Nurse Assisting Skills

1
Nurse Assisting Skills

• Diversified Health Occupations
• Chapter 20
• pg. 617-737

2
Nurse Assisting OBJECTIVES

• Upon completion of this unit, the student should
  be able to
• Admit, transfer, or discharge a patient,
  demonstrating proper care of pts belongings.
• Administer personal hygiene
• Measure and record intake and output
• Assist a patient with eating, feed a patient
• Collect stool specimens
• Ostomy care
• Catheter care

3
ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT

• This may be one of your responsibilities.
• Alleviating anxiety and fear
• Admission can cause anxiety and fear for many pts
  and their families
• Even a transfer from one room to another can
  cause anxiety because the individual will have to
  adjust to another environment
• Essential for health care provider to create a
  positive first impression
• Assistant can do much to alleviate fear by being
  courteous, supportive, and kind.

4
ADMITTING, DISCHARGING, AND TRANSFERRING A PATIENT

• Alleviating anxiety and fear
• Help patient become familiar with the unit
• Provide clear instructions on how to operate
  equipment
• Explain the type of routine to expect, such as
  times for meals
• Do not hurry or rush
• Allow the pt to ask questions and to express
  concerns
• If you do not know the answers to specific
  questions, refer to your immediate supervisor

5
ADMISSION FORMS

• Forms list the procedures that must be performed
• Will vary slightly from facility to facility
• Important for health care worker to become
  familiar with required information on the form
• Much of the information on the admission form is
  used as a basis for the nursing care plan
• Must be complete and accurate!
• It the pt is unable to answer the questions, a
  relative or the person responsible for the pt is
  usually able to provide the information

6
PROCEDURES PERFORMED UPON ADMISSION

• Vital signs
• Height and weight measurements
• Collection of a routine urine specimen
• Protect patients possessions
• Make a list of clothing, valuables, and personal
  items
• In a hospital a family member will frequently
  take clothing home
• Any personal items left in a room should be noted
  on a list, and the list should be signed by the
  pt and the assistant
• At the time of transfer or discharge, the list of
  items is checked to make sure all of the
  belongings are returned
• If the family member does not take items home,
  the items should be placed in a safe
• FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE
  PROCEDURES!!

7
PROCEDURES PERFORMED UPON ADMISSION

• Orient patient to facility
• Provide instructions on how to operate the bed,
  call light, remote control for TV, etc.
• Explain visiting hours, location of lounges,
  smoking regulations, availability of services,
  times for meals, and other rules and regulations
• Many facilities have a pamphlet or paper listing
  this information, which is given to the patient
  and family members.
• FOLLOW CORRECT TECHNIQUE WHILE PERFORMING THESE
  PROCEDURES!!

8
TRANSFERS

• Done for a variety of reasons
• Change in the patients condition
• Per patient request
• Agency policy must be followed during any
  transfer
• Reason for transfer should be explained to
  patient and family by the appropriate personnel
• New room or unit must be ready to receive the
  patient
• All personal items must be moved with patient
• Organized and efficient transfer will help
  prevent fear and anxiety for the patient

9
DISCHARGE

• Doctors order usually required
• If an individual plans to leave a facility
  without permission, report this immediately to
  your supervisor
• Facilities have special policies that must be
  followed when a patient leaves against medical
  advice (AMA)
• When an order for discharge is received,
  assistant must check and pack the patients
  belongings
• Check the unit, including any drawers, closets,
  and storage areas carefully to find all items

10
DISCHARGE

• Most agencies require a staff member to
  accompany the individual to the car
• If a patient is transferred by ambulance, the
  ambulance attendants will bring a stretcher to
  the room
• Most agencies have forms or checklists that are
  used during a discharge to ensure that all
  procedures have been followed.

