6.02 - Alamance-Burlington School System

6.02 - Alamance-Burlington School System

Unit B Nurse Aide Resident Care Skills Essential Standard NA6.00 Understand nurse aide skills needed to provide for residents nutrition, hydration, elimination, and urination needs. Indicator 6.02 Understand nurse aide skills needed to provide care for residents' elimination and urination needs. Understand NAI skills needed to provide care for residents' elimination and urination needs. 6.02 Nursing Fundamentals 7243

1 6.02 Introduction Elimination is the process of expelling solid wastes made up of the waste products of food that are not absorbed into the cells of the body. Urination is the passage urine from the bladder to the outside of the body. Urine is made up of water and waste products filtered from the blood by the kidneys. 6.02

Nursing Fundamentals 7243 2 6.02 Introduction Residents often require assistance from the nurse aide in caring for elimination and urination needs. Reviews of the body systems involved assist the nurse aide in understand the importance of these excretory functions.

6.02 Nursing Fundamentals 7243 3 There is intentional repeat of some HSII course content in Nursing Fundamentals.

Repeating course content distributes learning over time and increases long term memory. Academic and skill competence must be maintained at a very high level for direct resident care. 6.02 Be GREEN. Recycle

knowledge and build Nursing Fundamentals on 7243 it! 4 Digestive System An excretory system 6.02 Nursing Fundamentals 7243

5 Digestive System AKA gastrointestinal system Extends from mouth to anus Functions Digestion Absorption 6.02 Nursing Fundamentals 7243

6 Digestive System - Structures Mouth Stomach holds food until digestive juices chemically break it down into liquid chyme 6.02 Nursing Fundamentals 7243

7 Digestive System - Structures Intestines small intestine about 20 ft. long food digestion completed and nutrients absorbed into bloodstream 6.02

Nursing Fundamentals 7243 8 Digestive System - Structures Intestines large intestine 6 ft. long absorbs water, mineral salts and vitamins secretes mucus to aid in movement of feces

has ability to add or remove water from feces 6.02 Nursing Fundamentals 7243 9 Digestive System Accessory Organs Liver produces bile for breakdown of fats Gallbladder stores bile produced by liver

Pancreas manufactures insulin and digestive enzymes 6.02 Nursing Fundamentals 7243 10 Digestive System Common Diseases D Ulcer - a lesion or erosion of the lining of the stomach or small intestine D Hepatitis inflammation of the liver

D Cirrhosis chronic disease of liver where scar tissue replaces liver tissue D Cholelithiasis - stones in the gallbladder 6.02 Nursing Fundamentals 7243 11 Digestive System Common Diseases D Pancreatitis inflammation of the pancreas

D Cholecystitis inflammation of the gallbladder D Colitis inflammatory disease of the colon 6.02 Nursing Fundamentals 7243 12 Digestive System Common Diseases D Gastritis inflammation of the

stomach lining D Enteritis inflammation of the intestines D Gastroenteritis - inflammation of the stomach lining and intestines 6.02 Nursing Fundamentals 7243 13 Digestive System Common Diseases

D Cancer - may occur anywhere along digestive tract D Hernia protrusion of organ through wall of cavity where it is normally contained 6.02 Nursing Fundamentals 7243 14 Digestive System Common Diseases D Diverticulosis - chronic disease in

which many diverticula (small blind pouches) form in the lining and wall of the colon D Diverticulitis inflammation of diverticula 6.02 Nursing Fundamentals 7243 15 Digestive System Common Diseases D Diarrhea watery bowel movements D Constipation - difficulty in expelling fecal material; incomplete or

infrequent bowel movements- severe constipation leads to a FECAL IMPACTION D Hemorrhoids - enlarged veins in anal area Care Point 6.02 Nursing Fundamentals 7243 16 Digestive System FECAL IMPACTION 6.02

Nursing Fundamentals 7243 17 Be extra careful when inserting a thermometer, enema tip, or when cleaning the rectal area of a resident with 6.02 Nursing Fundamentals 7243

18 Hemorrhoids 6.02 Nursing Fundamentals 7243 19 Digestive System Changes Due to Aging Loss of teeth and decreased number of taste buds

Decrease in amount of digestive enzymes and saliva production Difficulty chewing and swallowing Altered taste and smell Decreased appetite 6.02 Nursing Fundamentals 7243 20 Digestive System Changes Due to Aging

