HS2 Medical and Nursing Services - PowerPoint Presentation

Slide1

HS2 Medical and Nursing ServicesCreated by: Dana Cashion, Spring 2016

Part 3, PP#2

Admitting, transferring, discharging patient

Turning and transferring patient to wheelchair

Measuring Input and Output

Assisting with Urinal

Catheter CareSlide2

HCW in hospital and LTC facility may have to admit, transfer, and discharge ptsAdmission can cause anxiety and fear for pt and familyHCW needs to be positive, courteous, and supportive to alleviate fear

Give clear instructions on what to expect-how to operate equipment and routines

21:1 Admitting, Transferring, and Discharging

PatientsDHO pg 782

)Slide3

Complete required formsInformation on forms used for nursing care plansIf pt cannot answer questions, have relative or responsible person answerQuestions re: medications and allergies fall under RN scope of practice

AdmissionSlide4

Besides paperwork, specific procedures performedVSHeight and weightRoutine urine specimen

Admission ProceduresSlide5

Instructions on how to operate call light, bed controls, television, and telephoneVisiting hours, pt lounges, religious services, mealtime, and other routines explained to pt and familyPt and family given info pamphlet, but still verbally go over the information

Patient and Family OrientationSlide6

Can be done for a variety of reasons-r/t change in pt condition ie. To ICUTransfer may be at pt request, such as to a private room

Reason for transfer should be explain to pt and family (usually MD or RN)

Gather all of patient’s personal items

And consider how to transport pt to new room-pt ambulate, wheelchair, stretcherPatient TransferSlide7

Physician’s order required to discharge ptMost facilities require HCW to accompany individuals to their car, and most require individual to be in a wheelchairPt can leave facility against doctor’s orders. Called AMA-against medical advice

DischargeSlide8

If procedure done correctly, provides patient with optimum comfort and careImproper moving, turning, or transferring

can result in serious injury to

patient

Correct body mechanics essential for either of these proceduresIf you are unable to move or turn a patient by yourself, always get helpAlways have proper authorization before procedure

21:2

Turning and Transferring Patients

DHO

pg

790Slide9

Pt confined to bed-Pt position must be changed every 2 hours, ie 6,8,10,noon

Frequent turning provides exercise for muscles, stimulates circulation, prevents pressure ulcers and contractures, and provides pt comfort

You are responsible for reading DHO CH 21, procedure 21:2A

Patient PositioningSlide10

Different ways to move a pt from bed to wheelchairMechanical lift transfer weak or paralyzed ptCan also use a transfer belt to move pt

Observe proper body mechanics during transfer

Once pt moved and belt removed, observe pt for signs of distress

Read Ch 21 procedure 21:2F pg 803Transferring Pt from Bed to WheelchairSlide11

AKA surgical hose or TED hoseCan be ordered to support the veins of the legs and increase circulationAlso help prevent formation of blood clots in the legs

Must be applied correctly-if too tight, they can interfere with circulation

Prevent wrinkles, smooth out sock

Top should be just below the kneeProvide toe roomApplying elastic stockingsDHO CH 21.13, pg 915Slide12

Check hose at intervalsLook for signs of impaired circulationAbnormal skin color or temperatureSwellingReport abnormalities to supervisor immediately

Remove hose at least once/8

hrs

Perform skin care to skin under the hoseRead Procedure 21:13D on page 915Checking the elastic hoseSlide13

A large part of the body is fluid, so there must be a balance between the amount of fluid taken into the body and the amount lost from the bodySwelling or edema results from excessive fluid

ie

heart or kidney disease

Dehydration is excessive fluid loss ie vomiting, diarrhea, perspiration, bleedingEither condition can result in death

21:5 Measuring and Recording

Intake and

Output

DHO

pg

849

)Slide14

Intake: fluids taken in by patientThis can be liquids such as water, tea, soups, ice creamCan also be tube feedings, or enteral feeding for pts unable to swallow or comatose