11
ADMITTING

• Obtain orders
• Prepare the room for the admission
• Greet and identify the patient
• Introduce yourself
• Ask the family to wait in the lounge or lobby
• Close the door and screen the unit
• Ask the patient to change into a gown
• Position the patient comfortably in the bed

12
ADMITTING

• Complete the admission form or checklist
• Measure and record vital signs
• Weigh and measure the patient
• Complete the clothing list and make sure patient
  or family member checks the list
• Obtain a urine specimen, if ordered
• Orient the patient to the facility and explain
  all routines
• Fill the water pitcher if patient is allowed to
  have liquids

13
ADMITTING

• Observe all checkpoints
• Patient is comfortable and in good alignment
• S/R ? x 4
• bed is at lowest position
• Call light and supplies within reach
• Area is neat and clean
• When admission is complete, allow family members
  to return and answer any questions they have
• Record required information on patients chart

14
DISCHARGING

• Obtain orders
• Check with patient to determine when relatives
  will arrive for discharge
• Close the door or screen the room
• Help the patient dress, if needed
• Assemble all the patients personal belongings
• Assemble any equipment that is given to the
  patient, such as the admission kit
• Check to make sure patient has received d/c
  orders and instructions from the nurse or
  physician

15
DISCHARGING

• Obtain the patients valuables if they are in a
  safe
• Complete a d/c checklist
• Place all patients belongings on a cart
• Assist the patient into a w/c
• Transport patient to exit area and help patient
  into the car
• Observe all safety factors while transporting
  patient
• Say good-bye J

16
DISCHARGING

• Return to the unit, strip the bed, remove any
  equipment and follow agency policy for cleaning
  the room
• Record all required information on the patients
  chart

17
WORDS TO THE WISE!!!

• TALK WITH YOUR PATIENTS AT ALL TIMES
• WATCH WHAT YOU SAY!!
• UNCONSCIOUS AND SEMI-CONSCIOUS PATIENTS MAY BE
  ABLE TO HEAR YOU
• ALWAYS BE KIND!!!!!!!!!!

18
Positioning, Turning, Moving, and Transferring
Patients

• ALIGNMENT positioning body parts in relation to
  each other in order to maintain correct body
  posture
• PREVENTS
• Fatigue
• Pressure ulcers (decubitus ulcers)
• Contractures
• FOOT DROP

19
Decubitus Ulcers
STAGE I
STAGE II
STAGE III
STAGE IV
20
PREVENTION

• PROVIDING GOOD SKIN CARE
• PROMPT CLEANING OF URINE AND FECES FROM SKIN
• MASSAGING IN A CIRCULAR MOTION AROUND A REDDENED
  AREA
• FREQUENT TURNING
• POSITIONING TO AVOID PRESSURE ON IRRITATED AREAS
• KEEPING LINEN CLEAN, DRY, AND WRINKLE FREE
• APPLYING PROTECTORS TO BONY PROMINENCES (HEELS
  ELBOWS)
• EGG CRATE, ALTERNATING PRESSURE MATTRESSES OR
  WATER/GEL FILLED MATTRESSES

21
TURNING

• AT LEAST q 2 hr IF PERMITTED BY MD
• PROVIDES EXERCISE FOR MUSCLES
• STIMULATES CIRCULATION
• PREVENTS DECUBITUS ULCERS AND CONTRACTURES
• PROVIDES COMFORT TO PATIENT

22
DANGLING

• FOR PATIENTS WHO HAVE BEEN CONFINED TO THE BED
  FOR A PERIOD OF TIME
• DONE PRIOR TO PATIENT BEING TRANSFERRED FROM THE
  BED
• SITTING WITH THE LEGS HANGING DOWN OVER THE SIDE
  OF THE BED
• PULSE CHECKED AT LEAST 3 TIMES DURING THIS
  PROCEDURE!!!

23
DANGLING

• PULSE CHECKED
• BEFOREused as control, or resting rate
• DURINGimmediately after positioning the patient
  in the dangling position
• AFTERreturning the patient to the supine
  position
• ALSO NOTE RESPIRATIONS, BALANCE, COLOR,
  PERSPIRATION, COLOR, OTHER CHARACTERISTICS
• RETURN PATIENT TO SUPINE POSITION IMMEDIATELY IF
  DANGLING IS NOT TOLERATED!!
• FOLLOW PROPER CHARTING AND NOTIFICATION TO
  SUPERVISOR

24
TRANSFERS

• BED TO WHEELCHAIR OR CHAIR
• WHEELCHAIR OR CHAIR TO BED
• BED TO STRETCHER
• MECHANICAL LIFT
• NEVER TRANSFER WITHOUT PROPER AUTHORIZATION
• OBSERVE PATIENT CLOSELY FOR CHANGES IN PULSE
  RATE, RESPIRATIONS, AND COLOR, DIZZINESS,
  INCREASED PERSPIRATION, OR DISCOMFORT

