CPCT #2

What is an ostomy?

A surgically created opening from intestines to the outside of body where the contents will drain into an ostomy bag.

What determines the consistency of stool in an ostomy?

The location of the ostomy.

If the ostomy is closer to the rectum, how will the stool be?

More solid.

What type of stool comes from an ileostomy (small intestine)?

Liquid stool.

What type of stool comes from a colostomy (large intestine)?

More solid stool.

Can an ostomy be temporary or permanent?

It can be either, depending on the condition.

What are some conditions that may require an ostomy?

Cancer, trauma, inflammatory bowel disease.

what can a PCT do in an ostomy?

empty the puch, cleanse the ostomy and the surrounding skin, and reapplying the appliance.

what are the three main types of ostomy pouch systems?

one-piece, two-piece and two-piece adhesive system

in a one-piece ostomy system, what is connected?

the skin barrier (wafer) and pouch are combined into one piece

in a two-piece ostomy system, what stays on the skin?

the wafer (skin barrier) stays on the skin while the bag can be removed and replaced

how is a two-piece adhesive system different from a standard two-piece system?

instead of snapping together with a flange, it uses adhesive to attach the pouch to the wafer

if the wafer is not precut, what must you do?

cut the hole yourself to fit the stoma

when cutting a hole in the wafer for the stoma, how much larger should it be?

1/16 inch larger in circumference than the stoma

when is it time to empty an ostomy bag?

when it is half-full and you should ALWAYS WEAR GLOVES

what is the purpose of a bed protector during ostomy care?

to catch spills while emptying the ostomy bag

what is the first step when emptying an ostomy bag?

detach the clamp and empty contents into the container used by your unit.

what part of the puch should be wiped during emptying?

the lower 2 inches of the puch

how should you handle the pouch after wiping?

turn it up like a cuff and then apply the clamb back to the pouch

what is the final step in ostomy care?

discard stool in the toilet and clean the container

what do you report to the RN in an octomy?

changes in stool, changes in the appearence of the stoma (if it looks blue or pale or if it is separating from the body) or skin breakdown around stoma. Also document all care and findings either normal or abnormal.

what is non-weight bearing?

the patient’s affected leg cannot touch the floor

what is touch-down weight-bearing?

affected leg can only touch the floor for balance

what is partial weight-bearing?

affected leg can only bear part of their weight

what is weight-bearing as tolerated

stand or walk on the affected leg, bearing the total weight is tolerated

what is full weight-bearing?

able to bear full weight on the affected leg

what should you determine first before assiting a patient with ambulation?

whether they need a 1- or 2- person assist

when should a second aide be used for ambulation?

if the patient has had narcotics/sedatives, or of they are weak (to prevent falls).

what assistive devices are commonly used for ambulation?

walkers, crutches, and canes

what must be done before using an assistive device?

inspect the equipment to ensure it functions properly

can assistive device be shared between patients?

no, assistive devices are not shared between patients

what are the guidelines when helping a patient go from sitting to standing?

1. allow patient to sit on the side of the bed (allowing time for dizziness to pass)

2. place gait belt on the patient while they are sitting on the side of the bed

3. have the patient lean forward and push off the bed with their hands while the PCT lifts on the gait belt with palms up

4. when they stand reevaluate steadiness/dizziness and grab assistive device

when PCT is lifting the patient with the gait belt, what needs do be done?

be very clear on instructions before performing task, verify understading and dont let the patient pull on clothing or body to prevet injurying PCT.

when ambulating a patient where should you stand?

slightly behind them on their weak side

what safety measures should you take when ambulating a patient?

PCT should keep head up and remain facing forward to prevent losing balance and have a chair nearby to use in case the patient gets tired.

when should you call the nurse when ambulating a patient?

SOB (shortness of breath), CP (chest pain), sudden headache, new pain with ambulation, patient refuses to ambulate, change in condition due to strength and ability and if the patient begins to fall ease them down by their waist as they slide down their leg safely onto the floor (call the nurse to assess the situation).

what steps should you take when transferring a weight-bearing patient from their bed to wheelchair?

Place chair on strong side of patient at a 45 degree angle. Lock the wheels. Bed is in lowest position and HOB is raised.Guide patient’s shoulders while they swing their legs to the side of the bed (make sure that they are wearing proper footwear non-skid socks). Put a gait belt on patient. Stand infront of patient, knees bent, feet on each side of patients. Patient’s hand on each side of their thighs.PCT hands on gait belt w/ palms up. Count of 3 have patient push up on bed and PCT straighten knees to help patient stand. Guide patient to wheelchair and down. Place blanket over their knees.

what are the two tools use for transferring non-weight bearing patient?

transfer board and mechanical lift

what steps should be taken when using a transfer board?

