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					AH 180 -- Module 9




      Resident Care Procedures
            Terminology
   Admission
   Anti-
   Anti-embolic stockings
   Bandage
   Binders
   Clean catch
   Closed bed
   Defecate
   Discharge




           Terminology #2
   Drawsheet
   Edematous
   Elastic bandage
   Electric bed
   Evacuation
   Excoriated
   Expectorate
   Fan fold




             Terminology #3
    Fluid
   Gastrostomy
   Gatch
   Hives
   Intake
   Integumentary system
   Intravenous
   Lesions




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AH 180 -- Module 9




            Terminology #4
   Manual bed
   Mitered corner
   Mucus
   Nasogastric
   Non-
   Non-prescription
   Occupied bed
   Ointment
   Open Bed




            Terminology #5
   Output
   Pruritus
   Reverse Trendlenberg
   Scaling
   Semi- Fowler’
   Semi-Fowler’s position
   Side rails
   Specimen




           Terminology #6

   Suppository
   T.E.D. hose
   Transfer
   Trendlenberg
   Unoccupied bed




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AH 180 -- Module 9




   Collecting sputum specimens
   Reason for study sputum

   Blood
   Microorganisms
   Abnormal cells




   Collecting sputum specimens –
             Role of NA
   Usually coughed up in early AM
   Allow resident to rinse mouth with
   water
   Do not use mouthwash
   May be embarrassing to the resident
   Specimen may be perceived as
   unpleasant




     Collecting urine specimens –
         Methods of collection
   Mid-
   Mid-stream

   Clean catheter urine specimen

   24-
   24-hour urine specimen

   Fresh-
   Fresh-fractional urine (second void)




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AH 180 -- Module 9




     Collecting urine specimens –
              Role of NA
   Wash hands before and after

   Use Standard Precautions

   Use correct and clean container

   Label the container accurately




     Collecting urine specimens –
             Role of NA #2
   Do not touch inside the container

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

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

   Document that specimen was obtained




     Collecting stool specimens –
               Purpose
   Blood

   Fat

   Micro-
   Micro-organisms

   Worms

   Any abnormal contents




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AH 180 -- Module 9




     Collecting stool specimens –
              Role of NA
   Maintain privacy
   Use Standard Precautions
   Give clear instruction
   Label container accurately
   Clarify if specimen must be kept
   warm or at room temperature
   Take specimen and requisition slip to
                       pick-
   the designated lab pick-up station




      Bed making - Role of NA
                 wrinkle-
   Linen must be wrinkle-free

   Keep call bell clipped to linen

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




    Bed making - Role of NA #2
   Wash hands before and after
   Hold and carry linen away from
   uniform
   Do not shake linens
   Keep linens off the floor or bedside
   table
   Soiled linen hampers kept covered




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AH 180 -- Module 9




    Hospital Bed – Functions and
              structures
   Manually operated beds

   Electric beds

   Side rails




                Bed Positions
   High positions

   Low positions

   Fowler’
   Fowler’s position

   Semi- Fowler’
   Semi-Fowler’s position




  Bed making – Body Mechanics

   Know your limitations
   Get close to sides of bed
   Keep back straight and knees bent
   Keep feet apart
   Move feet to turn
   Face in the direction you are working




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AH 180 -- Module 9




      Maintaining Environment –
             Role of NA

   Rooms should be comfortable

   Rooms should be safe




      Maintaining Environment –
            Role of NA #2
   Make sure resident can reach
   bedside stand
   Arrange personal belongings as per
   resident’
   resident’s preference
   Keep call bell within reach
   Make sure resident can reach equip.
   Provide tissues and toilet paper




         Enemas - Purpose

   Stimulate a bowel movement

   Cleanse bowel prior to surgery

   Remove flatus (gas)




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AH 180 -- Module 9




           Enemas - Types

   Cleansing enemas

   Oil retention enemas

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




        Enemas – Role of NA

   Temperature of solution
   Amount of solution
   Resident position
   Height of enema bag
   Depth of tube insertion




      Enemas – Role of NA #2

   Administer solution slowly
   Hold enema tube in place
   Make sure toilet facility is nearby and
   available
   Observe the results of the enema
   Use Standard Precautions




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AH 180 -- Module 9




              Rectal Tube
   Inserted into rectum to relieve
   flatulence and intestinal distention

   Equipment:
   Tube and flatus bag or folded
   waterproof pad

   Method: See book




       Suppository - Purpose

   Stimulate one to empty the bowel

   Lubricate the stool to ease
   evacuation




     Suppository – Role of NA
   Identify the resident
   Remove wrapper from suppository
   Place suppository
   Instruct resident to hold the
   suppository in the rectum as long as
   possible
   Observe results
   Report results




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AH 180 -- Module 9




        Gastrointestinal tubes

   Nasogastric tubes ( inserted through
   nose )

   Gastrostomy tubes ( inserted
   through abdominal wall )




        Gastrointestinal tubes –
             Nursing Care
   Frequent oral hygiene
   Securing tubing with clamp or tape
   to clothing
   Tubing free of kinks
   Checking if suction machine
   operating satisfactorily
   Position head of bed elevated at all
   times to prevent reflux




        Gastrointestinal tubes –
           Nursing Care #2
   Keep environment clean
   Answer call lights promptly
   Give emotional support
   Giving an extra back rub
   Straightening or changing bed linen
   Asking resident to express concerns
   Encourage resident to be up, dress in
   day clothes and join in activities




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AH 180 -- Module 9




     Intravenous (I.V.) Therapy
   Provides the body with needed
   elements that cannot be given
   rapidly or efficiently by other means.