Slower absorption of nutrients Slowing of peristalsis causing constipation Loss of bowel muscle tone 6.02 Nursing Fundamentals 7243 21 Digestive System Observations O Stool color and consistency O Abdomen flat or distended

O Date/time of last bowel Mmovement O Nausea and/or vomiting 6.02 Nursing Fundamentals 7243 22 R R R R R

6.02 Blood in emesis or stool Complaint of pain in stomach Difficulty swallowing Poor appetite Constipation and/or diarrhea Nursing Fundamentals 7243 23 Digestive System Bowel Retraining Incontinence: Inability

to control defecation Embarrassing for resident Uncomfortable 6.02 Nursing Fundamentals 7243 24 Digestive System Bowel Retraining Information collected: bowel pattern before incontinence present bowel pattern

dietary practices Plan developed to assist to return to normal elimination pattern and Recorded on care plan 6.02 Nursing Fundamentals 7243 25 Digestive System Bowel Retraining Participants in plan

resident family all staff members 6.02 Nursing Fundamentals 7243 26 Bowel Retraining - Guidelines G Enemas may be ordered by physician and given by nurse aide, as directed by supervisor G Regular, specific times to evacuate bowels

established G Fluids encouraged on regular basis 6.02 Nursing Fundamentals 7243 27 Bowel Retraining - Guidelines G High bulk foods given, (if not rrestricted) fruits vegetables

bread bran cereals 6.02 Nursing Fundamentals 7243 28 Bowel Retraining - Guidelines G Bowel aids ordered by physician and administered by licensed nurse only: laxatives suppositories

stool softeners G Regular exercise encouraged 6.02 Nursing Fundamentals 7243 29 C Offer bedpan on set schedule C Assist to bathroom when request is made

C Provide privacy C Display unhurried attitude 6.02 Nursing Fundamentals 7243 30 C Offer warm drink C Be patient C Encourage with positive remarks C Do not scold when accidents happen (this is verbal abuse) C Check on resident frequently

6.02 Nursing Fundamentals 7243 31 Urinary System An excretory system 6.02 Nursing Fundamentals 7243

32 Urinary System - Structure Kidneys: Purplish brown, beanshaped organs Located at back of abdominal cavity Weighs 4-6 ounces each 6.02 Nursing Fundamentals 7243 33

Urinary System - Structure Ureters - tubes that carry urine from kidneys to bladder Urinary bladder - muscular sac that expands to hold urine received from the kidney Urethra - tube extending from bladder to outside of body 6.02 Nursing Fundamentals 7243

34 Urinary System - Functions Filters waste products from blood Produces urine Aids in maintenance of water balance Regulates acid-base balance of body Stores urine until passed from body 6.02 Nursing Fundamentals 7243 35

Urinary System Characteristics of Normal Urine Pale yellow to amber Clear (not cloudy) Acidic / pH 5.0 7.0 Quantity (output) 1000-1500 ml. per day 6.02 Nursing Fundamentals 7243

36 Urinary System Common Disorders Nephritis - inflammation of kidney due to infection Cystitis - inflammation of urinary bladder due to infection Calculi kidney or bladder stones 6.02 Nursing Fundamentals 7243

37 Urinary System Common Disorders Uremia - accumulation of urea in blood due to kidney disease Urethritis inflammation of the urethra 6.02

Nursing Fundamentals 7243 38 Urinary System Common Disorders Kidney failure decreased ability of kidney to filter waste products from the blood Urinary incontinence -inability to control urination 6.02

Nursing Fundamentals 7243 39 Urinary System Common Disorders UTI - Urinary Tract Infection Retention - inability to completely empty the bladder Hematuria - blood in the urine

6.02 Nursing Fundamentals 7243 40 Urinary System Affects of Aging Decreased kidney size Decreased elasticity of ureters, bladder and urethra

Decreased muscle tone Diminished blood flow to kidneys 6.02 Nursing Fundamentals 7243 41 Urinary System Affects of Aging Decreased ability of kidneys to

concentrate urine Difficulty emptying urinary bladder Enlarged prostate in males which presses on urethra 6.02 Nursing Fundamentals 7243 42 Elevated temperature Sugar and/or acetone in urine (NAIIs may check blood sugar via finger stick)

Urine color other than clear, pale yellow 6.02 Nursing Fundamentals 7243 43 Complaint of burning on urination Incontinence Polyuria - excessive amounts of urine per

voiding 6.02 Nursing Fundamentals 7243 44 Hematuria - blood in urine Nocturia excessive urination at night Urine having strong odor or cloudy appearance Voiding small amounts of urine frequently