25
ADMINISTERING PERSONAL HYGIENE

• Usually includes the bath, back care, perineal
  care, oral hygiene, hair care, nail care, and
  shaving when necessary.
• Must be sensitive to the patients needs and
  respect the patients right to privacy while
  personal care is administered.
• Reasons for providing personal hygiene
• Promotes good habits of personal hygiene
• Provides comfort and stimulates circulation
• Provides health care worker an opportunity to
  develop a good and caring relationship with the
  patient

26
BATHS

• Type of bath depends on the patients condition
  and ability to help.
• Complete bed bath (CBB)
• Health assistant bathes all parts of the body
  which includes oral hygiene
• Partial bed bath (PB)
• Health assistant bathes some parts of the body
  and also gathers supplies needed by the patient
• Tub bath or shower
• Assistant helps by providing towels and supplies,
  preparing tub or shower area

27
ORAL HYGIENE

• Refers to the care of the mouth and teeth
• Should be done at least 3 times a day and more
  often if patients condition requires frequent
  oral care
• PURPOSES
• Prevents disease, caries, and halitosis.
• Stimulates appetite and provides comfort
• ROUTINE ORAL HYGIENE
• Refers to regular tooth brushing and flossing
• Patient can often do self care, but assistant can
  help when needed

28
ORAL HYGIENE

• Denture care
• Many patients sensitive about dentures
• Assistant must provide privacy and reassure the
  patient
• Extreme care must be taken while handling
  dentures
• NPO Patients
• Special oral hygiene
• Care provided to unconscious or semiconscious
  patient
• Care must be taken to clean all parts of the
  mouth
• Special supplies may be used for this procedure

29
HAIR CARE

• Important aspect of personal care that is often
  neglected
• Brushing will stimulate circulation to scalp and
  help prevent scalp disease
• Shampooing must be approved by the doctor
• Various types of dry or fluid shampoos are
  available for pts confined to bed
• Special devices are available for use while
  giving a shampoo to a pt confined to bed

30
NAIL CARE

• Should be done as part of daily hygiene and
  patient care
• Often neglected area in personal care of the pt
• Nails harbor dirt and can lead to infection and
  disease
• Never cut the toenails!

31
SHAVING

• Normal daily routine for most men
• Important to provide when pt unable to shave
• Both regular and electric razors may be used
• Correct technique must be used to prevent injury
  to patient
• Females usually appreciate shaving of legs and
  underarms
• BE SURE YOU HAVE SPECIFIC ORDERS FROM DOCTOR OR
  IMMEDIATE SUPERVISOR

32
BED BATHS

• As with any procedureobtain proper
  authorization, assemble equipment, knock,
  introduce yourself, identify the patient, screen
  the unit, eliminate drafts, adjust the
  thermostat, wash hands (you will need gloves for
  part of a complete bed bath), lock wheels on bed,
  elevate bed to proper level
• As you bathe patient, take special care to expose
  ONLY the area of the body you are washing at the
  time
• Keep patient warm and covered

33
BED BATHS

• Lower side rail on side you are working
• Replace top linen with bed blanket
• Provide oral hygiene
• Shave male patient or after face is washed
• Fill basin 2/3 full with warm, not hot water
  (105-110)

34
BED BATHS

• Help patient move to side of bed nearest you
• Remove bedclothes keeping patient covered with
  bath blanket
• Place towel over upper edge of bath blanket
• With washcloth, form mitten around hand, tucking
  in edges (see figure 20-41, page 668)

35
BED BATHS

• Wet washcloth, squeezing out extra water
• Wash patients eyes, starting at inner area,
  moving to outside
• Use different part of cloth for other eye
• Rinse cloth
• Wash face, neck, and ears, using soap on face if
  patient desires
• Rinse and pat dry

36
BED BATHS

• Towel lengthwise under arm on far side
• Hand and nails in basin
• Wash, rinse, and pat arm dry from axilla to hand
• Nail care

37
BED BATHS

• Bath towel over chest
• Fold bath blanket down from under towel
• Wash, rinse, and dry the chest and breasts
• Pay particular attention to area under females
  breasts
• Dry thoroughlyapply lotion as desired

