CNA Lab final

Chapters 25, 26, 27, 32 & 34

Urination

• 1500 ml per day

• Intake = output

Voiding

Process of emptying the bladder

Usually pale yellow, straw colored or amber

Observe for color, clarity, odor, amount, particles and blood

Use standard and bloodborne precautions

Voiding equipment

Bedpans, urinals, specimen pans (hard hat), bedside commode

Bedpans

• regular: for all patients, especially male

• Fracture: used if you have a cast, traction, limited back motion, osteoporosis, arthritis, spinal surgery, hip fracture, hip replacement, preferred by women

Urinals

• for men

• Never place on tables

• Hung in bed rails

• They are emptied for I &O’s

Bed side Commode (BSC)

• For people who can’t make it to the bathroom

• Lock the wheels

• Can be placed over a toilet as a raised toilet seat

Urinary incontinence

• can be temporary or permanent

• Check and change people who are inconvenient every 2 hours

• Holding urine can lead to incontinence

Managing incontinence

• Goal is to prevent UTIs and restore bladder function

• Depend and pull ups

• Control of urination is ultimate goal

Bladder training

• for controlling urination

• As a CNA, offer fluids and frequent trips to the bathroom

Catheter

Tube to drain or inject fluids through a body opening. Cauterization is the process of inserting a catheter,

Straight catheter

drains the bladder and is then removed

indwelling catheter

is left in the bladder and urine is drained into a bad. UTIs are common and proper care is essential to prevent infection. Also called Foley catheter and retention catheter. Drains into a bag. It is a closed system.

drainage bags

standard bag hold 2000 ml and is put on the moveable part of the bed.

the leg bag holds only 500 ml and is attached to the mid lower part of the leg

catheter care

Ø  Standard Precaution and Bloodborne Standard. Handwashing.  Gloves, Gloves, Gloves.

Ø  No kinks in the tubing.

Ø  Keep the catheter and drainage tube connected. Box 26-2 if they become disconnected.

Ø  Keep below the bladder. Even when ambulating (walking).

Ø  Hung on the beds movable frame or W/C frame. Not bed rails.

Ø  Do not let the bag touch the floor. Use pouches (the bag goes in the pouch).

Ø  Secure the bags tubing to the bottom linen. (Coiled or straight). Fig. 26-4.

Ø  Secure Catheter, Males, to the stomach or thigh. Females to the thigh. Fig. 26-4.

Ø  Perform Catheter care, according to the Care Plan. (Clean from the meatus and 4in downward the foley, fig, 26-6).

Ø  Don’t let the drain opening touch the graduate cylinder. 

Ileostomy

Artificial opening of the small intestines where liquid stools drain constantly. The feces contain irritable digestive juices so pouches should fit well and not irritate the skin.

Colostomy

Stools are formed and colon regulates water so the more colon you have, the better. The consistency will depend on water intake. Site depends on the part of the colon removed.

Emptying ostomy pouches

Emptied when 1/3 to ½ full of stool or air

Bed rest

Ordered to reduce pain, healing, reduce O2 needs. Patient has limited physical activity by staying in bed.

Complete bed rest

Everything is done for the person and all ADLs are done in person

Complications from immobility

UTIs, constipation, fecal impaction, pressure sores, blood clots, pneumonia

Contractures

Shortening of muscles and a decreased motion occurs. Contracted muscle is in a fixed position.

Atrophy

Muscles wasting away, immobility, decrease in size of the tissue.

Postural hypotension

Dizzy or syncope occurs from lying position to dangling to standing.

Preventing complications of immobility

ROM Exercises. 

• Reposition changes and good body alignment promote comfort, circulation and breathing is easier.

• Position devices to support body parts and maintain proper position. Pg. 418

• Weight bearing exercises needed to gain muscle strength. Ambulation Pg. 421.

• Increasing mobility to the extent possible is the goal.

Active ROM

the resident does the ROM

Passive ROM

We do the ROM

Active assist ROM

Patient needs some help

Rules with PROM

Ø  Privacy, cover with a bath blanket.

Ø  Expose only the part of the body that needs exercise. Follow the care plan.

Ø  Support the part of the body that needs exercise. Normally at the joint.

Ø  Do not force through its full range of motion or beyond resistance or pain.

Ø  Tell the resident to let you know if there is any pain or discomfort.

Ø  Normally, it is done 1-2 times per day.

Ø  Follow the nurses care plan.

Footboard

Prevents plantar flexion or footdrop. Also, it prevents pressure sores and breakdown on the toes. Maintains proper foot alignment.

Bed cradle

Foot pain from gout, arthritis, foot ulcers, cellulitis.