6.02 Nursing Fundamentals 7243 45 Urinary System Bladder Retraining Plan developed to assist to return to normal voiding pattern Recorded on care plan

Staff must be consistent and follow plan 6.02 Nursing Fundamentals 7243 46 Urinary System Bladder Retraining Individualized plan includes:

schedule that specifies time and amount of fluids to be given schedule for attempting to void 6.02 Nursing Fundamentals 7243 47 Urinary System Bladder Retraining Guidelines

G Get residents cooperation G Record incontinent times G Provide with opportunities to void: when resident awakens one hour before meals every two hours between meals before going to bed during night, as needed 6.02 Nursing Fundamentals 7243 48 Urinary System

Bladder Retraining Guidelines G Provide for comfortable voiding position G Be supportive and sensitive G Provide encouragement G Offer fluids according to schedule 6.02 Nursing Fundamentals 7243 49

Urinary System Bladder Retraining Guidelines G Provide stimuli as needed: run water in sink pour water over perineum offer fluids to drink place hands in warm water 6.02 Nursing Fundamentals 7243

50 Urinary System Bladder Retraining Guidelines G Provide good skin care to prevent skin breakdown G Retraining may take 6-10 weeks be patient be supportive ignore accidents respect residents feelings 6.02

Nursing Fundamentals 7243 51 Urinary System Bladder Retraining Guidelines Follow facility procedure for use of: incontinent pads adult protective pants incontinent briefs

6.02 Nursing Fundamentals 7243 52 Indwelling Catheters Balloons filled with fluid help prevent the catheter from slipping out of the bladder. Pulling on the catheter may damage soft tissue if the inflated balloon is pulled. 6.02

Nursing Fundamentals 7243 53 Hold the catheter securely near the meatus to prevent tugging while cleaning the indwelling catheter. 6.02 Nursing Fundamentals 7243

54 Indwelling Catheters Used to continuously drain urine from bladder Inserted by licensed nurse or NA II after being ordered by physician Attached to tubing that connects to urinary drainage bag 6.02 Nursing Fundamentals 7243

55 Indwelling Catheters When are they ordered? Residents with nerve injury: following spinal cord injury after stroke After surgery Some incontinent residents 6.02 Nursing Fundamentals 7243 56

Indwelling Catheters Increased Risk of Urinary Tract Infections Urinary meatus and surrounding area must be kept clean Catheter care given at least daily and PRN 6.02 Nursing Fundamentals 7243 57

Indwelling Catheters Guidelines maintain-drainage-bag-dependent-position.html nih.gov/ccc/patient_education/pepubs/bladder/foley G Never pull on catheter G Keep catheter tubing and drainage tubing free of kinks, so that urine can flow freely 6.02 Nursing Fundamentals 7243 58

Indwelling Catheters Guidelines G Keep collection bag below bladder G Attach collection bags to bed frame, never to side rail G Never leave on floor G Follow facility policy for securing catheter to residents leg without tension on catheter 6.02 Nursing Fundamentals 7243

59 Indwelling Catheters Guidelines G Never disconnect catheter from tubing to drainage bag G When emptying urinary drainage bag, never touch drain with measuring container or graduate 6.02 Nursing Fundamentals 7243

60 Leakage Complaints of pain Burning Need to urinate 6.02 Nursing Fundamentals 7243 61 Swelling Skin irritation

Discoloration 6.02 Nursing Fundamentals 7243 62 When measuring urinary output note color, odor and appearance of urine. 6.02 Nursing Fundamentals 7243

63 Routine Urine Specimens Collected for laboratory study Aids physician in diagnosis Evaluates effectiveness of treatment Laboratory requisition slip completed and sent to laboratory with each specimen 6.02 Nursing Fundamentals 7243

64 Routine Urine Specimens - Guidelines G Wash hands carefully before and after collection of urine specimens G Wear gloves G Collect specimen at appropriate time G Use proper container and do not touch inside of lid or container 6.02 Nursing Fundamentals 7243

65 Routine Urine Specimens - Guidelines G Label container accurately and transport to laboratory as soon as possible G Tell resident not to have bowel movement or discard tissue in bedpan when collecting urine specimen 6.02 Nursing Fundamentals 7243