38
BED BATHS

• Turn towel lengthwise to cover chest and abdomen
• Fold bath blanket down to pubic area
• Wash, rinse, and dry abdomen
• Replace bath blanket
• Remove towel

39
BED BATHS

• Fold bath blanket to expose patients far leg
• Place towel lengthwise under leg and foot
• Place foot in basin by flexing the knee
• Wash and rinse leg and foot
• Remove basin
• Dry leg and foot
• Repeat for other leg

40
BED BATHS

• Provide nail care as needed
• NEVER cut toenails
• File straight across
• Apply lotion to feet
• Observe for any color changes or irritated areas
  that may signify problems

41
BED BATHS

• ELEVATE SIDERAIL
• CHANGE WATER IN BASIN
• ALWAYS CHANGE WATER AT THIS TIME
• WATER MAY BE CHANGED AT OTHER TIMES IF IT BECOMES
  TOO COOL, DIRTY, OR SOAPY

42
BED BATHS

• Lower siderail
• Turn patient onto side or prone
• Place towel lengthwise on the bed along patients
  back
• Wash, rinse, dry entire back thoroughly with
  towel
• Observe for changes that may signify problems,
  especially bony areas
• Give backrub

43
BACK RUBS

• RUB SMALL AMOUNT OF LOTION INTO HANDS TO WARM
• A.REPEAT 4 TIMES
• B.REPEAT 4 TIMES
• C.REPEAT 1 TIME
• D. USE FIRST MOTION FOR 3-5 MINUTES
• E. REPEAT FOR 1-2 MINUTES (RELAXATION AFTER
  STIMULATION)

44
BED BATHS

• Turn patient onto back
• Keep patient draped with bath blanket
• If patient can wash perineal area, place basin
  with water, soap, washcloth, towel, and call
  signal within easy reach
• Raise siderail and wait outside for patient to
  complete procedure

45
BED BATHS

• STRAIGHTEN BED LINEN
• CHANGE GOWN AS NEEDED

46
BED BATHS

• If patient cannot wash perineal area
• Put on gloves
• Drape and position the female patient in dorsal
  recumbent position, male patient in horizontal
  recumbent position
• Towel or disposable underpad under patient

47
PERINEAL CARE--FEMALE

• Always wash from front to back (or rectal area)
• Separate the labia, or lips
• Cleanse area thoroughly with front to back motion
• Use clean area of washcloth or rinse cloth
  between each wipe
• Wash rectal area

48
PERINEAL CARE--MALE

• Cleanse the tip of penis using a circular motion
  starting at urinary meatus working outward
• Cleanse penis from top to bottom
• If not circumcised, gently draw the foreskin back
  to wash the area
• After rinsing and drying the area, gently return
  foreskin to normal position
• Wash scrotum and scrotal area
• Turn male patient on his side to wash rectal area

49
BED BATHS

• When perineal area is rinsed, clean, and dry,
  reposition patient on his/her back
• Remove towel or underpad
• Remove gloves
• Wash hands
• Provide clean bedclothes
• Provide hair care
• Make bedoccupied bed

50
BED BATHS

• Observe all checkpoints
• Clean and replace all equipment
• Proper charting procedures

51
TUB BATHS OR SHOWERS

• MAKE SURE THE TIME IS APPROPRIATE FOR A SHOWER OR
  BATH
• TAKE SUPPLIES TO BATH OR SHOWER AREA
• TUBS SHOULD BE CLEANED BEFORE AND AFTER USE
• NON SKID STRIPS OR RUBBER MAT IN TUB OR SHOWER
• FILL TUB ½ FULL OF WARM WATER (105) OR ADJUST
  SHOWER TEMPERATURE

52
TUB BATHS OR SHOWERS

• ASSIST PATIENT WITH ROBE AND SLIPPERS
• ASSIST PATIENT TO TUB/SHOWER AREA USING
  WHEELCHAIR AS NEEDED
• IF NECESSARY, OR IN ACCORDANCE WITH FACILITY
  POLICY, REMAIN WITH PATIENT OR INSTRUCT PATIENT
  ON USE OF EMERGENCY CALL LIGHT