Transfer board require a three person assit. Roll patient into their side. Place transfer board under the draw sheet. Ensure both surfaces are level and locked. Should form a bridge between the two surfaces. Be aware of IVs, catheter, patient’s arms crossed. On the count of 3 slide the patient to new surface in 1 swift motion and remove tranfer board and ensure comfort.

what steps should be taking when using mechanical lift when transfering a patient?

Explain the procedure to the patient. Lock wheels of the lift and surfaces. Place sling under the patient and connect to the sling to the lift. Check all connections are secure. Lift patient only high enough to ensure a safe transfer. Once patient is over the desired location lower the patient. Talk to the patient throughout the procedure and ensure their safety.

what are immobility splints?

stabilize extremities after surgery or injury to minimize pain and further damage.

what are some universal tips for immobility splints?

apply to the distal part of the extremity to the proximal part. Remove jewelry prior to splint placement. Check for circulation, movement, sensation beyond the splint. Compare the affected limb to the normal limb (color and temperature).

what should a PCT notify the nurse in a immobility splint?

changes in color and temperature, increase in pain, decrease in movement or tingling

what are some steps that you should take when doing skin care?

reposition patient every 2 hours minimum. Use assistive devices and special beds to limit chances of pressure ulcers. Protect against skin shearing (sliding of skin layers against each other). Clean and dry and no contact with grit/crumbs. Clean incontinent patients promptly and use a non-medicated moisture barrier to prevent sores from moisture. Don’t leave patients on bedpands or commode, move every 2 hours, ambulate every 2 hours. Pillow under knees (supine) to relieve pressure on heels.

in what areas should you look for skin breakdown?

look for breakdown on bony prominences (sacrum, heels, elbow, hips, and back of the head) and in the perineal area.

what is the fowler’s position?

lying on the back with the head of the bed elevated to various degrees (no more than 30 degrees to prevent pressure ulcers).

what is the sims’ position?

lying on one side with the knee on that side flexed abd in front of the other leg with the knee extended.

what is stage 1 of skin breakdown?

redness that does not blanch (return to the skin’s usual color) when you apply pressure with a finger.

what is stage 2 of skin breakdown?

blister with a surface that peel or cracks

what is stage 3 of skin breakdown?

lost the skin layers and fat and tissue is visible

what is stage 4 of skin breakdown?

crater with damage all the way through to the muscle and bone

when is skin breakdown considered unstageable?

when crater is full of dead tissue

when is the supine position used?

when resting or sleeping

when is prone position used?

when taking pressure off the spine and hips

when is the lateral position used?

when resting, sleeping, or taking prossure off of the spine

when is the fowler’s positon used?

when resting, reading, receiving care, eating, and watching televison

when is the sims’s position used?

when relieving pressure on the hips and tailbone, having some care procedures (enema).

compression devices (SCD, Sequential Compression Devices)

prevent blood clots from forming in the lower legs. Sleeves are applied around the lower legs and attach to an air compressor, the sleeves inflate and deflate. When applying leave 2 finger of room and check the device every 8 hours for skin breakdown.

Anti-embolism stocking / compression hose

Prevent deep vein thrombosis and fluid build up in the legs. Thromboembolic deterrent hose (TED hose) are elastic with an opening at the top of the toes to check circulation. Whrn applying stockings make sure they are smooth, w/o wrinkles, or twisting and do not fold the stockings down.

TCDB (Turn, Cough, Deep, Breathing)

TCDB helps prevent respiratory complications. Steps: Turn often from side to side, reposition frequently. Cough and deep breath every 1-2 hours while awake (splint incisions with a pillow if coughing is painful.

Incentive spirometry

Used to help patients deep breathe. Tell patient to exhale normally, patient will inhale through the device trying to raise the ball as high as possible, hold breath for 3 seconds after inhaling and then exhale, repeat cycle per prescribed amount or every 1-2 hours while awake.

what are some information that you should walways report?