Also can be IV fluids, such as blood or plasma

Can be irrigation fluids which are fluids placed into tubes that have been placed in the body, such as NG tube irrigation

You record only the amount of irrigation fluid that is left in the bodyInputSlide15

Output: fluids eliminated by patientShould include bowel movements (BM), both liquid and solid (feces)Emesis=vomitUrine-voided and drained via catheter is measured and recorded. Should be more than 30ml/hr

Irrigation-any irrigation or suction drainage from NG tubes,

hemo-vacs

, chest tubesOutputSlide16

Must be accurate Measure it in graduates, container that measures in mL/cm cubed or ouncesRecorded in 8 hr and/or 24 hr incrementsUsually record in metric units

1 mL=1 cc=15

gtts (drops)5mL=1 tsp

15mL=1 tbsp30mL=1 ounceRecording Intake and OutputSlide17

Various agencies can have different policies for recording I&OsWhere the I&O form is kept-BS vs chartWho actually records the info-MA, RN, unit secretary

Patients need to understand what is intake and output-when it is considered I&O, what is considered I&O, and how to collect output=bedpan/urinal, nun’s cap

Basic Principles of I&OsSlide18

Elimination of body waste is essentialMany patients sensitive about using bedpan/urinal

Provide privacy

Make patient comfortable

Provide bedpan immediately when called forOffer bedpan frequentlyAccurate observations important re: frequency, amount, and appearance of urine and stool

21:7 Assisting with a

Bedpan

DHO 21:7,

pg

859Slide19

Urinate, micturate, or void: emptying the bladder of urine produced by the kidneysUrinal used by malesBedpan used by females (either fracture or orthopedic bedpan and standard bedpan)

Defecate: discharge of waste (feces or stool) thru rectum

Terminology R/T EliminationSlide20

MUST be observed when handling urine or fecesHands washed and gloves wornOne glove technique: used to protect the environment while assisting with bedpans

Two gloves worn while handling bedpan

Then remove one glove and hold in other gloved handUngloved hand is used to open doors, turn on faucets, raise

siderailsNEVER place bedpan on overbed table or bedside standStandard PrecautionsSlide21

Rinse the bedpan thoroughlyThen disinfect bedpanUse for only one patientAfter d/c, dispose of bedpan or sterilizePatient’s should have opportunity to wash their hands and receive perineal care afterwards

You are responsible for reading 21:7 with procedure 21:7A

At the end:Slide22

A catheter may be inserted into the bladder if a patient cannot urinate or voidThe catheter is attached to a drainage unit to collect the urineFrench or straight cath-inserted and removed; for sterile urine specimen

Foley or indwelling or retention cath-used over an extended period of time. This catheter must be kept sterile at all times

Insertion of cath is a sterile technique

21:8 Providing Catheter CareDHO pg 864Slide23

Closed unit to keep microorganisms from entering catheter and prevent infectionUnit is the tubing attached to catheter and extends to the bag that collects urineCareful

observation of catheter and

drainage unit is required and should be checked frequently

10 listed items to monitor on page 866Drainage UnitSlide24

Make sure the connection between catheter and drainage unit secureTubing free from kinks and bends that stop urine flow

Bag below the level of the bladder

Urine is flowing freely into bag

Catheter is taped, strapped, or tied to patient’s legBad is emptied frequently (q8h)Bag is not lying on the floor

Monitoring the Catheter and Drainage UnitSlide25

No loops of drainage tub are hanging below the bagDrainage tubing leading to the bag is above the level of the urine

Pt complains of burning, pain, irritation, or tenderness in urethral area, report to supervisor immediately

Careful observation of the urine drained should be made-amount, color, type, and presence of other substances should be noted

Monitoring ContinuedSlide26

Urinary meatus must be kept clean and free from secretionsCatheter care provided for this purposeAdministered q8h

Usually provided during the bath and as a part of perineal care

Standard precautions used during procedure

You are responsible for reading 21:8A r/t female catheter careProviding Catheter Care