53
TUB BATHS OR SHOWERS

• CHECK ON PATIENT FREQUENTLY
• IF PATIENT SHOWS SIGNS OF WEAKNESS OR DIZZINESS,
  USE CALL BUTTON TO GET HELP
• ASSIST TO WHEELCHAIR/CHAIR FROM SHOWER
• EMPTY TUB
• KEEP PATIENT COVERED WITH TOWEL OR BATH BLANKET
  TO PREVENT CHILLING

54
TUB BATHS OR SHOWERS

• HELP AS NEEDED AFTER TUB OR SHOWER
• HELP WITH CLEAN BED CLOTHES
• ADMINISTER BACK RUB, HAIR, OR NAIL CARE
• OBSERVE ALL CHECKPOINTS BEFORE LEAVING PATIENT

55
TUB BATHS OR SHOWERS

• REPLACE ALL EQUIPMENT AND SUPPLIES
• CLEAN BATH/SHOWER AREA USING GLOVES
• WASH HANDS
• CHART ACCORDING TO POLICY

56
FEEDING A PATIENT

• Good nutrition is an important part of patients
  treatment
• Important to make mealtimes as pleasant as
  possible
• Mealtimes are social times
• Most people prefer to eat with others
• People who eat alone often have poor appetites
  and poor nutrition
• In LTCF, patients are encouraged to eat in the
  dining room and interact socially with others
• If patient is confined to bedimportant to talk
  while serving or feeding

57
FEEDING A PATIENT--Preparation

• Patient should be ready to eat when tray arrives
• Offer bedpan/urinal or assist to bathroom
• Clear room of offensive odors
• Allow patient to wash hands face
• Provide oral hygiene
• Position patient comfortably, in sitting
  position, if able
• Clear overbed table position it for meal tray
• Remove objects such as emesis basin urinal from
  patients view

58
FEEDING A PATIENT

• If patients tray is delayed due to tests, etc.,
  explain this to patient
• Check food tray carefully before serving
• Check patients name, room number, type of diet
• Note anything that seems out of place, such as
• Salt shaker on low salt diet
• Sugar on diabetic diet
• Inform supervisor of any problems
• Never add any food to tray without checking diet
  order

59
FEEDING A PATIENT

• ALWAYS allow patient to feed him/herself if
  possible
• Assist by cutting meat, opening milk cartons,
  buttering bread
• If patient is blind or visually impaired
• Tell patient what food is on plate by comparing
  it to clock face
• Ex Swiss steak at 12 peas and carrots at 4,
  mashed potatoes at 9
• Make sure all utensils are conveniently placed
• Position towel or napkin under the patients chin

60
FEEDING A PATIENT

• Test temperature of hot foods before feeding
  patient
• Place small amount on your wrist (NOT the
  patients!!) to check temperature
• NEVER blow on hot food to cool it!!!!

61
PRINCIPLES OF FEEDING A PATIENT

• Alternate the foods by giving sips of liquids
  between solid foods, but dont mix foods
• Use straws for liquids whenever possible
• Do not use straws if patient has dysphagia or
  difficulty in swallowing
• Straws can force liquids down the throat faster
  and cause choking
• Thick-It solidifies liquids slightly to make
  easier to swallow, but must be ordered by MD or
  dietician

62
FEEDING A PATIENT

• Hold spoon or fork at right angles to patients
  mouth so you are feeding them from the tip
• Place small amounts on the spoon1/3 to ½ full
• Tell the patient what s/he is eating
• Encourage the patient to eat as much as possible

63
FEEDING A PATIENT

• Provide relaxed, unhurried atmosphere
• Allow patient sufficient time to chew food
• Observe how much patient eats
• Keep record of nutritional intake
• If patient does not like a certain food, check
  with supervisor to see if substitutions can be
  made
• Record the intake if patient is on IO

64
FEEDING A PATIENT

• Always be alert to signs of choking while feeding
  a patient
• Make every effort to prevent choking
• Feed small quantities
• Allow patient time to chew and swallow
• Provide liquids to keep the mouth moist and make
  chewing and swallowing easier

65
FEEDING A PATIENT

• If patient has had a stroke, one side of mouth
  might be affected
• As you feed the patient, direct the food to
  unaffected side
• Watch patients throat to check swallowing
• Watch for food that may be lodged in the affected
  side of the mouth
• If patient chokes, be prepared to proved
  abdominal thrusts or Heimlich maneuver