Trochanter roll

Prevents external rotation. Hip fractures.

Hip wedge

Hip replacement post op.

Hand roll

prevents contractures of the thumb and fingers from occurring.

Finger cushion

prevents contractures of the thumb and fingers. Clean and dry skin under the device before use.

Splints

Keeps elbows, thumbs, fingers ankles, or knees in the normal position.

Braces

Prevents joint movement, corrects deformities, supports weak body parts.

AFOs

Worn with socks and shoes. Prevents footdrop.

Ambulation with gait belt

• Gait belt rules apply. Apply before ambulating!

•   Clothing rules apply, non-slip shoes.

•   Gait belt rules apply. Apply before ambulating!

•   Clothing rules apply, non-slip shoes.

• Monitor for Postural Hypotension.

•   Stand behind, off to the side on the weak side of the resident.

•   Resident should stand straight, look forward, and walk heel to toe.

• If the resident begins to fall, do not stop the fall. To break the fall, keep a hold of the gait belt and pull the resident close to you and down your leg. EASE the resident to the floor.

•   *Handrails are in the hallway for resident assistance. Residents use their strong side to grasp and support themselves with the rail. Another employee may assist you with a W/C trailing you if the resident becomes tired. Do not confuse with Grab bars, those are in the bathrooms.

•   Empty Foley bags before ambulating a resident and keep the bag below the bladder.

•   Monitor for Postural Hypotension.

•   Stand behind, off to the side on the weak side of the resident.

• Resident should stand straight, look forward, and walk heel to toe.

•   If the resident begins to fall, do not stop the fall. To break the fall, keep a hold of the gait belt and pull the resident close to you and down your leg. EASE the resident to the floor.

• *Handrails are in the hallway for resident assistance. Residents use their strong side to grasp and support themselves with the rail. Another employee may assist you with a W/C trailing you if the resident becomes tired. Do not confuse with Grab bars, those are in the bathrooms.

• Empty Foley bags before ambulating a resident and keep the bag below the bladder.

 

dysuria

painful or difficult urination

functional incontinence

the person has bladder control but cannot us toilet in time

hematuria

blood in urine

mixed incontinence

combination of stress incontinence and urge incontinence

nocturia

frequent urination at night

oliguria

scant amount of urine less than 500 ml in 24 hours

over flow incontinence

small amounts of urine leak from a full bladder

polyuria

abnormally large amounts of urine

reflex incontinence

urine is lost at predictable intervals when a specific amount of urine is in the bladder

stress incontinence

when urine leaks during exercise and certain movements

transient incontinence

temporary or occasional incontinence that is reversed when the cause is treated

urge incontinence

the loss of urine in response to a sudden, urgent need to void

urinary frequency

voiding at frequent time intervals

Urinary Incontinence (UI)

the involuntary loss of urine

urinary retention

not being able to completely empty the bladder

urinary urgency

the need to void at once

urination/ voiding

the process of emptying urine from the bladder

CAUTI

catheter associated urinary tract infection

constipation

passage of hard dry stool

defection

process of excreting feces

fecal impaction

prolonged retention and buildup of feces in the rectum

fecal incontinence

inability to control the passage of feces

flatus

gas or air passed through anus

melena

black tarry stoos

C diff

clostridiodes difficile is a microbe that causes diarrhea and intestinal infections

abduction

moving the body part away from the midline

adduction

moving a body part toward the midline of the body

ambulation

act of walking

atrophy

decrease in size or wasting away of tissue

bed rest

restricting a person to bed and limiting activity for health reasons

contracture

decreased motion and stiffness of a joint caused by shortening of a muscles

deconditioning

the loss of muscle strength from inactivity

dorsiflexion

bending the toes and foot up the ankle

extension

straightening of a body part

external rotation

turning the joint outward

flexion

bending of aa body part

footdrop

the foot falls down at the ankle permanent plantar flexion

hyperextension

excessive straightening of a body part

immobility

the inability to move

internal rotation

turning the joint inward

mobility

a persons ability to move

opposition

touching an opposite finger with the thumb

orthotic

a device used to support a muscle, a certain motion or correct a deformity

plantar flexion

bending the foot down at the ankle

pronation

turning the joint downward

rotation

turning the joint

supination

turning the joint upwards

acetone

substance that appears in urine (product of ketosis)

glucometer

device for measuring blood glucose

glucosuria

glucose in the urine

hemoptysis

bloody sputum

ketone

a substance appearing in urines from the rapid breakdown of fat for energy (acetone is the substance, also known as ketones)

ketone body

another word for the ketones that appear in urine

sputum

mucus from the respiratory system that is expectorated from the mouth