic hose/stockings are used Anti-embolic hose/stockings are used to increase circulation by improving to increase circulation by improving venous return from the legs to the venous return from the legs to the heartheart

Things to remember when applying Things to remember when applying elastic stockingselastic stockings

Always apply before resident gets Always apply before resident gets out of bedout of bed

Check frequently for wrinklesCheck frequently for wrinkles

Check circulation in feet frequentlyCheck circulation in feet frequently

Check popliteal pulseCheck popliteal pulse

Integumentary SystemIntegumentary System

Largest organ of the bodyLargest organ of the body

Forms water proof, protective Forms water proof, protective covering for the bodycovering for the body

Helps regulate the body temperatureHelps regulate the body temperature

Anatomy of the skinAnatomy of the skin

EpidermisEpidermis

DermisDermis

Symptoms associated with skin Symptoms associated with skin diseasedisease

PruritusPruritus

Swelling (edema)Swelling (edema)

Scaling Scaling

LesionsLesions

Hives Hives

Applying non-prescription Applying non-prescription ointments, lotions, or powdersointments, lotions, or powders

Provide emotional support to the Provide emotional support to the residentresident

Do not apply ointments, lotions, or Do not apply ointments, lotions, or powders to irritated skin surfaces or powders to irritated skin surfaces or open lesionsopen lesions

Skin conditions the nurse assistant Skin conditions the nurse assistant can care forcan care for

Foot careFoot care

DandruffDandruff

Dry skinDry skin

Report the existing skin conditions Report the existing skin conditions to a licensed nurseto a licensed nurse

AcneAcne

Minor burnMinor burn

Diaper rash or prickly heatDiaper rash or prickly heat

Eczema or psoriasisEczema or psoriasis

Poison ivy or poison oakPoison ivy or poison oak

Minor woundsMinor wounds

Insect bites or stingsInsect bites or stings

General rules the nurse assistant General rules the nurse assistant should followshould follow

Prepare the residentPrepare the resident

Position the residentPosition the resident

Cleanse the skinCleanse the skin

Protect the surrounding skinProtect the surrounding skin

Applying ointments, lotions, or Applying ointments, lotions, or powderspowders

Chart and report observationsChart and report observations

Admission Of A Resident To The Admission Of A Resident To The Facility-Role of NAFacility-Role of NA

First impression of the facility is First impression of the facility is importantimportant

The new resident may have many The new resident may have many feelings of lossfeelings of loss

Welcome the residentWelcome the resident

Collect baseline informationCollect baseline information

Report all questions and concernsReport all questions and concerns

Admission of a resident to the Admission of a resident to the facility #2-Role of NAfacility #2-Role of NA

Orient the resident and family to the Orient the resident and family to the facilityfacility

Care for personal belongingsCare for personal belongings

Transferring a resident from one Transferring a resident from one area to another in the facilityarea to another in the facility

Tell resident in advance about the Tell resident in advance about the transfertransfer

Collect all the resident’s belongingsCollect all the resident’s belongings

Introduce resident to new roommatesIntroduce resident to new roommates

Discharge of a resident-Role of NADischarge of a resident-Role of NA

Collect all personal belongingsCollect all personal belongings

Assist the resident to his or her Assist the resident to his or her vehiclevehicle