66
FEEDING A PATIENT

• Allow patient to hold bread or help to extent the
  patient is able
• Use towel or napkin to wipe mouth as necessary
• Be alert at all times to signs of dysphagia and
  or choking
• When meal is complete, allow patient to wash
  hands and face and provide oral hygiene
• Note amount of food eaten record IO

67
BEDPANS/URINALS

• ELIMINATION
• TERMINOLOGY
• URINATE, MICTURATE, VOID
• DEFECATE, BOWEL MOVEMENTS (BM)

68
INTAKE AND OUTPUT

• A large part of the body is fluid, so there must
  be a balance between the amount of fluid taken
  into the body and the amount lost from the body
• Fluid balance may be abnormal in certain pts
• Heart or kidney disease
• Loss of fluid through diarrhea, vomiting,
  diarrhea, excessive perspiration, or bleeding
• Swelling or edema occurs when excessive fluid is
  retained

69
INTAKE AND OUTPUT

• Dehydration occurs if excessive fluid is lost
• Edema or dehydration can lead to death if not
  treated
• I and O record used to record all fluids taken in
  and discharged from the body
• Forms vary but most contain separate sections for
  intake and output

70
INTAKE

• Oral
• Tube feeding or enteral feedings
• IV
• Irrigation

71
OUTPUT

• BM
• Emesis
• Urine
• Irrigation

72
INPUT AND OUTPUT

• Records must be accurate
• Care must be taken when adding or totaling the
  columns
• Totals are calculated for 8 hour and 24 hours
  periods
• Careful instruction must be given to patients AND
  their families on IOs

73
Procedure for recording IO

• Use a blue or black pen
• Find the correct time line and column to record
  the information
• Note the number of ccs or mls for standard
  containers such as coffee cup, glass, and other
  containers at the top of the chart
• Recheck all entries for accuracy
• Enter observations about colors, types, solutions
  used, and other information in the remarks column

74
Procedure for recording IO

• After all the information for an 8-hour time
  period is recorded, total each column separately
  to calculate the 8-hour total
• When all 8-hour time periods have been totaled,
  add the three 8-hour totals together for each
  separate column
• On some charts, all 24-hour totals for intake are
  added together for a 24-hour intake total, and
  all 24-hour totals for output are added together
  for a 24-hour output total

75
Procedure for recording IO

• If you make an error
• Draw one line through the error
• Initial, and record the correct information
• Do a final check of the I O
• Make sure all entries are correct
• Make sure comments are noted in comment section
• Make sure all additions are accurate and legible

76
CATHETER CARE

• Provided to keep urinary meatus clean and free of
  secretions
• Helps prevent bladder and kidney infections
• Done AT LEAST once every 8 hours
• Careful observation of urine
• Amount, color, presence of other substances
• Report unusual observations immediately

77
CATHETER CARE

• Obtain proper authorization
• Knock, pause, introduce self, identify patient,
  explain procedure, provide privacy
• Safety points standard precautions
• Female patient in dorsal recumbent position
• Male patient in horizontal recumbent position
• Drape patient to expose only perineal area
• Sterile applicator moistened with antiseptic
  solution or soap and water

78
CATHETER CARE--FEMALE

• Gently separate labia or lips to expose urinary
  meatus
• Wipe from front to back with sterile applicator
• Place used applicator in plastic waste bag
• Use clean, sterile applicator each time, and
  continue to wipe from front to back until area is
  clean

79
CATHETER CARE--MALE

• Gently grasp penis and draw foreskin back
• Use circular motion to clean around meatus
• Use sterile applicator to wipe from meatus down
  the shaft
• Place used applicator in plastic waste bag
• Use clean sterile applicator each time, and
  continue to wipe from meatus down shaft until
  area clean
• After the area is clean, gently return the
  foreskin to its normal position

80
CATHETER CARE

• Use sterile applicator to clean catheter from
  meatus down about 4 inches
• Take care not to pull on catheter
• Place used applicator in plastic waste bag
• Use clean sterile applicator and repeat until
  clean
• Observe area carefully for any signs of
  irritation, abnormal discharges, or crusting