   Blood, plasma
   Nutritional – water, salt, sugar, etc.
   Medications




     Intravenous (I.V.) Therapy –
             Role of NA
   Keep tubing free of kinks
   Observe tube and condition of
   injection site for any infiltration
   Wash gently around the area
   Assist resident with ADLs
   Assist resident to ambulate




  Maintaining fluid body balance
   Death can result from taking
   inadequate fluids or loosing too much
   fluids
   Amount of fluid taken in and amount
   lost must be equal
   Edema
   Dehydration
   An adult needs 2000 ml of fluids/day




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AH 180 -- Module 9




              Force fluids
   Resident drink an increased amount
   of fluids
   May order specific amount of fluid for
   24-
   24-hour period
   Maintains fluid balance
   May be for general or specific
   amount of fluid




     Nurse assistant responsibility

   Keep record of amount taken in
   Provide variety of fluids
                 resident’
   Place within resident’s reach
   Offer fluids frequently to residents
   who cannot feed themselves




             Restrict fluids
   Sign posted above bed
   Water is offered in small amounts
   Keep accurate intake and output
   record
   Provide resident with frequent oral
   hygiene
   Explain to resident and family the
   reason for limiting fluid




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AH 180 -- Module 9




      Nothing by mouth (NPO)
   Reasons-
   Reasons-before and after surgery,
                                x-
   before certain lab tests and x-rays,
   and in the treatment of some
   illnesses




  Nurse assistant responsibilities
   NPO sign above bed

   Remove water pitcher and glass

   Offer frequent oral hygiene; no
   swallowing of any fluid




         “Intake and Output”
   The doctor or nurse may want to
                   resident’
   keep track of a resident’s fluid intake
   and output

   To evaluate fluid balance and kidney
   function, or medical treatment




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AH 180 -- Module 9




    Measuring the amount of fluid
      taken in by the resident
                      resident’
   Measurement of resident’s intake is
   done in milliliters (ml) or cubic
   centimeters (cc)
   Determine the fluid capacity
   A conversion table is on the intake
   and output record used to chart
   intake
   A graduated cylinder is used to
   measure fluid




    Measuring the amount of fluids
      excreted by the resident
                    resident’
   Measurement of resident’s output is
   also done in ml or cc

   Plastic urinals and emesis basins
   may be calibrated

   Use universal precautions when
   measuring output




    Recording intake and output
   Document amounts when fluid is
   taken or excreted
   Amounts are totaled at end of shift
                      patient’
   and entered in the patient’s record
   Other special forms may be required
   by facility
   Report any unusual occurences




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AH 180 -- Module 9




  Reasons for using bandages and
              binders
   To apply pressure
   To provide for immobilization
   To hold dressings in place
   To protect open wounds from
   contaminants
   To apply warmth
   To provide support and aid in venous
   circulation




   Materials used for dressings and
              bandages
   Gauze

   Bandages

   Binders




       Principles of bandaging
   Apply bandage so pressure is evenly
   distributed to area
   Support joint in a comfortable
   position with a slight flexion
   Attach bandage securely to avoid
   friction of underlying tissue




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AH 180 -- Module 9




     Observations that should be
              reported
   Swelling

   Pain

   Change in color

   Decreased temperature




     Use and method of applying
    antiembolic hose (T.E.D. hose)
   Anti-
   Anti-embolic hose/stockings are used
   to increase circulation by improving
   venous return from the legs to the
   heart




 Things to remember when applying
          elastic stockings
   Always apply before resident gets
   out of bed
   Check frequently for wrinkles
   Check circulation in feet frequently
   Check popliteal pulse




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AH 180 -- Module 9




       Integumentary System
   Largest organ of the body

   Forms water proof, protective
   covering for the body

   Helps regulate the body temperature




         Anatomy of the skin
   Epidermis

   Dermis




   Symptoms associated with skin
            disease
   Pruritus
   Swelling (edema)
   Scaling
   Lesions
   Hives




                                         17
AH 180 -- Module 9




                non-
      Applying non-prescription
    ointments, lotions, or powders
   Provide emotional support to the
   resident

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




 Skin conditions the nurse assistant
             can care for
   Foot care

   Dandruff

   Dry skin




  Report the existing skin conditions
         to a licensed nurse
   Acne
   Minor burn
   Diaper rash or prickly heat
   Eczema or psoriasis
   Poison ivy or poison oak
   Minor wounds
   Insect bites or stings




                                           18
AH 180 -- Module 9




  General rules the nurse assistant
            should follow
   Prepare the resident
   Position the resident
   Cleanse the skin
   Protect the surrounding skin
   Applying ointments, lotions, or
   powders
   Chart and report observations




   Admission Of A Resident To The
         Facility-
         Facility-Role of NA
   First impression of the facility is
   important
   The new resident may have many
   feelings of loss
   Welcome the resident
   Collect baseline information
   Report all questions and concerns




    Admission of a resident to the
                #2-
       facility #2-Role of NA
   Orient the resident and family to the
   facility

   Care for personal belongings




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AH 180 -- Module 9




   Transferring a resident from one
     area to another in the facility
   Tell resident in advance about the
   transfer
                   resident’
   Collect all the resident’s belongings
   Introduce resident to new
   roommates




                resident-
 Discharge of a resident-Role of NA
   Collect all personal belongings

   Assist the resident to his or her
   vehicle




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AH 180 -- Module 9




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AH 180 -- Module 9




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