Nursing Assistant

Resident Care Procedures

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

Sputum collection

Early a.m. best Allow 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

Sputum collection (cont)

Observations
Color Odor Consistency Blood

Document
Specimen obtained Where you took it

Need 1 2 Tbsp

Urine Specimens
Can be sent to lab or tested on unit Methods

Clean catch midstream Catheter Routine 24 hour urine

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

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

Observations about urine collection

Difficulty obtaining specimen Color Clarity Odor Complaints of discomfort &/or urgency

Stool specimen

Test for
Blood Fat Microorganisms Worms or parasites Any abnormal contents

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 to designated area

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

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

Types of enemas
Tap water Soap suds Saline Oil retention

Need to hold for 20 minutes

Commercial Fleets

Rules for giving enemas

Nursing assistants ARE allowed to give if supervised by licensed nurse Temperature of solution 105 degrees Amount if 500 1000 cc for adults Position left 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

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 using gloved hand & index finger Instruct resident to hold suppository as long as possible (15 20 minutes) Observe results & report

Maintaining fluid balance

After 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 to maintain health

Edema fluid intake>fluid output, tissues swell Dehydration fluid intake< fluid output, tissues shrink

Need about 2000 ml of fluid/day.

Residents depend of nursing staff for fluid needs

Force fluids

Have resident drink increased amounts of fluids

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 cannot feed themselves

Restrict fluids
Physicians order to limit fluids to a specific amount 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 limiting fluids

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

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

Output

All liquid output

Urine Emesis Liquid stools Suctions Drains Blood loss

Plastic urinals & emesis basins may be calibrated Use Standard Precautions

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

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 stomach to feed resident

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 resident lie on it) Check if suction working properly If allowed, permit resident to suck on ice chips, throat lozenges, or hard candy to keep throat moist (USUALLY NPO) During feedings, HOB 45 degrees during feeding & 30-60 min after, then at 30 degrees

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 & group activities

NG tubes Observations to report & record

NVD Discomfort Distended abd Coughing C/o indigestion, heartburn Fever Respiratory distress Tachycardia Flatulence

Gastrostomy tubes nursing 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 prevent reflux Remove drsg, clean & dry area, replace drsg Report unusual conditions
Same as NG tube Redness, swelling, drainage, odor, pain at site

Gastrostomy tube mental 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 & group activities

Intravenous therapy

Provides body with needed elements that cant be given as rapidly or efficiently by other means
Blood Plasma Nutritional requirements
Water Salt Sugar

Meds

Rate of flow often controlled by infusion pump

Nursing care for IV

Keep tubing free of twists or kinks Observe for infiltration

Catheter has come out of vein & IV fluid leaks into tissue, causes swelling REPORT immediately to licensed nurse
Painful Infections Meds that can damage integument

Check restraints to be sure they do not block vein

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

Nursing responsibilities (CONT)

Ambulation
Provide a portable IV stand Assist OOB Observe closely for weakness Support IV arm to ensure continuous flow, may need 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 other hand free to keep balance

Use of bandages & binders

Apply pressure (Compression) to stop bleeding, 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

NA role in use of dressings

Ordered by physician & initially applied by licensed nurse Your role

Apply 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

Materials used for dressings & bandages

Dressings
Usually gauze 2, 3, or 4 inch squares Size depends on area of body & purpose of dressing

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

Principles of bandaging

Apply bandage so pressure is evenly distributed to area

Support joint in comfortable position with slight flexion Attach bandage securely to avoid friction & rubbing of underlying tissue which could cause irritation

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

Observations related to dressings

Report if
Swelling Pain Change in color Decrease or increase in temperature Drainage color, consistency, amount Odor

Elastic bandages
Remove every 8 hours unless ordered more frequently to check underlying skin Replace moist or soiled bandage Reapply loose or wrinkle bandage

Anti-embolic hose (TEDS)

Used to increase circulation by improving venous return from legs to heart Remember

Always apply before resident gets OOB Check for wrinkles Check skin color & temperature Check popliteal pulse

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 open lesions

CAN provide care for these problems

Foot care Dandruff Dry skin

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 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

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

Observations about OTC products

Note skin appearance & describe changes Identify signs of irritation

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

Admission

Welcome resident
Greet them by name Introduce yourself Explain what you will be doing Convey warm welcome through tone of voice & facial expression

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

Admission
Report all questions & concerns to licensed nurse Orient resident & family to facility

Review facility routine Introduce resident to roommate & staff Tour facility Explain operation of bed controls, TV controls & call light

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

Transfers

Tell resident about transfer & reason for moving Collect all belongings & take them to new room
Be careful not to lose anything Check all drawers & closets for personal items

Introduce resident to new roommates

New surrounding may cause confusion, orient resident to new room Continue to remind resident of new room

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

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 of transportation