81
CATHETER CARE

• Reposition patient comfortably in correct
  alignment
• Check all points on catheter and urinary drainage
  unit
• Always check patient for safety and comfort
  before leaving
• Record and/or report all required information

82
OSTOMY CARE

• OBJECTIVES
• DEFINE OSTOMY
• DIFFERENTIATE BETWEEN A URETEROSTOMY, ILEOSTOMY,
  COLOSTOMY
• LIST BASIC PRINCIPLES FOR OSTOMY CARE
• IDENTIFY UNIVERSAL PRECAUTIONS OBSERVED DURING
  OSTOMY CARE

83
OSTOMY CARE

• Ostomy
• Surgical procedure in which an opening, called a
  stoma, is created in the abdominal wall
• Allows wastes such as urine or stool (feces) to
  be expelled through the opening
• Most often done due to tumors/cancers in urinary
  bladder or intestine
• Birth defects, ulcerative colitis, bowel
  obstruction, injuries
• Permanent or temporary

84
TYPES OF OSTOMIES

• Ureterostomy
• Opening into one of the ureters
• Ureter is brought to the surface of abdomen to
  drain urine
• Ileostomy
• Opening in ileum (small intestine), with loop
  brought to abdomen
• Entire large intestine is bypassed
• Stool expelledliquid and frequent
• Contains digestive enzymes that irritate skin

85
TYPES OF OSTOMIES

• Colostomy
• Opening into large intestine or colon
• Different kinds of colostomies depending on the
  area of large intestine involved
• Stool expelled through an ascending colostomy is
  usually more liquid
• Transverse or descending colostomy more solid and
  formed
• Sigmoid colostomy is similar to normal stool
• Digestive products have moved through most of the
  intestine
• Water and other substances have been reabsorbed

86
OSTOMY CARE

• Bags or pouches to collect urine or stool
• Held in place by belt or adhesive seal
• Problems include leakage, odor, irritation of
  skin surrounding stoma
• Pouch must be emptied frequently
• Good stoma and skin care essential since these
  areas are irritated by the urine or stool
  drainage
• Skin barriers

87
OSTOMY CARE

• New colostomies are cared for by RNs
• older ostomies may be cared for by trained
  health care assistants
• Know facility policy and legal responsibilities
• Eventual self care of ostomy

88
OSTOMY CARE-Pyschological

• Loss of self worth and dignity
• Patient feels different even though clothes cover
  bag
• Sometimes difficulty maintaining normal sex life
• Anger, anxiety, depression, fear, hopelessness
  (especially with CA diagnosis)
• Allow expression of feelings, verbalize fears
• Understanding
• Support groups

89
OSTOMY CARE--Observations

• Stoma is mucous membrane-no nerve endings
• Bright to dark red with wet appearance
• Rubbing or pressure can cause bleeding
• Report any abnormal appearance
• Blue to black color indicates interference with
  blood supply
• Pale or pink color can indicate low hemoglobin
• Dry or dull appearance signifies dehydration

90
OSTOMY CARE-Observations

• Profuse bleeding, ulceration or cuts, or
  formation of crystals on the stoma indicate
  problems
• Discharge in bag should be observed
• Note amount, color, type (liquid, semi-formed,
  formed)
• REPORT and RECORD anything unusual

91
OSTOMY CARE

• Standard precautions
• Gloves, wash hands often, eye protection
• Discard pouch in biohazard bag
• If bedpan is used, it must be cleaned and
  disinfected
• Any areas contaminated with urine or stool must
  be cleaned with disinfectant

92
OSTOMY CARE

• Obtain proper authorization
• Knock, pause, introduce yourself, identify
  patient, explain the procedure, provide privacy
• Observe all safety points regarding body
  mechanics, siderails, height of bed, and patient
  safety
• Observe standard precautions

93
OSTOMY CARE

• Cover the patient with a bath blanket
• Place bed protector or underpad under the
  patients hips on the side of the stoma
• Fill basin with water (105-110F)
• Place the bedpan and plastic waste bag within
  easy reach and put on gloves

94
OSTOMY CARE

• Open belt and carefully remove ostomy bag
• Be gentle when peeling bag away from stoma
• Note amount, color, and type of drainage in the
  bag
• Place bag in bedpan or biohazard bag (if ostomy
  bag is disposable)

