Chapter 24/25

What toileting device is safest for someone who recently had hip surgery and cannot get out of bed?

A fracture pan

What toileting device is safest for someone who is able to get out of bed but cannot walk to the bathroom?

Bedside commode (BSC)

What urine specimen is needed to accurately check for a UTI?

A midstream (clean-catch) urine sample

What device measures urine for someone using a standard toilet or commode?

A commode hat

What should a CNA report to the nurse regarding urination?

- Hematuria, Nocturia, Dysuria, Polyuria, Oliguria, Anuria

- Frequency-voiding that occurs more often than usual

- Urgency-need to urinate immediately

- Urine is cloudy or contains particles, has an abnormal color, or odor

- A person is having incontinence episodes or more frequent incontinence accidents

What is the major difference between a routine urine specimen and a midstream (clean-catch) specimen?

A midstream specimen requires sterile collection with cleansing of the urethral area, where a routine urine specimen does not

How should a patient be positioned to receive an enema?

Left-side Sims' position

What is a suprapubic catheter?

A catheter that enters the bladder through a small opening above the pubic bone, the opening is initially made surgically

What should you do if a patient's stool appears black and tar-like?

Notify the nurse immediately

How should a condom catheter be secured?

With spiral taping

How many inches of catheter tubing should be cleaned from the body outward?

4 inches

How should tubing for an indwelling catheter be secured?

Coil it gently and clip it to the bed linens

How should urine drainage be emptied from a drainage bag?

Drain into a graduate container placed on a paper towel beneath the bag

When starting a 24-hour urine collection, what should be done with the first urine of the day?

Discard it

What is the most comfortable position for using a bedpan?

Fowler's position

Why must the drainage bag of an indwelling catheter stay below bladder level?

To prevent urine from flowing backward intro the bladder and causing infection

What type of stool is expected from someone with an ileostomy?

Liquid stool that drains continuously

Who is most appropriate for a urinary catheter?

Someone who is incontinent and has pressure ulcers

What does normal urine look like?

Clear and yellow/straw-colored

Which dietary items should be recorded as fluid intake?

All liquids including jello, milk on cereal, and ice cream

Why must CNAs know each resident's ordered diet?

To recognize if incorrect food is delivered

How can a CNA reduce dry mouth for a resident who is NPO?

Provide frequent oral care

What foods are allowed on a clear liquid diet?

Clear liquids are substances that can be poured at room or body temperature and that you can see through. Foods that are considered clear liquids include water, gelatin, fat-free broth or bouillon, popsicles, clear juices (for example, apple, cranberry, grape), clear carbonated sodas, and coffee and tea (without cream).

What IV-related issues must be reported to the nurse immediately?

- Tubing that has become disconnected

- The fluid bag is empty

- IV fluid is not dripping into the drip chamber

- Blood has backed up the IV tubing

- The person complains of pain at the IV site

- Swelling or redness at the IV site-infiltrated IV

Which nutrient best supports healing of a pressure ulcer?

Protein

Why should meals be served while still hot?

Cooling food increases risk of bacterial growth

What would be considered bodily fluid output?

urine, vomit, blood, wound drainage, and diarrhea

Which diet is used for stomach irritation or inflammation of the intestinal tract?

Bland diet

What adaptive device would help a person with one hand maintain independence?

A plate with a raised rim

Who is most likely to need a carbohydrate-controlled diet?

A person with diabetes taking insulin, but can also be diabetic who does not take insulin

What is the liquid texture that coats a fork and drips slowly?

Honey-thick

How should a tube-fed resident's bed be positioned to reduce aspiration risk?

Head of bed raised to at least semi-Fowler's

How should vomit on linens be measured for output?

Estimate the amount

How many mL are in 1 oz?

30 mL

What is the liquid texture that quickly sinks through the prongs of a fork?

Nectar thick liquid

What is the liquid texture that remains on the fork and holds well together?

Pudding thick liquid

Hematuria

blood in urine

Nocturia

frequent urination at night, more than once or twice at night

Dysuria

difficulty voiding that may or may not be associated with pain (burning or cramping)

Polyuria

excessive urination

Oliguria

100- 400 mL of urine in 24 hours

Anuria

Under 100 mL of urine in 24 hours

What foods are allowed on a full liquid diet?

A full-liquid diet is the clear-liquid diet, plus any food that can be poured at room or body temperature. For example, milk, plain frozen desserts (such as popsicles, ice cream, or frozen yogurt), pasteurized eggs (egg custard or eggnog), cereal gruels, and strained soups and juices are all considered full liquids. Full liquids contain more nutrition than clear liquids, but a high-calorie, high-protein liquid dietary supplement may be added if the person must be on a full-liquid diet for more than 3 days.

Why might someone be on a clear liquid diet?

Some medical tests require a person to be placed on a clear-liquid diet for a short period of time. A person who is nauseous or vomiting, or who has just had surgery or is recovering from an acute illness or trauma, may be given a clear-liquid diet initially. Clear liquids do not contain enough nutrients to maintain health for very long, so a person is usually progressed into a more nutritious diet as soon as the body can tolerate it.

What must be reported to the nurse regarding a patient with an indwelling urinary catheter?

Changes in color, clarity, or odor of the urine

Failure of urine to flow freely through the tubing(make sure that the tubing is not kinked or bent)

The person complains of pain or discomfort as a result of the catheter

Redness, swelling, or discharge from the catheter insertion site

What is a mechanical soft diet?

A mechanical diet is a diet that has been changed slightly to remove foods that are hard to chew or digest. The texture of the foods is altered to make them easier to eat, and fried or high-fiber foods may be eliminated or very limited. A mechanical chopped diet provides foods cut in small pieces to make them easier to chew. Some people need only chopped meats. Others may also need vegetables chopped, depending on the vegetable.

What foods are allowed in a mechanical soft diet?

A mechanical soft diet includes foods that are ground up. For example, a sirloin steak would be put through a meat grinder to make a sirloin patty. Vegetables and other foods may also need to be altered to make them easier to chew.

What is a puree diet?

For a pureed diet, the food is blended to a smooth consistency, similar to that of pudding or very moist mashed potatoes. Some people may require a drinkable puree. To create a drinkable puree, the food is blended to a liquid, milk shake-like consistency.

Who is a puree diet ordered for?

Pureed and drinkable puree diets are often prepared for those who have very poor dentition, have dysphagia, are very frail, or who have end-stage disease.

How do you assist a resident with poor eyesight in eating a meal?

A clock face is used to reference the location of the food on the tray for people with poor eyesight

What is dysphagia?

Difficulty swallowing

What are the aspiration precautions?

- Small bites

- Small sips

- Alternate liquid and solid swallows

- Ensure oral clearance after each bite

- Sit upright (90 degrees) when eating and drinking and for 30 minutes after eating

- Multiple swallows per bite/sip

- Small, frequent meals throughout the day

- No Straws

What is edema?

Swelling that occurs when there is too much fluid in the body

How can a CNA promote normal bowel and bladder elimination?

- Encourage/ push plenty of fluids

- Answer call lights and take people to the bathroom or put on a bedpan ASAP!

- Encourage patients/ residents to call when they have the urge to use the bathroom

- Ensure privacy and comfort are provided (close curtains, consider door, fall precaution measures)