66 Other Types of Urine Collections 1. Clean Catch Urine Specimen 2. 24-Hour Urine Collection 3. Straining Urine for Stones 6.02 Nursing Fundamentals 7243 67 Clean Catch Urine Specimen

AKA: Mid-Stream Specimen Cleansing of perineum prior to collection of urine reduces number of microbes that may contaminate specimen 6.02 Nursing Fundamentals 7243 68 Clean Catch Urine Specimen - Procedure

1. Follow standard precautions 2. Assure residents perineum is cleaned prior to collection 3. Instruct resident to begins voiding into appropriate receptacle and stop midstream 4. Place container in urine stream and collect specimen 6.02 Nursing Fundamentals 7243 69

24-Hour Urine Collection All urine voided in 24-hour period collected Urine chilled on ice to prevent growth of microorganisms Some tests may require preservative Urine usually collected in dark colored gallon jug 6.02 Nursing Fundamentals 7243 70

24-Hour Urine Collection Imperative that resident and staff understand procedure and exact time period for urine collection 6.02 Nursing Fundamentals 7243 71

24-Hour Urine Collection - Procedure 1. Follow Standard Precautions 2. Begin test with residents bladder empty 3. Discard first voiding 4. Collect all voidings for next 24 hours 5. Restarted collection with new gallon jug if test is interrupted 6.02 Nursing Fundamentals 7243

72 Straining for Kidney Stones 6.02 Nursing Fundamentals 7243 73 Condom Catheters Description and Use External catheter used for incontinent

men Made of soft rubber sheath that fits over penis with tubing connected to urinary drainage bag Ambulatory residents may prefer leg bags during day New condom catheter is applied daily 6.02 Nursing Fundamentals 7243 74 Observe penis for

reddened or open areas and report to supervisor prior to new condom being application. 6.02 Nursing Fundamentals 7243 75 The Endocrine System Endocrine glands secrete chemicals called hormones

directly into the blood stream. Why discuss it? 6.02 Nursing Fundamentals 7243 76 The Endocrine System Endrocrine System

6.02 affects the function of the Nursing Fundamentals 7243 Urinary System and other body functions 77

Endocrine System - Function Secretes hormones that regulate: growth and development, metabolism and reproduction, and the immune response. 6.02 Nursing Fundamentals 7243 78 Diabetes Mellitus

The most common disorder of the endocrine system. 6.02 Nursing Fundamentals 7243 79 Diabetes Mellitus 80% of diabetics over 40 years of age Incidence increases as

people age 5% of people over age 65 require treatment 6.02 Nursing Fundamentals 7243 80 Diabetes Mellitus USA has highest morbidity and mortality rates Disorder of carbohydrate metabolism with decreased

insulin production from pancreas 6.02 Nursing Fundamentals 7243 81 Diabetes Mellitus Uncontrolled diabetes leads to damage to eyes, kidneys, circulation Diabetes characterized by consistent, elevated blood glucose levels requiring oral medication to stimulate pancreas or insulin injections

6.02 Nursing Fundamentals 7243 82 Diabetes Mellitus L Hypoglycemia W

Low blood sugar 6.02 Nursing Fundamentals 7243 83 lavated Diabetes Mellitus Hyperlycemia

High blood sugar 6.02 Nursing Fundamentals 7243 84 Endocrine System Changes Due to Aging Decrease in thyroid, parathyroid, adrenal and sex hormone secretions Decreased glucose tolerance (Diabetes M) Multiple physical changes due to decrease

of sex hormones 6.02 Nursing Fundamentals 7243 85 Endocrine System Observations O Irritability & restlessness O Nervousness O Confusion O Weight loss O Diaphoresis O Edema

O Excessive thirst O Sweet, fruity odor to breath 6.02 Nursing Fundamentals 7243 86 Endocrine System Observations O Complaint of headache O Drowsiness O Rapid, weak pulse O Low blood pressure O Nausea or vomiting

O Flushed, dry, hot skin O Excessive urination 6.02 Nursing Fundamentals 7243 87 Observations previously listed must be reported to the nurse. 6.02 Nursing Fundamentals 7243

88 Endocrine system & diabetes Have we got it? Lets check and see Student Name A me B a N t n e

d Stu Stick diagnostics 6.02 Nursing Fundamentals 7243 89 END 6.02 Understand nurse aide skills needed to

care for residents' elimination and urination needs. 6.02 Nursing Fundamentals 7243 90

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