95
OSTOMY CARE

• If bag is reusable
• Drain the fecal material (or urine) by placing
  the clamp end of the bag over a bedpan
• Release the clamp and allow the fecal material to
  empty into the bedpan
• Wash the inside of the bag with soap and water
  and allow it to dry before reapplying the bag
• Most people use a second bag while the first is
  drying
• Use toilet tissue to gently wipe around the stoma
  to remove feces or drainage

96
OSTOMY CARE

• Look at the stoma and surrounding skin carefully
• Check for irritated areas, bleeding, edema or
  swelling, or discharge
• Report unusual observations
• Wash ostomy area gently with soap and water,
  using a circular motion, working from the stoma
  outward
• Rinse entire area well to remove any soapy
  residue and dry the area gently
• Use measuring chart to determine the correct size
  barrier wafer

97
OSTOMY CARE

• If the wafer is not self-adhesive
• Apply adhesive stoma paste to the skin around the
  stoma
• Allow paste to dry if necessary
• Peel the paper backing from the wafer
• Position the wafer, adhesive side down, over the
  adhesive paste
• Position the belt around the patient

98
OSTOMY CARE

• Place a clean ostomy bag in place over the wafer
  and seal bag tightly to wafer to prevent leakage
• If the pouch has a drainage area, make sure the
  clip or clamp is secure
• Remove underpad
• Reposition patient comfortably in correct
  alignment
• Check patient for comfort and safety before
  leaving
• Observe standard precautions while discarding the
  used ostomy bag, drainage, and other contaminated
  equipment
• REPORT AND RECORD

99
URINE SPECIMENS

• SPECIMEN USUALLY COLLECTED FROM FIRST URINE
  VOIDED IN AM
• URINE IS MORE CONCENTRATED
• MORE SHOW MORE ABNORMALITIES
• USUALLY HAS ACID pH, WHICH HELPS PRESERVED CELL
  PRESENT
• IF TEST FOR GLUCOSE AND ACETONE, SPECIMEN MUST BE
  FRESH AND COLLECTED JUST BEFORE TESTING

100
URINE SPECIMENS

• MAY BE COLLECTED IN BEDPAN/URINAL OR SPECIAL
  URINE COLLECTOR AND POURED INTO SPECIMEN
  CONTAINER
• MAY VOID DIRECTLY INTO CONTAINER
• USUALLY 120cc SUFFICIENT FOR TESTING
• PLACE IN BIOHAZARD BAG TO SEND TO LAB
• REFRIGERATE UNTIL TESTING

101
URINE SPECIMENS

• CLEAN CATCH OR MIDSTREAM
• SPECIAL METHOD OF OBTAINING URINE SPECIMEN FREE
  FROM CONTAMINATION
• STERILE URINE SPECIMEN
• CATHETERIZATION REQUIRED

102
URINE SPECIMENS

• 24 HOUR SPECIMEN
• USED FOR KIDNEY FUNCTION FOR COMPONENTS SUCH AS
  PROTEIN, CREATININE, UROBILINOGEN, HORMONES,
  CALCIUM
• PT VOIDS, URINE DISCARDED-TIME NOTED BEGINNING 24
  HOUR PERIOD
• ALL URINE VOIDED IN NEXT 24 HOURS SAVED
• LAST URINE VOIDED AT END OF 24 HOUR PERIOD SAVED
  FOR FINAL COLLECTION

103
STOOL SPECIMENS

• Specimen of feces or stool examined by lab
  personnel
• Usually done for ova and parasites (OP)eggs and
  worms!!
• Specimen must be kept warm at body temperature
• Should be tested within 30 minutes for accurate
  results
• Can be examined for presence of fats,
  microorganisms, and other abnormal substances or
  OCCULT BLOOD
• Special stool specimen container

104
STOOL SPECIMENS-Hemoccult

• Blood from intestinal tract in stooloccult
  (hidden) blood
• Test requires very small amount of stool
• Special card with chemical
• Uses developing solution
• Color change indicates positive resultspresence
  of blood
• No requirements for immediate testing or special
  temperature

105
PRACTICE CHECK OFF

• PCA REQUIREMENTS!!!