1. patient condition

2. bodily functions

3. edema

4. pain scale

5. wound infection

6. patient specimens

7. critical values

8. vital signs

patient condition

report any changes to the nurse. Experience will help to discern what changes are urgent and which changes can wait shortly. ABC - airway, breathing, circulation are URGENT.

bodily function I/O

measure intake of fluids and output in milliters (measurable intake: anything that becomes liquid at room temperature, drinks, IV fluids, ice chips and enter formulas received. Measurable output: urine, emesis, diarrhea, and collection of fluids and drainage (suction catheters, chest tube drainage, wound drainage reservoirs, ileostomy pouches)). Instruct patient not to empty or have visitors empty the urinal, inform PCT of food/drink that was not provided by the staff. Document percentage of food eaten. Document I&O. Document amount, color, and consistency of stool (No BM in past 3 days = report to urse).

Edema

Accumulation of fluid in body part(s), area, system. Recognize and report to a nurse (swelling, shiny and tight). Pitting edema means you can see an indentation if you press to the edematous area with your finger.

pain scale

numeric scale from 0-10. If patient cannot report then we look at their emotions/faces. Subjective but pain is what the patients says it is and should be treated. Take into consideration cultural displays of pain, spiritual beliefs of pain, etc. Watch for non-verbal signs of pain. Acute pain can cause changes in vital signs (increase RR, HR, BP) but sometimes acute pain won’t change vital signs or the change will be temporary and the vital signs return to baseline.

wound infection

be alert to indications that an infection is developing in a wound and report those findings to the nurse immediately. S/S of infection: redness swelling fever, increase in pain and discomfort, warmth around the wound, fould odor, drainage. Some drainage may be expected but purulent (pus) drainage is clear sign of infections. Report signs that a wound needs to be redressed: moisture or drainage seeping through the bandage, looseness of dressing, nonadherence of adhesive. DO NOT PULL TUBES FROM A WOUND DRAIN. Make sure any ties are secure and report loosening of ties, drainage or changes to the dressing to the nurse.

patient specimens

report in stool: diarrhea, hard pebble-like stool (constipation), no stool in 3x days, unudual quantity/frequency of stool, blood in stool, tarry-looking stool, visible pus or fat in stool, and unusual objects or substances

patient specimens 2

report in sputum: yellow or green sputum.mucus, red or brown or has red or brown particles, and unusual particles such as food or beverages that may have been aspirated

patient specimens 3

report urine: unusual or unexplained color, blood, unusual or unexplained odor, unusual volumes and frequency, unusual concentrated urine, unusually dilute urine and no urine or scant amounts

patient speciments 4

report in emesis (vomit): report immediately if patient vomits, save emesis if possible, blood, coffee ground material (partially digested blood) and emesis that contains any objects or substances that do not look life food.

clitical values

PCT can NOT interpret but must recognize and report, Will see critical values in point of care testing (glucose most commonly). Make sure to perform quality control steps ir calibration methods for accurate readings.

what are the critical glucose values for females?

less then 40mg/dL or greater than 450 mg/dL

what are the critical glucose values for males?

less then 50mg/dL or greater than 450 mg/dL

what is the expected random blood glucose level (any time, all ages)?

less than 200 mg/dL

what are the 5 rights of delegation

1. right task: can it ve delagated?

2. right circumstance: should it be delagated?

3. right person: do i have any reason to hesitate?

4. right supervision: will the nurse be available to answer any questions that arise and make sure I am performing the task safely?

5. right direction: do I understand what the nurse expects of me?

Maslow’s hierarchy of needs

level 1: physiological needs, level 2: safety and security needs, level 3: belongingness and love needs, level 4: self esteem, level 5: self actualization

hospice care

For patients with a terminal illness (estimated 6 months or less to live). Goals: comfort, keeping patients and families involved in care, providing support to family caregivers, and encouraging best possible life under the circumstances. COMFORT CAREnot looking to cure! Can take place in patient’s home, hospital, or long term care facility

Coping mechanism

Patients and families facing grief and loss display a wide range of coping mechanisms:
- Apathy
- Compensation
- Conversion
- Denial
- Displacement
- Intellectulization
- Physical avoidance
- Projection
- Rationalization
- Repression
- Sarcasm
- Verbal aggression

Kubler-Ross stage of grief

1. Denial

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Post-mortem care

Guiding principle: treat body with utmost respect and sensitivity with thoughtful consideration for family’s needs.

Steps: Close eyes and mouth, remove all tubes and devices (unless there will be an autopsy). Position body supine, with a small pillow under the head. Place arms at side of body, palms down, or across abdomen (not on top of each other) Replace soiled bandages and bathe patient enough to present clean, odor-free appearance. Brush or comb hair and place a clean gown on the body and clean sheet on top (cover up to shoulders). Make sure you document valuables, so they can be given to family.